Worsening Physical Function during Hospitalization is Associated with Poor Outcome in Patients with Acute Decompensated Heart Failure

Sakuragi Satoru, Kodera Nobuhisa, Iida Toshihiro, Yamada Takashi, Nakashima Mitsutaka, Moriwaki Atsushi, Koide Yuji, Wada Tadashi, Kawamoto Kenji, Tanaka Machiko, Katayama Yusuke
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Abstract

Recent reports have indicated a marked impairment of physical function in patients with acute cardiac disease. In addition, further deterioration in physical activity has been found during hospitalization especially in elderly patients, which may be associated with poor outcome after discharge. In this study, we repeatedly measured gait speed (GS) during hospitalization and evaluated the association of change in GS with mortality after discharge. Methods: From January 2015 to October 2017, we enrolled 445 consecutive patients admitted to our hospital with congestive heart failure and undergoing exercise training during hospitalization. Physical examinations, including a 10 m walking test for measuring gait speed, were performed at the beginning of training (1st time point) and before discharge (2nd time point). Clinical parameters and clinical outcome after discharge during the follow-up period were compared between these groups. Results: Eighty-two participants (18%) showed a decline in GS even after training. In the linear regression analysis, age, poor activities of daily living (ADL) before admission, hand grip strength, controlling nutritional status (CONUT) score, tricuspid annular plane systolic excursion (TAPSE), change in hand grip strength and change in CONUT score were associated with the change in GS. Kaplan-Meier analysis showed the cumulative risk between groups in allcause admission (log-rank test, p = 0.015) and all-cause death (log-rank test, p = 0.035). Conclusion: Worsening gait speed during hospitalization was associated with poor outcome in patients with acute decompensated heart failure.
急性失代偿性心力衰竭患者住院期间身体功能恶化与预后不良相关
最近的报告表明,急性心脏病患者的身体功能明显受损。此外,住院期间发现身体活动进一步恶化,尤其是老年患者,这可能与出院后的不良结果有关。在这项研究中,我们在住院期间反复测量步态速度(GS),并评估GS的变化与出院后死亡率的关系。方法:从2015年1月到2017年10月,我们连续招募了445名因充血性心力衰竭入院并在住院期间接受运动训练的患者。在训练开始时(第一个时间点)和出院前(第二个时间点,)进行身体检查,包括测量步态速度的10米步行测试。比较两组患者出院后随访期间的临床参数和临床结果。结果:82名参与者(18%)即使在训练后也表现出GS下降。在线性回归分析中,年龄、入院前日常生活能力差(ADL)、握力、控制营养状态(CONUT)评分、三尖瓣环平面收缩偏移(TAPSE)、握持力变化和CONUT评分变化与GS变化相关。Kaplan-Meier分析显示了组间全因入院(log-rank检验,p=0.015)和全因死亡(log-rak检验,p=0.035)的累积风险。结论:急性失代偿性心力衰竭患者住院期间步态速度减慢与预后不佳有关。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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