Development and validation of a scoring system to predict hospitalization-associated disability in older patients...

Older patients with heart failure are vulnerable to hospitalization-associated disability (HAD). This study aimed to develop and validate a scoring system to predict the occurrence of HAD in these patients, enabling early risk assessment.

This study was a secondary analysis of the Japanese PT multicenter Registry of Older Frail patients with heart failure, a multicenter prospective cohort of heart failure patients aged 65 years and older. A predictive score for HAD was developed based on the beta coefficients of a logistic regression model in a development cohort. The score's performance was then evaluated in a validation cohort using C-statistics and calibration plots, comparing predicted probabilities with observed values.

Based on the analysis of 9412 patients (median age 83 years, 49% female), a prediction scoring system (0-14 points) was developed. The final model included age, serum albumin, New York Heart Association class, preadmission functional independence, frailty, low muscle strength, and cognitive decline. The C-statistic was 0.69 (95% confidence interval [CI] 0.67-0.70, p < 0.001) in the development cohort and 0.69 (95% CI 0.67-0.70, p < 0.001) in the validation cohort. The incidence of HAD significantly increased with higher score groups: 54.0% (high score, ≥ 10), 38.7% (moderate score, 5-9), and 12.8% (low score, < 4) (p < 0.001).

A scoring system was developed to predict the occurrence of HAD in older patients with heart failure. This score can help identify high-risk patients early in hospitalization.