Lower Extremity Function Is Independently Associated With Hospitalization Burden in Heart Failure With Preserved Ejection Fraction

Hornsby, Whitney E.; Sareini, Mohamed-Ali; Golbus, Jessica R.; Willer, Cristen J.; McNamara, Jennifer; Konerman, Matthew C.; Hummel, Scott L.

doi:10.1016/j.cardfail.2018.09.002

Cited by 28 publications

(24 citation statements)

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“…86 ± 6.7 years. Acute HF Hornsby et al [ 79 ], 2019. USA University of Michigan Prospective High Performance.…”

Section: Resultsmentioning

confidence: 99%

“… 6MWT 2.3 ± 1.9 years All-Cause Mortality Per each 10 m increased HR = 0.96 95% CI [0.94–0.97]*** Low Moderate García et al [ 78 ], 2019. SPPB 1 year HF Hospitalisation SPPB ≤ 7 VS SPPB > 7 OR = 6.7 95%CI [1.5–30.4]** Moderate Not Reported All-Cause Mortality SPPB ≤ 7 VS SPPB > 7 OR = 1.2 95%CI [0.3–5.4]* Very Low Hospitalisation and Mortality SPPB ≤ 7 VS SPPB > 7 OR = 3.6 95%CI [1.0–12.9]** Very Low Hornsby et al [ 79 ], 2019. SPPB 6 months Hospitalisation and Mortality Per 1-unit change in SPPB OR = 0.81 95%CI [0.69–0.94]** Moderate Very Low Number of All-Cause Hospitalisations Per 1-unit change in SPPB IRR = 0.92 95%CI [0.86–0.97]** Not Reported Days Hospitalized or Dead Per 1-unit change in SPPB IRR = 0.85 95%CI [0.73–0.99]** Not Reported Chiarantini et al [ 80 ], 2010.…”

Section: Resultsmentioning

confidence: 99%

“…A score below 7 points on the SPPB was associated with a larger risk of the combined endpoint of hospitalisation and mortality for any cause (OR = 3.6 95%CI [1.0–12.9, p < 0.05]) in patients with acute HF [ 78 ]. However, per each 1-unit improved in SPPB the risk of the combined endpoint of hospitalisation and mortality for any cause could be reduced OR = 0.81 95%CI [0.69–0.94, p < 0.05] in patients with HFpEF [ 79 ]. Patients with HFrEF and HFpEF with a gait speed slower than 0.8 m/s also showed a larger risk of the combined endpoint of hospitalisation and mortality for any cause (HR = 1.31 95%CI [1.08–1.58, p < 0.05]) [ 84 ].…”

Section: Resultsmentioning

confidence: 99%

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Physical functional performance and prognosis in patients with heart failure: a systematic review and meta-analysis

Fuentes-Abolafio

Stubbs

Pérez‐Belmonte

et al. 2020

BMC Cardiovasc Disord

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Background Patients with Heart Failure (HF) show impaired functional capacities which have been related to their prognosis. Moreover, physical functional performance in functional tests has also been related to the prognosis in patients with HF. Thus, it would be useful to investigate how physical functional performance in functional tests could determine the prognosis in patients with HF, because HF is the leading cause of hospital admissions for people older than 65 years old. This systematic review and meta-analysis aims to summarise and synthesise the evidence published about the relationship between physical functional performance and prognosis in patients with HF, as well as assess the risk of bias of included studies and the level of evidence per outcome. Methods Major electronic databases, such as PubMed, AMED, CINAHL, EMBASE, PEDro, Web of Science, were searched from inception to March 2020 for observational longitudinal cohort studies (prospective or retrospective) examining the relationship between physical functional performance and prognosis in patients with HF. Results 44 observational longitudinal cohort studies with a total of 22,598 patients with HF were included. 26 included studies reported a low risk of bias, and 17 included studies showed a moderate risk of bias. Patients with poor physical functional performance in the Six Minute Walking Test (6MWT), in the Short Physical Performance Battery (SPPB) and in the Gait Speed Test showed worse prognosis in terms of larger risk of hospitalisation or mortality than patients with good physical functional performance. However, there was a lack of homogeneity regarding which cut-off points should be used to stratify patients with poor physical functional performance from patients with good physical functional performance. Conclusion The review includes a large number of studies which show a strong relationship between physical functional performance and prognosis in patients with HF. Most of the included studies reported a low risk of bias, and GRADE criteria showed a low and a moderate level of evidence per outcome.

