P3380Decline in daily activity by admission of acute heart failure is independently associated with mortality in community-based registry; KICKOFF Registry

Abstract

Background: Hospitalization itself worsens the performance of activity of daily living (ADL). ADL was reported to be closely associated with mortality, but a relationship between a decline in ADL and mortality in heart failure (HF) patients is unknown in the Asian Pacific region, Japan. Purpose: The purpose of this study is to identify the association of a decline of ADL by admission in acute heart failure (AHF) and following outcomes. Methods: We have enrolled 746 patients with AHF in the Kitakawachi Clinical Background and Outcome of Heart Failure Registry (KICKOFF Registry) from April 2015 to January 2017. The KICKOFF Registry is a prospective multicenter community-based cohort of HF patients. The patients were categorized into 4 types of ADL: (1) independent outdoor walking, (2) independent indoor walking, (3) indoor walking with assistance, or (4) abasia before admission and at discharged. We defined a decline in ADL as down grade in the 4 types of ADL before discharge compared with that of admission. Six-months follow-up was complete in 553 patients as of January 2017. We compared the clinical characteristics and outcomes between patients with a decline in ADL (decline group; n=98) and the others (non-decline group; n=455). Results: The decline group was older, more in female, had lower body mass index, and longer mean length of hospitalization than the non-decline group. They had more history of dementia, major bleeding and stroke. There was no significant difference in other co-morbidities. In Kaplan-Meier analyses, there was no significant difference in hospitalization of HF, but mortality was higher in the decline group than the non-decline group during six-months follow-up (p<0.001). After the adjustment by gender, age, and the other co-morbidities in multiple logistic regression models, a decline in ADL was independently associated with higher risk of mortality (adjusted hazard ratio, 3.8; 95% confidence interval, 2.15-6.66 p<0.001). Conclusion: A decline in ADL by admission of HF was independently associated with higher risk of mortality. Thus, we should prevent any decline in the performance of ADL in patients with HF to reduce mortality. (Figure Presented).