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

Abstract

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.

Higher hemoglobin levels are associated with better physical performance among older adults without anemia: a longitudinal analysis

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Development and Validation of an Early Mortality Risk Score for Older Patients Treated with Chemotherapy for Cancer

“…The optimal cut-point for the laboratory values SPPB and BMI was determined using the Youden index. The cutoff usually established for frailty in the SPPB is 8, but its value for predicting mortality is not currently addressed, ranging from 4 to 8 [ 27 , 28 , 29 ]. Thus, we chose the Youden index to determine the optimal cutoff value for the SPPB.…”

Higher Hemoglobin Levels Are Associated With Better Physical Performance Among Older Adults Without Anemia: A Longitudinal Analysis

“…Some authors point out that other factors are determinants for this decline, such as education (8,28,29). It is also well known that physical function decline is higher with chronic diseases (30,31). Our analysis also opted to consider cardiometabolic conditions separately because it was already discussed that those conditions have an important interaction with anemia in physical function (13,22).…”