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“…86 ± 6.7 years. Acute HF Hornsby et al [ 79 ], 2019. USA University of Michigan Prospective High Performance.…”

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Physical functional performance and prognosis in patients with heart failure: a systematic review and meta-analysis

Fuentes-Abolafio

Stubbs

Pérez‐Belmonte

et al. 2020

BMC Cardiovasc Disord

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“…15,17,25 We opted to include medications associated with geriatric syndromes because most adults with heart failure with preserved ejection fraction-a condition that disproportionately affects older adults-either already have these conditions or are at risk for developing them. 4,7,19,26,27 To identify and count medications that would be considered potentially inappropriate medications, we cross-referenced each class of potentially inappropriate medications with the medications listed in the first note from the Heart Failure with Preserved Ejection Fraction Clinic within the electronic medical record.…”

Section: Potentially Inappropriate Medicationsmentioning

confidence: 99%

“…[3][4][5] Multimorbidity (the presence of multiple comorbid conditions) is the rule rather than the exception in heart failure with preserved ejection fraction and is believed to closely intertwine with its pathophysiology. 4,[6][7][8] Despite the link between heart failure with preserved ejection fraction and multimorbidity, there are few data about the accompanying complexity of medication regimens in this population. 9,10 Polypharmacy defined as taking a high burden of medications, potentially inappropriate medications defined as medications that pose risks that may outweigh benefits in older adults, and therapeutic competition defined as the scenario in which a medication for 1 condition may worsen a coexisting condition all contribute to this complexity.…”

Section: Introductionmentioning

confidence: 99%

Complex and Potentially Harmful Medication Patterns in Heart Failure with Preserved Ejection Fraction

Brinker

Konerman

Navid

et al. 2021

The American Journal of Medicine

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Frailty and Effects of a Multidomain Physical Rehabilitation Intervention Among Older Patients Hospitalized for Acute Heart Failure

et al. 2023

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ImportanceFrailty is common among older patients with acute decompensated heart failure (ADHF) and is associated with worse quality of life (QOL) and a higher risk of clinical events. Frailty can also limit recovery and response to interventions. In the Rehabilitation Therapy in Older Acute Heart Failure Patients (REHAB-HF) trial, a 3-month innovative, early, transitional, tailored, multidomain physical rehabilitation intervention improved physical function and QOL (vs usual care) in older patients with ADHF.ObjectiveTo evaluate whether baseline frailty modified the benefits of the physical rehabilitation intervention among patients with ADHF enrolled in the REHAB-HF trial and to assess the association between changes in frailty with the risk of adverse clinical outcomes on follow-up.Design, Setting, and ParticipantsThis prespecified secondary analysis of the REHAB-HF trial, a multicenter randomized clinical trial, included 337 patients 60 years and older hospitalized for ADHF. Patients were enrolled from September 17, 2014, through September 19, 2019. Participants were stratified across baseline frailty strata as assessed using modified Fried criteria. Data were analyzed from July 2021 to September 2022.InterventionsPhysical rehabilitation intervention or attention control.Main Outcomes and MeasuresPrimary outcome was the Short Physical Performance Battery (SPPB) score at 3 months. Clinical outcomes included all-cause hospitalization or mortality at 6 months.ResultsThis prespecified secondary analysis included 337 participants; 181 (53.7%) were female, 167 (49.6%) were Black, and the mean (SD) age was 72 (8) years. A total of 192 (57.0%) were frail and 145 (43.0%) were prefrail at baseline. A significant interaction was observed between baseline frailty status and the treatment arm for the primary trial end point of overall SPPB score, with a 2.6-fold larger improvement in SPPB with intervention among frail patients (2.1; 95% CI, 1.3-2.9) vs prefrail patients (0.8; 95% CI, −0.1 to 1.6; P for interaction = .03). Trends consistently favored a larger intervention effect size, with significant improvement among frail vs prefrail participants for 6-minute walk distance, QOL, and the geriatric depression score, but interactions did not achieve significance.Conclusions and RelevanceIn this prespecified secondary analysis of the REHAB-HF trial, patients with ADHF with worse baseline frailty status had a more significant improvement in physical function in response to an innovative, early, transitional, tailored, multidomain physical rehabilitation intervention than those who were prefrail.Trial RegistrationClinical Trials.gov Identifier: NCT02196038

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Lower Extremity Function Is Independently Associated With Hospitalization Burden in Heart Failure With Preserved Ejection Fraction

Abstract: Lower extremity function, as measured by the SPPB, independently predicts hospitalization burden in outpatients with HFpEF. Additional studies are warranted to explore shared mechanisms and treatment implications of frailty in HFpEF.

Cited by 28 publications

References 46 publications

Physical functional performance and prognosis in patients with heart failure: a systematic review and meta-analysis

Physical functional performance and prognosis in patients with heart failure: a systematic review and meta-analysis

Complex and Potentially Harmful Medication Patterns in Heart Failure with Preserved Ejection Fraction

Frailty and Effects of a Multidomain Physical Rehabilitation Intervention Among Older Patients Hospitalized for Acute Heart Failure

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