Relationship between average daily rehabilitation time and decline in instrumental activity of daily living among older patients with heart failure: A preliminary analysis of a multicenter cohort study, SURUGA-CARE

Abstract

Background Limitation of instrumental activity of daily living (IADL) is independently associated with an adverse prognosis in older heart failure (HF) patients. Aims This multicenter study aims to examine the relationship between average daily rehabilitation time (ADRT) and risk of IADL decline during acute hospitalization in older patients with HF. Methods Four hundred eleven older patients who were hospitalized due to acute HF and underwent rehabilitation were divided into three groups based on the tertile of the ADRT: short, intermediate, and long groups. IADL was assessed by the National Center for Geriatrics and Gerontology Activities of Daily Living (NCGG-ADL) scale. Change in NCGG-ADL (Δ NCGG-ADL) was calculated by subtracting the pre-hospitalization score from the at-discharge score and IADL decline was defined as Δ NCGG-ADL < = −1 point. Logistic regression analysis was carried out examining the association between ADRT and occurrence of IADL decline. Results The ADRT was 23.9, 32.0, and 38.6 minutes in short, intermediate, and long group, respectively. The proportion of patients with IADL decline during hospitalization was 21% among all subjects and short group had the highest proportion of IADL decline (33%) and long group had the lowest proportion (14%). The long group had significantly lower odds of IADL decline compared with the short group (OR:0.475, 95% CI:0.231–0.975, P = 0.042). Among the items of NCGG-ADL scale, significant decreases in the “go out by oneself”, “travel using a bus or train”, “shop for necessities”, “vacuum”, and “manage medication” were observed at discharge compared to pre-hospitalization in the short group (p<0.01, p<0.01, p<0.01, p<0.05, and p<0.05). Conclusions The present study demonstrated that short of ADRT may be associated with the risk of IADL decline during hospitalization in older patients with HF.

Clinical impact of non-lying time on hospital-associated functional decline in older patients undergoing transcatheter aortic valve implantation

“…The result of multivariable analysis indicated that non-lying time was selected as independent related factor of the HAFD after adjustment for propensity score. Although an association between HAFD and in-hospital physical activity including step count [ 7 ] and rehabilitation time [ 8 ] has previously been reported in heart failure patients, the association with non-lying time has not been addressed. A possible explanation for this finding may be that sitting/standing posture reduced the risk of muscle weakness including iatrogenic sarcopenia, a major hospital-acquired comorbidity caused by excessive bed rest in an acute phase clinical setting.…”

“…Several previous studies demonstrated that lower physical activity, especially daily step counts, and shorter rehabilitation time is possible risk factor for HAFD [ 7 , 8 ]. The link between the amount of physical activity and HAFD implies that early mobilization and enhancing physical activity during hospitalization may be effective in preventing HAFD.…”

Differences in Prognostic Factors among Patients Hospitalized for Heart Failure According to the Age Category: From the KUNIUMI Registry Acute Cohort

“…Undoubtedly, the management of frailty is essential for elderly patients with HF. As recent research has shown that appropriate rehabilitation implementation can prevent a decline in activities of daily living in elderly patients with HF (35), early and active rehabilitation may help prevent physical frailty, which is a risk factor for poor outcomes in elderly patients with HF.…”

Relationship Between the Frequency and Duration of Physical Therapy and Hospitalization-associated Disability Among Geriatric Patients with Heart Failure

“…We retrieved the average frequency and duration of PT per week from the medical records and compared them to those reported by previous studies of patients with HF, Kato et al reported that the median length of hospital stay was 21 days, and the median number of rehabilitation days was 9 for the intermediate group 16) . Takahashi et al reported that the median duration of rehabilitation was 7 days, and the median total unit of rehabilitation was 15 (where 1 unit = 20 minutes) 18) .…”

“…Therefore, it is necessary to determine the different effects of frequency and duration of PT on ADLs in patients with HF. A study investigating these associations in hospitalized geriatric patients with acute HF suggested that shorter average daily rehabilitation times may increase the risk of a decline in instrumental ADLs during hospitalization 16) . Nevertheless, no studies have investigated the relationship between the frequency and duration of PT and basic ADLs, which are widely used as a definition of HAD.…”