Clinical Impact of Hospital-Associated Disability in Patients With Acute Decompensated Heart Failure

Background: Hospital-associated disability (HAD) may affect long-term outcomes in heart failure (HF), but evidence remains limited, so in this study we aimed to evaluate the impact of HAD on long-term outcomes in acute decompensated HF (ADHF). Methods and Results: We analyzed data from the Japanese Registry of Acute Decompensated Heart Failure (JROADHF), including patients enrolled from January 2013 to December 2017. HAD was defined as a decline of ≥5 points in the Barthel Index from admission to discharge. The primary outcome was all-cause death, and the secondary outcomes were cardiovascular (CV) death, non-CV death, and HF readmission. Of the 8,965 patients enrolled (mean age 76.9±12.7 years; 54.8% male), 537 (6.0%) had HAD. In the multivariate analysis, HAD was independently associated with all-cause death (hazard ratio [HR]: 1.58; 95% confidence interval [CI]: 1.31–1.91; P<0.001) and non-CV death (HR: 1.44; 95% CI: 1.08–1.92; P=0.013), but not with CV death or HF readmission. Subgroup analyses revealed a stronger association between HAD and all-cause death in patients under 80 years (<80 years: HR: 2.48; 95% CI: 1.80–3.41; ≥80 years: HR: 1.36; 95% CI: 1.09–1.71; P for interaction <0.001). Conclusions: HAD significantly affects the long-term mortality rate in ADHF patients, particularly in those under 80 years of age. These findings highlight the importance of considering age-specific management approaches in this population.