Association between a pre-admission limitation in walking ability and post-discharge adverse outcomes among hospitalized patients with heart failure: Report from a multicenter prospective cohort study

• Published in: International journal of cardiology 2021-08, Vol.337, p.105-112
• Main Authors: Kamiya, Kuniyasu, Adachi, Takuji, Iwatsu, Kotaro, Kamisaka, Kenta, Iida, Yuki, Iritani, Naoki, Yamada, Sumio
• Format: Article
• Language: English
• Subjects: Heart failure; Left ventricular ejection fraction category; Limitation in walking ability; Multicenter cohort study; Older patients; Pre-admission
• ISSN: 0167-5273; 1874-1754
• DOI: 10.1016/j.ijcard.2021.05.020

Background: Although limited walking ability at discharge is a known risk factor for adverse outcomes in older patients with heart failure (HF), the association between pre-admission limitations and adverse outcomes is unknown. Therefore, we evaluated the prevalence of a pre-admission limitation in walking ability and its relationship with post-discharge outcomes among patients with HF with reduced, mid-range, and preserved left-ventricular ejection fraction (HFrEF, HFmrEF, and HFpEF). Methods: We followed 2042 patients aged ≥65 years (HFrEF, n = 668; HFmrEF, n = 360; HFpEF, n = 1014) from a multicenter cohort study in Japan. A limitation in walking ability was defined as the necessity of any assistance or a walking aid. Adverse outcomes were defined as the composite of HF rehospitalization and all-cause death within 2 years after discharge. Results: During 2978.0 person-years of follow-up, 563 patients were rehospitalized due to HF exacerbation and 103 patients died. In HFrEF, HFmrEF, and HFpEF groups, the prevalence of a pre-admission limitation in walking ability was 12.1%, 18.6%, and 21.1%, respectively, the crude hazard ratios [95% confidence interval] of a pre-admission limitation in walking ability were 2.46 [1.79–3.39], 1.34 [0.87–2.06], and 1.94 [1.53–2.47], and the adjusted hazard ratios were 2.21 [1.58–3.16], 1.19 [0.75–1.89], and 1.39 [1.06–1.82], respectively. Conclusions: A pre-admission limitation in walking ability is a predictor of post-discharge HF rehospitalization or all-cause death among patients with HFrEF and HFpEF, but not among patients with HFmrEF. Shortly after admission, information regarding pre-admission functional limitations should be obtained to better understand the risk of post-discharge adverse outcomes. •A pre-admission limitation in walking predicted adverse outcomes in HFrEF and HFpEF.•A pre-admission limitation in walking did not predict adverse outcomes in HFmrEF.•HRs were the similar for a limitation in walking before admission and at discharge.•The prognosis was worse for HFrEF than for HFpEF even adjusted for age.