Association between a pre-admission limitation in walking ability and post-discharge adverse outcomes among hospitalized patients with heart failure: Report from a multicenter prospective cohort study
Association between a pre-admission limitation in walking ability and post-discharge adverse outcomes among hospitalized patients with heart failure: Report from a multicenter prospective cohort study
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住院心力衰竭患者入院前步行能力受限与出院后不良结局之间的关联：来自多中心前瞻性队列研究的报告
DOI：
10.1016/j.ijcard.2021.05.020
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发表时间：
2021
影响因子：
3.5
通讯作者：
Sumio Yamada
中科院分区：
文献类型：
--
作者：
Kuniyasu Kamiya;Takuji Adachi;Kotaro Iwatsu;Kenta Kamisaka;Yuki Iida;Naoki Iritani;Sumio Yamada
背景：虽然出院时步行能力受限是老年心力衰竭(HF)患者不良结局的已知危险因素，但入院前受限与不良结局之间的关联尚不清楚。因此，我们评估了入院前步行能力受限的发生率及其与出院后预后的关系。方法：在日本的一项多中心队列研究中，我们跟踪了2 042名年龄65岁的≥患者。行走能力的限制被定义为需要任何辅助或行走辅助。不良结果定义为出院后2年内心力衰竭再住院和全死因死亡的综合结果。结果：在2978.0人年的随访中，563例患者因心力衰竭加重而再住院，103例患者死亡。在HFrEF、HFmrEF和HFpEF组中，入院前步行能力受限的患病率分别为12.1%、18.6%和21.1%，入院前步行能力受限的粗略危险比[95%可信区间]为2.46[1.79~3.39]，1.34[0.87~2.06]和1.94[1.53~2.47]，调整后的危险比为2.21[1.58~3.16]，1.19[0.75~1.89]，结论：入院前步行能力受限是HFrEF和HFpEF患者出院后再住院或全因死亡的预测因素，但在HFmrEF患者中不是。入院后不久，应获得有关入院前功能限制的信息，以更好地了解出院后不良结局的风险。
Background:Although limited walking ability at discharge is a known risk factor for adverse outcomes in older patients with heart failure (HF), the association between pre-admission limitations and adverse outcomes is unknown. Therefore, we evaluated the prevalence of a pre-admission limitation in walking ability and its relationship with post-discharge outcomes among patients with HF with reduced, mid-range, and preserved left-ventricular ejection fraction (HFrEF, HFmrEF, and HFpEF).Methods:We followed 2042 patients aged ≥65 years (HFrEF,n= 668; HFmrEF,n= 360; HFpEF,n= 1014) from a multicenter cohort study in Japan. A limitation in walking ability was defined as the necessity of any assistance or a walking aid. Adverse outcomes were defined as the composite of HF rehospitalization and all-cause death within 2 years after discharge.Results:During 2978.0 person-years of follow-up, 563 patients were rehospitalized due to HF exacerbation and 103 patients died. In HFrEF, HFmrEF, and HFpEF groups, the prevalence of a pre-admission limitation in walking ability was 12.1%, 18.6%, and 21.1%, respectively, the crude hazard ratios [95% confidence interval] of a pre-admission limitation in walking ability were 2.46 [1.79–3.39], 1.34 [0.87–2.06], and 1.94 [1.53–2.47], and the adjusted hazard ratios were 2.21 [1.58–3.16], 1.19 [0.75–1.89], and 1.39 [1.06–1.82], respectively.Conclusions: A pre-admission limitation in walking ability is a predictor of post-discharge HF rehospitalization or all-cause death among patients with HFrEF and HFpEF, but not among patients with HFmrEF. Shortly after admission, information regarding pre-admission functional limitations should be obtained to better understand the risk of post-discharge adverse outcomes.