Early In-Hospital Functional Status Predicts Recovery at Discharge in Older Patients Hospitalized for Acute...

Acute decompensated heart failure (ADHF) often causes functional decline in older adults, leading to frailty and poor outcomes. This study aimed to identify factors linked to inadequate functional recovery during hospitalization and to assess how early in-hospital functional status predicts recovery at discharge.

We enrolled 166 patients aged ≥75 years hospitalized for ADHF who had maintained basic activities of daily living before admission (Barthel Index [BI] ≥70). Functional status was assessed weekly during hospitalization using the BI. We then investigated the clinical factors associated with insufficient improvement in BI. Multivariable logistic regression analysis revealed that advanced age (odds ratio [OR] 1.11; 95% confidence interval [CI] 1.03-1.20; P=0.010), concomitant dementia (OR 3.17; 95% CI 1.34-7.52; P=0.008), and BI <50 1 week after admission (OR 4.94; 95% CI 2.07-11.80; P<0.001) were significantly associated with inadequate functional recovery (BI <70) at discharge. Furthermore, BI <50 1 week after admission was associated with higher cardiovascular mortality and rehospitalization for heart failure (HF) after discharge compared with those who improved (log-rank P=0.044).

In older patients with ADHF, advanced age, concomitant dementia, and insufficient BI improvement 1 week after admission were associated with inadequate functional recovery during hospitalization. Insufficient early functional recovery was also linked to adverse post-discharge outcomes. Therefore, early BI assessment may facilitate risk stratification for functional recovery at discharge in older HF patients.