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Incidence of Hospitalization-Associated Disability in Older Patients With Heart Failure
Tetsuya Takahashi1, Kentaro Iwata1, Tomoyuki Morisawa1
1Committee of the J-Proof HF Registry, Japanese Society of Cardiovascular Physical Therapy.
Insights
Hospitalization-associated disability (HAD) affects 37.1% of older heart failure patients in Japan. Early rehabilitation is crucial for managing HAD in this population.
Area of Science:
- Gerontology
- Cardiology
- Rehabilitation Medicine
Background:
- Heart failure (HF) is a significant health concern in aging populations.
- Hospitalization-associated disability (HAD) is a common complication in elderly patients.
- Understanding the incidence and characteristics of HAD in older HF patients is critical for effective care.
Purpose of the Study:
- To determine the incidence of hospitalization-associated disability (HAD) in older patients with heart failure in Japan.
- To identify the characteristics and risk factors associated with HAD in this demographic.
- To inform the implementation of rehabilitation strategies for older HF patients.
Main Methods:
- Nationwide multicenter registry study (J-Proof HF) involving 96 institutions.
- Enrolled 9,403 consecutive heart failure patients aged ≥65 years prescribed physical rehabilitation.
- Collected data on patient demographics, comorbidities, preadmission functional status (Barthel Index, Kihon checklist), and functional classification (New York Heart Association).
Main Results:
- 37.1% of enrolled patients (3,488/9,403) experienced HAD.
- The HAD group was older and had higher rates of hypertension, chronic kidney disease, and cerebrovascular disease.
- Preadmission functional status (lower Barthel Index, higher Kihon checklist) was significantly worse in the HAD group.
- Predictors of HAD differed based on preadmission Barthel Index scores (≥85 vs. <85).
Conclusions:
- A high incidence of HAD (37.1%) was observed in older heart failure patients in Japan.
- Patients with HAD are indicated for convalescent rehabilitation.
- Widespread implementation of rehabilitation for older heart failure patients is recommended in Japan.
Background:
This study determined the incidence of hospitalization-associated disability (HAD) and its characteristics in older patients with heart failure in Japan.
Methods And Results:
Ninety-six institutions participated in this nationwide multicenter registry study (J-Proof HF). From December 2020 to March 2022, consecutive heart failure patients aged ≥65 years who were prescribed physical rehabilitation during hospitalization were enrolled. Of the 9,403 patients enrolled (median age 83.0 years, 50.9% male), 3,488 (37.1%) had HAD. Compared with the non-HAD group, the HAD group was older and had higher rates of hypertension, chronic kidney disease, and cerebrovascular disease comorbidity. The HAD group also had a significantly lower Barthel Index score and a significantly higher Kihon checklist score before admission. Of the 9,403 patients, 2,158 (23.0%) had a preadmission Barthel Index score of <85 points. Binomial logistic analysis revealed that age and preadmission Kihon checklist score were associated with HAD in patients with a preadmission Barthel Index score of ≥85, compared with New York Heart Association functional classification and preadmission cognitive decline in those with a Barthel Index score <85.
Conclusions:
This nationwide registry survey found that 37.1% of older patients with HF had HAD and that these patients are indicated for convalescent rehabilitation. Further widespread implementation of rehabilitation for older patients with heart failure is expected in Japan.
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