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Impact of Delayed Initiation of Cardiovascular Physical Therapy on Prolonged Hospital Length of Stay in Patients With

Chisaki Heiuchi¹, Kenichi Kasai¹, Katsuyoshi Hirose¹

¹Department of Rehabilitation, Matsushita Memorial Hospital Osaka Japan.

Circulation Reports

|June 11, 2026

Abstract

Background:

Prolonged hospital length of stay (LOS) remains a major clinical and economic challenge in heart failure (HF) management. Although early initiation of cardiovascular physical therapy improves functional capacity and prognosis in HF, the impact of delayed initiation on LOS has not been fully clarified. This study examined the association between the timing of cardiovascular physical therapy initiation and prolonged LOS in patients hospitalized for HF.

Methods And Results:

This retrospective cohort study included 280 patients hospitalized for HF between January 2022 and December 2023. Patients were categorized into standard and prolonged LOS groups based on the median LOS of 17 days. Receiver operating characteristic curve analysis identified hospital Day 3 as the optimal cut-off for predicting prolonged LOS. Patients who initiated cardiovascular physical therapy on or after Day 3 had a significantly longer LOS than those who started within 2 days (24±14 vs. 19±12 days; P<0.01). Delayed initiation remained independently associated with prolonged LOS after adjustment for age, sex, Meta-Analysis Global Group in Chronic Heart Failure score, intensive care unit stay duration, and B-type natriuretic peptide.

Conclusions:

Delayed initiation of cardiovascular physical therapy beyond hospital Day 3 was independently associated with prolonged hospitalization in HF patients. Early initiation guided by hemodynamic assessment during the acute phase may reduce LOS and improve the efficiency of HF care.

Keywords:

Cardiovascular physical therapy Clinical outcomes Early mobilization Heart failure Length of stay

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