What is the clinical evidence from this study?

Study design: Observational. Population: Heart failure (n=9403). Intervention: Hospitalization for acute heart failure. Primary outcome: Incidence of hospitalization-associated disability (HAD).

January 12, 2024Open Access

Incidence of Hospitalization-Associated Disability in Older Patients With Heart Failure

TTTetsuya TakahashiUniversity of Fukui KIK. IwataHeart Failure & Transplant TMTomoyuki MorisawaCross-Cutting Cardiology

Key Result

Among older patients hospitalized with heart failure in Japan, 37.1% developed hospitalization-associated disability, with risk factors varying based on preadmission functional status.

Study Design

Type

Observational (n=9,403)

Multicenter

Yes

Structured PICO

What is the incidence and what are the characteristics of hospitalization-associated disability in older patients with heart failure?

Population

9,403 older adults (aged ≥65 years, median age 83.0) hospitalized for heart failure and prescribed physical rehabilitation, evaluated for hospitalization-associated disability.

Outcome

Incidence of hospitalization-associated disability (HAD)

Hospitalization-associated disability is highly prevalent (37.1%) among older patients with heart failure, highlighting the need for convalescent rehabilitation.

Limitations

Did not cover all regions of Japan or all hospitals offering cardiac rehabilitation
Did not investigate detailed treatment in the emergency department or coronary care unit
Difficult to analyze changes in the content of highly individualized exercises for each participating facility
Data collection period was during the COVID-19 pandemic, which may have affected HAD incidence

Abstract

BACKGROUND: This study determined the incidence of hospitalization-associated disability (HAD) and its characteristics in older patients with heart failure in Japan. METHODS AND RESULTS: Ninety-six institutions participated in this nationwide multicenter registry study (J-Proof HF). From December 2020 to March 2022, consecutive heart failure patients aged ≥65 years who were prescribed physical rehabilitation during hospitalization were enrolled. Of the 9,403 patients enrolled (median age 83.0 years, 50.9% male), 3,488 (37.1%) had HAD. Compared with the non-HAD group, the HAD group was older and had higher rates of hypertension, chronic kidney disease, and cerebrovascular disease comorbidity. The HAD group also had a significantly lower Barthel Index score and a significantly higher Kihon checklist score before admission. Of the 9,403 patients, 2,158 (23.0%) had a preadmission Barthel Index score of <85 points. Binomial logistic analysis revealed that age and preadmission Kihon checklist score were associated with HAD in patients with a preadmission Barthel Index score of ≥85, compared with New York Heart Association functional classification and preadmission cognitive decline in those with a Barthel Index score <85. CONCLUSIONS: This nationwide registry survey found that 37.1% of older patients with HF had HAD and that these patients are indicated for convalescent rehabilitation. Further widespread implementation of rehabilitation for older patients with heart failure is expected in Japan.

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