Kensuke Takabayashi1, Shouji Kitaguchi2, Kotaro Iwatsu3, Yuko Morikami2, Tahei Ichinohe2, Takashi Yamamoto2, Kotoe Takenaka2, Hiroyuki Takenaka2, Hiroyuki Muranaka2, Ryoko Fujita2, Osamu Nakajima4, Ryou Yokoyama4, Yuka Terasaki5, Hideki Nishio6, Miho Masai6, Hitoshi Koito7, Miyuki Okuda8, Hirohisa Uwatoko9, Yoshihide Kawakami10, Sen Matsumoto11, Tetsuhisa Kitamura12, Ryuji Nohara2. 1. Department of Cardiology, Hirakata Kohsai Hospital, Osaka, Japan. Electronic address: taka410@gmail.com. 2. Department of Cardiology, Hirakata Kohsai Hospital, Osaka, Japan. 3. Department of Rehabilitation, Hirakata Kohsai Hospital, Osaka, Japan. 4. Department of Cardiology, Hirakata City Hospital, Osaka, Japan. 5. Department of Internal Medicine, Arisawa General Hospital, Osaka, Japan. 6. Department of Cardiology, Ueyama Hospital, Osaka, Japan. 7. Department of Cardiology, Otokoyama Hospital, Kyoto, Japan. 8. Department of Respiratory Medicine, Hirakata Kohsai Hospital, Osaka, Japan. 9. Department of Cardiology, Yawata Central Hospital, Kyoto, Japan. 10. Department of Cardiology, Nakamura Hospital, Osaka, Japan. 11. Department of Cardiology, Hoshigaoka Medical Center, Osaka, Japan. 12. Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan.
Abstract
BACKGROUND: Although activities of daily living (ADL) are recognized as being pertinent in averting relevant readmission of heart failure (HF) and mortality, little research has been conducted to assess a correlation between a decline in ADL and outcomes in HF patients. METHODS: The Kitakawachi Clinical Background and Outcome of Heart Failure Registry is a prospective, multicenter, community-based cohort of HF patients. We categorized the patients into four types of ADL: independent outdoor walking, independent indoor walking, indoor walking with assistance, and abasia. We defined a decline in ADL (decline ADL) as downgrade of ADL and others (non-decline ADL) as preservation of ADL before discharge compared with admission. RESULTS: Among 1253 registered patients, 923 were eligible, comprising 98 (10.6%) with decline ADL and 825 (89.4%) with non-decline ADL. Decline ADL exhibited a higher risk of hospitalization for HF and mortality compared with non-decline ADL. A multivariate analysis revealed that decline ADL emerged as an independent risk factor of hospitalization for HF [hazard ratio (HR), 1.42; 95% confidence interval (CI): 1.01-1.96; p=0.046] and mortality (HR, 1.95; 95% CI: 1.23-2.99; p<0.01). Although 66.3% of patients with decline ADL were registered for long-term care insurance, few received daycare services (32.7%) or home-visit medical services (8.2%). CONCLUSIONS: Decline in ADL is a predictor of hospitalization for HF and mortality in HF patients.
BACKGROUND: Although activities of daily living (ADL) are recognized as being pertinent in averting relevant readmission of heart failure (HF) and mortality, little research has been conducted to assess a correlation between a decline in ADL and outcomes in HF patients. METHODS: The Kitakawachi Clinical Background and Outcome of Heart Failure Registry is a prospective, multicenter, community-based cohort of HF patients. We categorized the patients into four types of ADL: independent outdoor walking, independent indoor walking, indoor walking with assistance, and abasia. We defined a decline in ADL (decline ADL) as downgrade of ADL and others (non-decline ADL) as preservation of ADL before discharge compared with admission. RESULTS: Among 1253 registered patients, 923 were eligible, comprising 98 (10.6%) with decline ADL and 825 (89.4%) with non-decline ADL. Decline ADL exhibited a higher risk of hospitalization for HF and mortality compared with non-decline ADL. A multivariate analysis revealed that decline ADL emerged as an independent risk factor of hospitalization for HF [hazard ratio (HR), 1.42; 95% confidence interval (CI): 1.01-1.96; p=0.046] and mortality (HR, 1.95; 95% CI: 1.23-2.99; p<0.01). Although 66.3% of patients with decline ADL were registered for long-term care insurance, few received daycare services (32.7%) or home-visit medical services (8.2%). CONCLUSIONS: Decline in ADL is a predictor of hospitalization for HF and mortality in HF patients.
Authors: Caroline Madrigal; Jenny Kim; Lan Jiang; Jacob Lafo; Melanie Bozzay; Jennifer Primack; Stephen Correia; Sebhat Erqou; Wen-Chih Wu; James L Rudolph Journal: JAMA Netw Open Date: 2021-03-01