Key result
Transitional cardiac rehab achieving >198m walking distance linked to ~52% lower mortality in older patients.
Why the study?
Poor functional status is common in older patients hospitalized for HF and marks a downward prognostic trajectory, prompting evaluation of the prognostic value of post-rehabilitation 6-minute walk testing.
Does functional capacity (measured by 6-minute walk distance) after transitional cardiac rehabilitation predict 3-year all-cause mortality in older patients hospitalized for acute heart failure?
Observational (n=759)
Yes
Does functional capacity (measured by 6-minute walk distance) after transitional cardiac rehabilitation predict 3-year all-cause mortality in older patients hospitalized for acute heart failure?
Higher functional capacity (measured by 6-minute walk distance) achieved after transitional cardiac rehabilitation is strongly and independently associated with improved long-term survival in older patients hospitalized for acute heart failure.
Answers are grounded in this paper and cite their sources.
May support targeting higher 6MWD in transitional CR for older HF patients; hypothesis-generating, should not yet change practice.
Background Poor functional status is highly prevalent among older patients hospitalized for HF and marks a downward inflection point in functional and prognostic trajectories. We assessed the prognostic value of 6‐min walk test after transitional cardiac rehabilitation in older patients hospitalized for heart failure (HF). Methods We studied 759 patients aged ≥60 years who had been transferred to six inpatient rehabilitation facilities (IRF) from acute care hospitals after a hospitalization for acute HF. The primary outcome was 3‐year all‐cause mortality. We used multivariable Cox analysis to determine the association between 6‐min walk distance (6MWD) at discharge from the IRFs and the primary outcome, adjusting for established predictors of death. The optimal cutoff for 6MWD was considered as the one that maximized the chi‐square statistic. Results Mean age was 75 ± 8 years. 6MWD significantly increased from admission to discharge (145 to 210 m; p < 0.001). The optimal cutoff for 6MWD was 198 m. After full adjustment, the hazard ratio for each 50 m‐increase in discharge 6MWD was 0.90 (0.87–0.94; p < 0.001) and that for discharge 6MWD dichotomized at the optimal cutoff 0.48 (0.38–0.60; p < 0.001). The incidence rate of death/100 person‐years for the patients who walked >198 m was 13.0 (10.0–15.5) compared with 30.8 (26.9–35.4) for those who walked <198 m. A statistically significant interaction of discharge 6MWD with left ventricular ejection fraction (EF) on the risk of death was observed ( p value for interaction 0.047). Conclusions A rehabilitation intervention provided in the critical hospital‐to‐home transition period to older patients hospitalized for HF resulted in improved functional capacity. Increasing levels of functional capacity following rehabilitation were closely associated with decreasing risk of death; this association was significantly stronger for the subgroup with preserved EF.
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Scrutinio et al. (2022) conducted an observational in Heart failure (n=759). Transitional cardiac rehabilitation (discharge 6-minute walk distance >198 m) vs. Discharge 6-minute walk distance <198 m was evaluated on 3-year all-cause mortality (HR 0.48, 95% CI 0.38-0.60, p=<0.001). Transitional cardiac rehabilitation resulting in a walking distance >198 m at discharge was associated with a 52% decreased risk of 3-year all-cause mortality in older patients.
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