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

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.