Physical function-dependent calf circumference thresholds for predicting 1-year mortality in older patients...

Calf circumference (CC) reflects muscle mass and nutritional status but may be confounded by peripheral edema in heart failure (HF). The Short Physical Performance Battery (SPPB) is a validated predictor of adverse outcomes in HF. This study developed and temporally validated a simple risk-stratification model combining SPPB and CC to predict 1-year mortality in hospitalized older patients with HF.

We analyzed data from the Japanese multicenter J-Proof HF Registry, comprising 7362 patients aged ≥ 65 years. Participants were divided chronologically into training (n = 4417) and temporal validation (n = 2945) cohorts. Decision-tree analysis using SPPB and CC identified cutoff values and defined three mortality risk groups. Model performance was assessed using Kaplan-Meier analysis and multivariable Cox regression.

Patients were classified into low (SPPB ≥10 and CC ≥ 25.9 cm), intermediate (SPPB ≥10 and CC < 25.9 cm orSPPB 7-9 and CC ≥ 25.3 cm), and high (SPPB 7-9 and CC < 25.3 cm or SPPB < 7) risk groups. In the temporal validation cohort, 1-year survival differed significantly across groups (log-rank P < 0.001), with stepwise increases in adjusted mortality risk. Findings were consistent across sex subgroups.

The combined SPPB-CC model provides a simple approach for stratifying 1-year mortality risk in older patients hospitalized with HF. This bedside tool may help identify patients who could benefit from further nutritional and rehabilitation assessment.