Clinical Impact of Hospital-Associated Disability in Patients With Acute Decompensated Heart Failure

Hospital-associated disability (HAD) may affect long-term outcomes in heart failure (HF), but evidence remains limited, so in this study we aimed to evaluate the impact of HAD on long-term outcomes in acute decompensated HF (ADHF).

We analyzed data from the Japanese Registry of Acute Decompensated Heart Failure (JROADHF), including patients enrolled from January 2013 to December 2017. HAD was defined as a decline of ≥5 points in the Barthel Index from admission to discharge. The primary outcome was all-cause death, and the secondary outcomes were cardiovascular (CV) death, non-CV death, and HF readmission. Of the 8,965 patients enrolled (mean age 76.9±12.7 years; 54.8% male), 537 (6.0%) had HAD. In the multivariate analysis, HAD was independently associated with all-cause death (hazard ratio [HR]: 1.58; 95% confidence interval [CI]: 1.31-1.91; P<0.001) and non-CV death (HR: 1.44; 95% CI: 1.08-1.92; P=0.013), but not with CV death or HF readmission. Subgroup analyses revealed a stronger association between HAD and all-cause death in patients under 80 years (<80 years: HR: 2.48; 95% CI: 1.80-3.41; ≥80 years: HR: 1.36; 95% CI: 1.09-1.71; P for interaction <0.001).

HAD significantly affects the long-term mortality rate in ADHF patients, particularly in those under 80 years of age. These findings highlight the importance of considering age-specific management approaches in this population.