Hospitalization-Associated Disability and 1-Year Mortality Risk in Older Patients With Heart Failure.

Abstract

Objectives: Hospitalization-associated disability (HAD) is the loss of the ability to perform one of the basic activities of daily living (ADLs) required for independent living during hospitalization. This study aimed to determine whether HAD is a significant prognostic risk factor in older patients with heart failure (HF) and independent ADLs.

Design: Prospective, nationwide, multicenter registry study conducted between December 2020 and March 2022.

Setting and participants: This study was conducted across 96 centers in Japan and included 6519 older patients (aged ≥65 years) with HF who were independent in ADL before hospitalization.

Methods: HAD was defined as a drop of at least 5 points in the Barthel Index (BI) at discharge, relative to a stable score before hospitalization. Subgroup analysis classified HAD as mild (a decrease of 5-15 points in the BI) and severe (a decrease of ≥20 points in the BI). The primary outcome was all-cause mortality within 1 year after hospital discharge, and the secondary outcomes were HF-related mortality and rehospitalization.

Results: All-cause mortality, HF-related mortality, and rehospitalization rates within 1 year were 12%, 5%, and 41%, respectively. Multivariate Cox regression analysis revealed that HAD increased the risk of 1-year all-cause mortality after hospital discharge (adjusted hazard ratio, 1.749; 95% CI, 1.475-2.075). Subgroup analysis showed a significantly higher risk of all-cause mortality among patients with severe HAD than among those with mild HAD (1.388; 1.109-1.739). HAD was a significant risk factor for HF-related mortality (1.556; 1.216-2.017). However, no relationship was observed between HAD and readmission (1.062; 0.970-1.163).

Conclusions and implications: The development of HAD was identified as a significant risk factor for 1-year post-discharge mortality among older patients with HF who were independent in ADLs before hospitalization. Preventing minor declines in ADL and mitigating any ADL impairments during hospitalization are crucial to avoiding a worsening prognosis.