Association between the changes in walking speed during 6 months after discharge and subsequent prognosis in older patients with heart failure: report from a multicenter prospective cohort study. (3rd October 2022)

• Record Type: Journal Article
• Authors: Hanada, S; Adachi, T; Iwatsu, K; Kamisaka, K; Kamiya, K; Yamada, S
• Is Part Of: European heart journal. Volume 43(2022)Supplement 2
• Publication Date: 2022-10-03
• Subjects: Cardiology -- Periodicals; Heart -- Diseases -- Periodicals; 616.12005
• DOI: 10.1093/eurheartj/ehac544.2471
• Languages: English
• ISSNs: 0195-668X

Abstract

Abstract: Background: Walking speed (WS) is one of the key components of physical frailty associated with a prognosis in patients with heart failure (HF). However, the prognostic impact of changes in WS after discharge in patients with HF remains to be examined. Purpose: The purpose of this study was to examined the association between the change in WS during 6 months after discharge and subsequent prognosis in older patients with HF. Methods: This study was performed as a sub-analysis of the multicenter cohort study in Japan (FLAGSHIP). We analyzed patients hospitalized for HF aged ≥65 years whose WS was measured at discharge and after 6 months of discharge. Based on the patterns of WS at the two points, patients were divided into four groups (A: WS ≥0.98 m/s both at discharge and 6-month; B: ≥0.98 m/s at discharge, <0.98 m/s at 6-month; C: <0.98 m/s at discharge, ≥0.98 m/s at 6-month; D: <0.98 m/s both at discharge and 6-month). WS <0.98 m/s has been identified as a cut-off value predicting the prognosis of HF in the main analysis of the FLAGSHIP. Kruskal - Wallis test was used to compare among groups. Furthermore, Cox proportional hazards model was performed to evaluate the association between the WS subgroups and HF rehospitalization after 6-month of discharge. Additionally, adjustments were made for age and sex in model 1, and for age, sex, cognitive function (Mini-mental state examination, MMSE ≤23), past HF hospitalization, rehospitalization within 6 months after discharge, and variables with a p value <0.05 both at discharge and 6 months in univariate analysis in model 2. Results: A total of 890 patients were included in this study (Group A: n=386, B: n=51, C: n=143, D: n=310). There was a significant difference in HF rehospitalization after 6-month of discharge among the four groups (Log-rank test, p=0.01, Figure 1). In the crude model, hazard ratio (HR) of group B compared with A was 2.26 [95% confidence interval: 1.19–4.27, p=0.013], HR of C was 1.00 [0.56–1.77, p=0.988], and HR of D was 1.66 [1.11–2.47, p=0.013]. In model 1, HR of B was 2.12 [1.11–4.07, p=0.023], HR of C was 0.99 [0.56–1.75, p=0.964], and HR of D was 1.56 [1.01–2.42, p=0.047]. In model 2, HR of B was 0.95 [0.45–1.97, p=0.897], HR of C was 0.67 [0.35–1.26, p=0.212], and HR of D was [0.25–0.80, p=0.007]. Conclusion: Although slow WS is associated with poor prognosis, the prognosis might be improved if WS increases by 6 months after discharge. Funding: This study is supported by a Grant-in-Aid for Scientific Research (A) from the Japanese Society for the Promotion of Science [16H01862]. Funding Acknowledgement: Type of funding sources: Public Institution(s). Main funding source(s): The Japanese Society for the Promotion of Science