Key result
Black and female older patients hospitalized with ADHF had more severely impaired walking function (e.g., lower 6-min walk distance, P<0.001) and higher frailty than White male patients.
Why the study?
Older patients hospitalized with acute decompensated heart failure have marked functional impairments, but whether impairment severity differs by race and sex is unknown.
Do functional impairments differ by race and sex in older patients hospitalized with acute decompensated heart failure?
Cross-Sectional (n=337)
Do functional impairments differ by race and sex in older patients hospitalized with acute decompensated heart failure?
Frailty and functional impairments are common and severe across older patients hospitalized for ADHF, with impairment severity often worse in Black and female patients, highlighting the need for formal screening and tailored care.
Answers are grounded in this paper and cite their sources.
Impairments often worse in Black and female subgroups; leaves open whether targeted screening improves outcomes before prospective validation.
BACKGROUND: Older patients hospitalized with acute decompensated heart failure (ADHF) have marked functional impairments, which may contribute to their delayed and incomplete recovery and persistently poor outcomes. However, whether impairment severity differs by race and sex is unknown. METHODS: REHAB-HF trial participants (≥60 years) were assessed just before discharge home from ADHF hospitalization. Physical function [Short Physical Performance Battery; 6-min walk distance (6MWD)], frailty (Fried criteria), cognition [Montreal Cognitive Assessment (MoCA)], quality-of-life [Kansas City Cardiomyopathy Questionnaire, Short-Form-12, EuroQol-5D-5L], and depression [Geriatric Depression Scale (GDS)] were examined by race and sex. RESULTS: This prespecified subgroup cross-sectional analysis included 337 older adults (52% female, 50% Black). Black participants were on average younger than White participants (70.3 ± 7.2 vs. 74.7 ± 8.3 years). After age, body mass index, ejection fraction, comorbidity, and education adjustment, and impairments were similarly common and severe across groups except: Black male and Black and White female participants had more severely impaired walking function compared with White male participants [6MWD (m) 187 ± 12, 168 ± 9170 ± 11 vs. 239 ± 9, p < 0.001]; gait speed (m/s) (0.61 ± 0.03, 0.56 ± 0.02, 0.55 ± 0.02 vs. 0.69 ± 0.02, p < 0.001); White female participants had the highest frailty prevalence (72% vs. 47%-51%, p = 0.007); and Black participants had lower MoCA scores compared with White participants (20.9 ± 4.5 vs. 22.8 ± 3.9, p < 0.001). Depressive symptoms were common overall (43% GDS ≥5), yet underrecognized clinically (18%), especially in Black male participants compared with White male participants (7% vs. 20%). CONCLUSION: Among older patients hospitalized for ADHF, frailty and functional impairments with high potential to jeopardize patient HF self-management, safety, and independence were common and severe across all race and sex groups. Impairment severity was often worse in Black participant and female participant groups. Formal screening across frailty and functional domains may identify those who may require greater support and more tailored care to reduce the risk of adverse events and excess hospitalizations and death.
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Ye et al. (2022) conducted a cross-sectional in Acute decompensated heart failure (ADHF) (n=337). Race and sex (Black vs. White, Female vs. Male) vs. White male participants was evaluated on Physical function (6-min walk distance and gait speed), frailty, cognition, and depression (p=<0.001). Black and female older patients hospitalized with ADHF had more severely impaired walking function (e.g., lower 6-min walk distance, P<0.001) and higher frailty than White male patients.
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