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Prognostic value of Short Physical Performance Battery in older patients with Stage B heart failure: a prospective
Insights
The Short Physical Performance Battery (SPPB) can predict mortality in older adults with Stage B heart failure. A threshold of 6 points on the SPPB, rather than 9, better identifies high-risk individuals.
Area of Science:
- Gerontology
- Cardiology
- Clinical Epidemiology
Background:
- Stage B heart failure (HF) risk stratification currently overlooks functional status.
- The prognostic value of the Short Physical Performance Battery (SPPB) for mortality in older adults with Stage B HF is unknown.
- This study assesses the SPPB's association with mortality and its incremental predictive value over conventional metrics.
Purpose of the Study:
- To evaluate the association between SPPB and all-cause mortality in older adults with Stage B HF.
- To establish an optimal SPPB threshold for risk stratification.
- To determine the incremental prognostic value of SPPB and its subtests compared to traditional cardiac indicators.
Main Methods:
- Prospective cohort study of 527 patients aged ≥65 years with Stage B HF, followed for 5 years.
- Analysis of all-cause mortality using multivariable Cox regression and restricted cubic splines.
- Evaluation of SPPB's incremental predictive value using AUC, IDI, cNRI, and DCA, with a focus on a 6-point threshold.
Main Results:
- An SPPB threshold of ≤6 was associated with a threefold higher risk of all-cause mortality (HR=3.29).
- The 6-point SPPB threshold demonstrated superior predictive performance (AUC=0.840) compared to the conventional 9-point threshold.
- Gait speed, an SPPB subtest, provided the strongest incremental prognostic value (AUC=0.833).
Conclusions:
- SPPB is an independent predictor of mortality in older adults with Stage B HF.
- A 6-point SPPB threshold improves risk discrimination more effectively than the conventional 9-point threshold.
- Incorporating SPPB, particularly gait speed, enhances prognostic assessment and risk stratification for Stage B HF.
Background:
Stage B heart failure (HF) requires precise risk stratification. Current guideline-recommended approaches focus on cardiac indicators, neglecting functional status. The Short Physical Performance Battery (SPPB) predicts outcomes in symptomatic HF, but its prognostic value for mortality in older adults with Stage B HF remains unexplored. This study aimed to evaluate this association, establish an optimal SPPB threshold, and determine the incremental value of SPPB and its subtests over conventional metrics.
Methods:
This prospective cohort enrolled patients with Stage B HF aged ≥ 65 years and followed them for 5 years to evaluate all-cause mortality. Restricted cubic splines were applied to explore potential non-linear relationships between SPPB and mortality. Prognostic thresholds were identified using segmented regression. Associations with mortality were examined using multivariable Cox regression. Incremental predictive value of SPPB and its subtests over the base model was evaluated using area under the curve (AUC), integrated discrimination improvement (IDI), continuous net reclassification improvement (cNRI), and decision curve analysis (DCA).
Results:
A total of 527 patients were included (mean age 75.3 ± 6.4 years; 53.9% female). SPPB showed an L-shaped association with all-cause mortality, with a threshold of 6. After adjustment for age, sex, log-transformed NT-proBNP, and left atrial anteroposterior diameter, SPPB ≤ 6 was associated with a threefold higher risk of all-cause mortality (HR = 3.29, 95% CI: 1.90-5.70) compared with SPPB > 6. Using the 6-point threshold of the SPPB, rather than the conventional 9, more effectively improved the predictive performance (AUC = 0.840; IDI = 0.061; cNRI = 0.433). DCA further showed higher net benefit for the 6-point model across threshold probabilities of 0.05-0.50. Among the subtests, gait speed provided the greatest incremental value (AUC = 0.833; IDI = 0.053; cNRI = 0.258).
Conclusion:
SPPB was independently associated with mortality in older patients with Stage B HF. In this dataset, a 6-point threshold showed improved discrimination for identifying higher-risk individuals compared with the conventional 9-point threshold. Gait speed showed the strongest incremental prognostic value among the subtests. Incorporating SPPB into prognostic assessment may improve risk stratification in this population.
Trial Registration:
ChiCTR1800017204; 07/18/2018.
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