Characteristics of Prognostic Factors in Super-Old Patients With Heart Failure ― Findings From the J-Proof HF Registry Study ―

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Heart failure (n=5371). Intervention: Prehospitalization activities of daily living decline and hospitalization-associated disability vs. Maintained activities of daily living and no hospitalization-associated disability. Primary outcome: 1-year all-cause death (p=<0.001).

Q: What does this research mean for the field?

Prehospitalization activities of daily living and hospitalization-associated disability are independently associated with 1-year all-cause mortality in heart failure patients across all age groups, including super-old patients aged ≥90 years. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Koji Sakurada; Tomoyuki Morisawa; Masakazu Saitoh; Michitaka Kato; Yuki Iida; Kentaro Iwata; Yuji Kono; Masanobu Taya; Yoshinari Funami; Kentaro Kamiya; Tetsuya Takahashi

doi:10.1253/circrep.cr-26-0253

October 13, 2026Circulation ReportsOpen Access

Characteristics of Prognostic Factors in Super-Old Patients With Heart Failure ― Findings From the J-Proof HF Registry Study ―

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Why the study?

The associations of prehospitalization activities of daily living and hospitalization-associated disability with death in super-old patients with heart failure remain unclear.

Key Points

To examine how prehospitalization activities of daily living and hospitalization-associated disability associate with 1-year all-cause death in super-old patients hospitalized with heart failure.
Analyzed 5,371 patients (including 799 aged ≥90 years) discharged home from the nationwide J-Proof HF Registry who were referred for physical therapy across three age groups (65–74, 75–89, and ≥90 years).
Evaluated prehospitalization functional status using the Barthel Index (BI; dichotomized as ≥85 or <85) and defined hospitalization-associated disability (HAD) as a decline of ≥5 BI points from prehospitalization to discharge.
Assessed independent associations and interactions (age×BI, age×HAD, and BI×HAD) with 1-year all-cause death using multivariable Cox proportional hazards regression models.
Prehospitalization Barthel Index and HAD were independently associated with 1-year all-cause death across all age groups, with patients aged ≥90 years having the highest 1-year all-cause death rate at 22.5%.
Survival differed significantly across functional categories in each age group (log-rank P<0.001), with the highest 1-year survival observed in patients with BI ≥85 without HAD.
No significant interactions were detected between age and either BI or HAD, whereas BI and HAD exhibited a significant interaction.

Study Design

Type

Cohort (n=5,371)

Multicenter

Yes

Structured PICO

P

Population

5,371 older adults (aged ≥65 years) hospitalized for heart failure, referred for physical therapy, and discharged home, followed for 1 year.

O

Outcome

1-year all-cause death after dischargehard clinical

Main Result

p-value: p=<0.001

Limitations

Only patients discharged home were included, underrepresenting those with poorer prehospital ADL.
Approximately 40% of eligible patients were excluded because of missing data, potentially introducing selection bias.
Causal relationships cannot be established because of the observational nature of the study.
Only patients discharged home were included, meaning patients with poorer prehospitalization ADL may have been underrepresented
Approximately 40% of eligible patients were excluded because of missing data, introducing potential selection bias
Causal relationships cannot be established because of the observational design

Implication

In older and super-old patients with heart failure, prehospitalization functional status and functional decline during hospitalization are strong, independent predictors of 1-year mortality.

Abstract

Background: The associations of prehospitalization activities of daily living (ADL) and hospitalization-associated disability (HAD) with death in super-old patients with heart failure (HF) remain unclear. Methods and Results: We analyzed 5,371 J-Proof HF Registry patients, including 799 patients aged ≥90 years. Prehospitalization Barthel Index (BI) and HAD were independently associated with 1-year all-cause death across all age groups. No significant interactions were observed between age and BI or HAD, whereas BI and HAD showed a significant interaction. Conclusions: The findings suggested that optimizing ADL before HF hospitalization and preventing HAD during hospitalization may be important physical therapy targets.

Discussion

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Cite This Study

Sakurada et al. (2026) conducted a cohort in Heart failure (n=5,371). Prehospitalization activities of daily living decline and hospitalization-associated disability vs. Maintained activities of daily living and no hospitalization-associated disability was evaluated on 1-year all-cause death (p=<0.001).

synapsesocial.com/papers/6acfe7849473cd42e9e2c6aa https://doi.org/10.1253/circrep.cr-26-0253

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Characteristics of Prognostic Factors in Super-Old Patients With Heart Failure ― Findings From the J-Proof HF Registry Study ―

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Characteristics of Prognostic Factors in Super-Old Patients With Heart Failure ― Findings From the J-Proof HF Registry Study ―

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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