Association of muscular fitness with rehospitalization for heart failure with reduced ejection fraction

Abstract

Background Limited information is available regarding the prognostic potential of muscular fitness parameters in heart failure (HF) with reduced ejection fraction (HFrEF). Hypothesis We aimed to investigate the predictive potential of knee extensor muscle strength and power on rehospitalization and evaluate the correlation between exercise capacity and muscular fitness in patients newly diagnosed with HFrEF. Methods Ninety nine patients hospitalized with a new diagnosis of HF were recruited (64 men; aged 58.7 years [standard deviation (SD), 13.2 years]; 32.3% ischemic; ejection fraction, 28% [SD, 8%]). The inclusion criteria were left ventricular ejection fraction <40% and sufficient clinical stability to undergo exercise testing. Aerobic exercise capacity was measured with cardiopulmonary exercise testing. Knee extensor maximal voluntary isometric contraction (MVIC) and muscle power (MP) were measured using the Baltimore therapeutic equipment system. The clinical outcome was HF rehospitalization. Results Over a mean follow‐up period of 1709 ± 502 days, 39 patients were rehospitalized due to HF exacerbation. HF rehospitalization was more probable for patients with diabetes and lower oxygen uptake at peak exercise (peak VO2), knee extensor MVIC, and MP. The Kaplan–Meier survival analysis revealed significantly different cumulative HF rehospitalization rates according to the tertiles of peak VO2 (P = 0.005) and MP (P = 0.002). Multivariable Cox proportional hazard model showed that the lowest tertiles of peak VO2 (hazard ratio (HR), 6.26; 95% confidence interval (CI), 1.93–20.27); and MP (HR, 5.29; 95% CI, 1.05–26.53) were associated with HF rehospitalization. Knee extensor muscle power was an independent predictor for rehospitalization in patients with HFrEF. Conclusion Knee extensor muscle power was an independent predictor for rehospitalization in patients with HFrEF.

Association between frailty and physical performance in older patients with heart failure

“…In particular, patients with HF experience easy fatigability of the lower extremities, 29 which leads to limitations in exercise and mobility. In addition, knee extensor muscle power in patients with HFrEF is an independent predictor of HF rehospitalization 17 . However, similar to handgrip strength, muscular strength and power of the lower extremities did not significantly differ between the degrees of the frailty of the K‐FRAIL scale.…”

Effects of cardiac rehabilitation with motion assistance from a wearable cyborg hybrid assistive limb on patients with chronic heart failure: a randomized controlled trial with a one-year follow-up

“…Kono et al reported that knee extensor muscle strength is an independent factor determining exercise capacity, especially in elderly HF patients with sarcopenia, and provided useful information on exercise prescription 35) . Knee extensor muscle power is an independent predictor for rehospitalization in HF patients with reduced ejection fraction 36) . Therefore, physical therapists need to focus on improving knee extensor muscle strength in patients with HF.…”

Cardiovascular and Pulmonary Research: The Year (2022) in Review

“…Treadmill training was continued on the regular floor until the patient could ambulate with minimum support (FAC-score 2). In an intention to treat analysis (ITT), the median time to independent ambulation was 6 (3-9) days in the intervention group and 11 (7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23) days in the UC group (P 5 .063). The authors noted that although not significant in the ITT analysis, the difference in time to independent ambulation was considerable between the intervention and UC group, because of the large hazard ratio (1.97) and Kaplan-Meier curve.…”

“…Resistance training is an important method for improving lean muscle mass; however, there is limited evidence for optimal RT prescription because of a low number of studies. A study by Lee et al 9 indicated that knee extensor power is an independent predictor of rehospitalization in patients with HFrEF. Overall, RT can be used as an appropriate intervention in patients with HF, as an adjunct to AT or for those who cannot tolerate AT.…”