Satoshi Katano1, Toshiyuki Yano2, Katsuhiko Ohori2,3, Hidemichi Kouzu2, Ryohei Nagaoka1, Suguru Honma4, Kanako Shimomura5, Takuya Inoue6, Yuhei Takamura7, Tomoyuki Ishigo8, Ayako Watanabe9, Masayuki Koyama2,10, Nobutaka Nagano2, Takefumi Fujito2, Ryo Nishikawa2, Wataru Ohwada2, Akiyoshi Hashimoto2,11, Masaki Katayose12, Sumio Ishiai13, Tetsuji Miura2,14. 1. Division of Rehabilitation, Sapporo Medical University Hospital. 2. Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine. 3. Department of Cardiology, Hokkaido Cardiovascular Hospital. 4. Department of Rehabilitation, Sapporo Cardiovascular Hospital. 5. Department of Rehabilitation, Hakodate Goryokaku Hospital. 6. Division of Rehabilitation, Hokuto Hospital. 7. Department of Rehabilitation, Hokkaido Ohno Memorial Hospital. 8. Division of Hospital Pharmacy, Sapporo Medical University Hospital. 9. Division of Nursing, Sapporo Medical University Hospital. 10. Department of Public Health, Sapporo Medical University School of Medicine. 11. Division of Health Care Administration and Management, Sapporo Medical University School of Medicine. 12. Second Division of Physical Therapy, Sapporo Medical University School of Health Sciences. 13. Department of Rehabilitation, Sapporo Medical University School of Medicine. 14. Department of Clinical Pharmacology, Faculty of Pharmaceutical Sciences, Hokkaido University of Science.
Abstract
BACKGROUND: A strategy to predict mortality in elderly heart failure (HF) patients has not been established.Methods and Results: We retrospectively enrolled 413 HF patients aged ≥65 years (mean age 78 years) who had received comprehensive cardiac rehabilitation (CR) during hospitalization. Basic activities of daily life were assessed before discharge using the Barthel index (BI). Of 413 HF patients, 116 (28%) died during a median follow-up period of 1.90 years (interquartile range 1.20-3.23 years). An adjusted dose-dependent association analysis showed that the hazard ratio (HR) of mortality increased in an almost linear manner as the BI score decreased, and that a BI score of 85 corresponded to an HR of 1.0. Kaplan-Meier survival curves showed that the survival rate was lower for patients with a low BI (<85) than for those with a high BI (≥85; 65% vs. 74%, respectively; P=0.007). In multivariate Cox regression analyses, low BI was independently associated with higher mortality after adjusting for predictors, including B-type natriuretic peptide. Inclusion of the BI into the adjusted model improved the accuracy of the prediction of mortality. CONCLUSIONS: A BI score <85 at the time of discharge is associated with increased mortality independent of known prognostic markers, and achieving functional status with a BI score ≥85 by comprehensive CR during hospitalization may contribute to favorable outcomes in elderly HF patients.
BACKGROUND: A strategy to predict mortality in elderly heart failure (HF) patients has not been established.Methods and Results: We retrospectively enrolled 413 HF patients aged ≥65 years (mean age 78 years) who had received comprehensive cardiac rehabilitation (CR) during hospitalization. Basic activities of daily life were assessed before discharge using the Barthel index (BI). Of 413 HF patients, 116 (28%) died during a median follow-up period of 1.90 years (interquartile range 1.20-3.23 years). An adjusted dose-dependent association analysis showed that the hazard ratio (HR) of mortality increased in an almost linear manner as the BI score decreased, and that a BI score of 85 corresponded to an HR of 1.0. Kaplan-Meier survival curves showed that the survival rate was lower for patients with a low BI (<85) than for those with a high BI (≥85; 65% vs. 74%, respectively; P=0.007). In multivariate Cox regression analyses, low BI was independently associated with higher mortality after adjusting for predictors, including B-type natriuretic peptide. Inclusion of the BI into the adjusted model improved the accuracy of the prediction of mortality. CONCLUSIONS: A BI score <85 at the time of discharge is associated with increased mortality independent of known prognostic markers, and achieving functional status with a BI score ≥85 by comprehensive CR during hospitalization may contribute to favorable outcomes in elderly HF patients.