Early in-hospital gait speed and lower quadriceps strength are associated with the development of hospitalisation-associated disability in older patients with acute heart failure

Background A decline in activities of daily living (ADLs) caused by reduced physical activity during hospitalisation—independent of the primary disease—is referred to as hospitalisation-associated disability (HAD). Previous studies have shown that HAD in patients with heart failure (HF) is associated with poorer prognosis and higher rates of rehospitalisation. Therefore, prevention of HAD is crucial in the management of HF patients. However, it remains unclear whether physical function indicators in the early phase of hospitalisation, such as gait speed and lower quadriceps strength, are associated with the development of HAD. This study aims to investigate whether physical function indicators in the early phase of hospitalisation are associated with the development of HAD in older patients with acute HF. Methods This multicenter retrospective observational study included 208 patients aged 75 years or older who were hospitalised for acute HF and underwent assessment of physical function indicators (gait speed, lower quadriceps strength, and handgrip strength) early during hospitalisation. HAD was defined as a ≥5-point decrease in the Barthel Index (BI) at discharge compared to the pre-admission BI. Patients were divided into HAD and non-HAD groups. Clinical background and physical function indicators were compared between the two groups. A multivariable logistic regression analysis was conducted with the presence of HAD as the dependent variable and physical function indicators as independent variables. The cutoff values for physical function were defined as usual gait speed <1.0 m/s, lower quadriceps strength <36.2% of body weight (%BW), and handgrip strength <28 kg for male and <18 kg for female. Results Among the 208 patients (mean age: 84.5 years; 95 males), 145 (69.7%) were classified into the HAD group. Compared to the non-HAD group, the HAD group was younger, had a shorter length of hospital stay, and showed significantly lower values in all physical function indicators (P < 0.05)[Table 1]. In the multivariable logistic regression analysis adjusted for clinically relevant factors (age, sex, BMI, LVEF, length of hospital stay, and pre-admission Barthel Index <85), lower usual gait speed and decreased quadriceps strength were independently associated with the development of HAD (Table 2). Specifically, each 0.1 m/s increase in usual gait speed was associated with HAD (OR: 0.71, 95% CI: 0.60–0.82, P= 0.01). Lower quadriceps strength <36.2%BW was also significantly associated with HAD (OR: 2.27, 95% CI: 1.04–5.17, P = 0.03). Conclusion In older patients with acute heart failure, lower gait speed and reduced lower quadriceps strength in the early phase of hospitalisation are independent predictors of hospitalisation-associated disability.For image description, please refer to the figure legend and surrounding text. For image description, please refer to the figure legend and surrounding text.