Residual Risk Despite High Short Physical Performance Battery Scores in Older Patients With Heart Failure ― A Multicenter Retrospective Cohort Study ―

Q: What are the key findings of this study?

Among older heart failure patients with preserved physical performance, each 1-point increase in a sarcopenia-related composite physical function score increased the risk of all-cause death or heart failure rehospitalization by 24.5%.

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Heart Failure (n=3044). Intervention: Composite physical function score (impairments in handgrip strength, five-times chair stand test, and calf circumference) vs. Lower physical function score. Primary outcome: Composite of all-cause death or rehospitalization for heart failure within 1 year (HR 1.245, 95% CI 1.132-1.370, p=<0.001).

Q: What does this research mean for the field?

Among older heart failure patients with preserved physical performance, each one-point increase in a sarcopenia-related composite physical function score is associated with a 24.5% increased risk of all-cause death or heart failure rehospitalization. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

To evaluate whether sarcopenia-related physical function and muscle mass measures provide incremental prognostic value in older heart failure patients with high Short Physical Performance Battery scores.

Takatoshi Iwasaki; Hiroko Kurata; Yoshiki Hata; Yuji Kono; Yuki Iida; Kentaro Kamiya; Masakazu Saitoh; Masanobu Taya; Tetsuya Takahashi

doi:10.1253/circrep.cr-26-0159

September 10, 2026Circulation ReportsOpen Access

Residual Risk Despite High Short Physical Performance Battery Scores in Older Patients With Heart Failure ― A Multicenter Retrospective Cohort Study ―

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Key result

Worse sarcopenia-related physical function linked to ~25% higher 1-year death or HF rehospitalization per point.

HR 1.245
95% CI 1.132-1.370
P<0.001
n=3,044

Why the study?

The prognostic value of the Short Physical Performance Battery (SPPB) is unclear in heart failure patients with high SPPB scores, and additional prognostic factors need evaluation.

Does a composite physical function score evaluating muscle strength, function, and mass provide prognostic value for adverse outcomes in older patients with heart failure and preserved SPPB scores?

Key Points

To evaluate whether sarcopenia-related physical function and muscle mass measures provide incremental prognostic value in older heart failure patients with high Short Physical Performance Battery scores.
Multicenter retrospective cohort study analyzing 3,044 hospitalized heart failure patients from the J-Proof HF registry who had preserved physical function (Short Physical Performance Battery score ≥10) at discharge.
Assessed a 0-to-3 Physical Function Score using Asian Working Group for Sarcopenia 2019 criteria based on handgrip strength, five-times chair stand test, and calf circumference.
The 1-year rate of composite all-cause death or heart failure hospitalization increased progressively with higher Physical Function Scores: 14.1% (64/453) for score 0, 21.8% (209/959) for score 1, 28.7% (368/1,281) for score 2, and 34.5% (121/351) for score 3 (P<0.001).
Higher Physical Function Score was independently associated with the composite endpoint (adjusted HR 1.245, 95% CI 1.132–1.370, P<0.001), all-cause mortality (adjusted HR 1.565, 95% CI 1.309–1.872, P<0.001), and heart failure rehospitalization (adjusted HR 1.184, 95% CI 1.065–1.317, P=0.002).

Study Design

Type

Cohort (n=3,044)

Multicenter

Yes

Structured PICO

Does a composite physical function score evaluating muscle strength, function, and mass provide prognostic value for adverse outcomes in older patients with heart failure and preserved SPPB scores?

P

Population

3,044 older patients (aged ≥65 years) with heart failure and preserved physical performance (SPPB score ≥10) at discharge, followed for 1 year.

E

Exposure

Assessment of a composite physical function score (PFS) ranging from 0 to 3, based on the presence of impairments in handgrip strength, five-times chair stand test, and calf circumference (AWGS 2019 criteria).

O

Outcome

Composite endpoint of all-cause death and hospital readmission for HF within 1 year after discharge.composite

Main Result

Hazard Ratio: 1.245 (95% CI 1.132–1.37)

p-value: p=<0.001

In older heart failure patients with apparently preserved physical performance (SPPB ≥10), the accumulation of sarcopenia-related impairments is independently associated with an increased 1-year risk of death or heart failure rehospitalization.

Limitations

Physical function was assessed at a single time point (discharge), precluding the longitudinal assessment of changes in functional status.
Calf circumference may be affected by fluid retention and lower-extremity edema in patients with heart failure.
Partial conceptual overlap between the inclusion criterion (SPPB ≥10) and the five-times chair stand test cannot be completely excluded.
The physical function score has not been externally validated, so generalizability should be interpreted with caution.
Physical function was assessed at a single time point (discharge), precluding longitudinal assessment.
Calf circumference may be affected by fluid retention and lower-extremity edema in patients with HF, potentially overestimating skeletal muscle mass.
Partial conceptual overlap between the inclusion criterion (SPPB ≥10) and the score component (five-times chair stand test) cannot be completely excluded.

Implication

Sarcopenia scoring may flag residual risk beyond high SPPB in older HF; hypothesis-generating and should not yet change practice.

Abstract

Background: The prognostic value of the Short Physical Performance Battery (SPPB), which is widely used to assess physical function and prognostic risk in patients with heart failure (HF), is unclear in patients with high SPPB scores. In this study we evaluated whether sarcopenia-related factors defined by the Asian Working Group for Sarcopenia in 2019 provided additional prognostic value in this population.

Discussion

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Cite This Study

Iwasaki et al. (2026) conducted a cohort in Heart Failure (n=3,044). Composite physical function score (impairments in handgrip strength, five-times chair stand test, and calf circumference) vs. Lower physical function score was evaluated on Composite of all-cause death or rehospitalization for heart failure within 1 year (HR 1.245, 95% CI 1.132-1.370, p=<0.001). Among older heart failure patients with preserved physical performance, each 1-point increase in a sarcopenia-related composite physical function score increased the risk of all-cause death or heart failure rehospitalization by 24.5%.

synapsesocial.com/papers/6ad0fcf33afa093ea9ad00b0 https://doi.org/10.1253/circrep.cr-26-0159

Topics

Heart failure

HFrEF treatment

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Residual Risk Despite High Short Physical Performance Battery Scores in Older Patients With Heart Failure ― A Multicenter Retrospective Cohort Study ―

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Topics

Residual Risk Despite High Short Physical Performance Battery Scores in Older Patients With Heart Failure ― A Multicenter Retrospective Cohort Study ―

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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