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Takahashi T, Iwata K, Morisawa T, Kato M, Kono Y, Taya M, Iida Y, Funami Y, Kamiya K, Sakurada K, Saitoh M. Incidence of Hospitalization-Associated Disability in Older Patients With Heart Failure. Circ J 2024; 88:672-679. [PMID: 38220172 DOI: 10.1253/circj.cj-23-0722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2024]
Abstract
BACKGROUND This study determined the incidence of hospitalization-associated disability (HAD) and its characteristics in older patients with heart failure in Japan. METHODS AND RESULTS Ninety-six institutions participated in this nationwide multicenter registry study (J-Proof HF). From December 2020 to March 2022, consecutive heart failure patients aged ≥65 years who were prescribed physical rehabilitation during hospitalization were enrolled. Of the 9,403 patients enrolled (median age 83.0 years, 50.9% male), 3,488 (37.1%) had HAD. Compared with the non-HAD group, the HAD group was older and had higher rates of hypertension, chronic kidney disease, and cerebrovascular disease comorbidity. The HAD group also had a significantly lower Barthel Index score and a significantly higher Kihon checklist score before admission. Of the 9,403 patients, 2,158 (23.0%) had a preadmission Barthel Index score of <85 points. Binomial logistic analysis revealed that age and preadmission Kihon checklist score were associated with HAD in patients with a preadmission Barthel Index score of ≥85, compared with New York Heart Association functional classification and preadmission cognitive decline in those with a Barthel Index score <85. CONCLUSIONS This nationwide registry survey found that 37.1% of older patients with HF had HAD and that these patients are indicated for convalescent rehabilitation. Further widespread implementation of rehabilitation for older patients with heart failure is expected in Japan.
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Affiliation(s)
- Tetsuya Takahashi
- Committee of the J-Proof HF Registry, Japanese Society of Cardiovascular Physical Therapy
| | - Kentaro Iwata
- Committee of the J-Proof HF Registry, Japanese Society of Cardiovascular Physical Therapy
| | - Tomoyuki Morisawa
- Committee of the J-Proof HF Registry, Japanese Society of Cardiovascular Physical Therapy
| | - Michitaka Kato
- Committee of the J-Proof HF Registry, Japanese Society of Cardiovascular Physical Therapy
| | - Yuji Kono
- Committee of the J-Proof HF Registry, Japanese Society of Cardiovascular Physical Therapy
| | - Masanobu Taya
- Committee of the J-Proof HF Registry, Japanese Society of Cardiovascular Physical Therapy
| | - Yuki Iida
- Committee of the J-Proof HF Registry, Japanese Society of Cardiovascular Physical Therapy
| | - Yoshinari Funami
- Committee of the J-Proof HF Registry, Japanese Society of Cardiovascular Physical Therapy
| | - Kentaro Kamiya
- Committee of the J-Proof HF Registry, Japanese Society of Cardiovascular Physical Therapy
| | - Koji Sakurada
- Committee of the J-Proof HF Registry, Japanese Society of Cardiovascular Physical Therapy
| | - Masakazu Saitoh
- Committee of the J-Proof HF Registry, Japanese Society of Cardiovascular Physical Therapy
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Kono Y, Mukaino M, Ozawa Y, Mizutani K, Senju Y, Ogasawara T, Yamaguchi M, Muramatsu T, Izawa H, Otaka Y. Clinical impact of non-lying time on hospital-associated functional decline in older patients undergoing transcatheter aortic valve implantation. Heart Vessels 2024; 39:266-272. [PMID: 37843551 PMCID: PMC10858148 DOI: 10.1007/s00380-023-02326-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 09/28/2023] [Indexed: 10/17/2023]
Abstract
The purposes of the present study were: (1) to investigate the relationship between hospital-associated functional decline (HAFD) and non-lying time and (2) to clarify the optimal cut-off value for non-lying time associated with HAFD in older patients undergoing transcatheter aortic valve implantation (TAVI). From January 2021 to December 2022, patients admitted to a university hospital who underwent trans-femoral TAVI were consecutively recruited. We measured short physical performance battery (SPPB) pre and post-TAVI, and non-lying time from post-operative days 3-5. HAFD was defined as at least 1 point decrease in SPPB during pre and post-TAVI. Among 75 patients (47 female, mean age of 84.5 years) enrolled, 14 patients were classified as having HAFD. Non-lying time was significantly shorter in the HAFD group than in the non-HAFD group (371 min vs. 539 min, P < 0.001). Receiver-operating characteristic analysis determined an optimal cut-off value of 477 min for differentiating the patients more likely to experience HAFD (sensitivity, 75%; specificity, 92%; area under the curve, 0.798). The non-lying time could be one of the associated factors of HAFD in older patients with TAVI. Non-lying time of about 480 min (8 h) during hospitalization may be an initial target for preventing HAFD.
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Affiliation(s)
- Yuji Kono
- Department of Rehabilitation, Fujita Health University Hospital, Toyoake, Japan
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-Cho, Toyoake, Aichi, 470-1192, Japan
| | - Masahiko Mukaino
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-Cho, Toyoake, Aichi, 470-1192, Japan
| | - Yushi Ozawa
- Department of Rehabilitation, Fujita Health University Hospital, Toyoake, Japan
| | - Koji Mizutani
- Department of Rehabilitation, Fujita Health University Hospital, Toyoake, Japan
| | - Yuki Senju
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-Cho, Toyoake, Aichi, 470-1192, Japan
| | - Takayuki Ogasawara
- NTT Basic Research Laboratories and Bio-Medical Informatics Research Center, NTT Corporation, Atsugi, Japan
| | - Masumi Yamaguchi
- NTT Basic Research Laboratories and Bio-Medical Informatics Research Center, NTT Corporation, Atsugi, Japan
| | - Takashi Muramatsu
- Department of Cardiology, School of Medicine, Fujita Health University, Toyoake, Japan
| | - Hideo Izawa
- Department of Cardiology, School of Medicine, Fujita Health University, Toyoake, Japan
| | - Yohei Otaka
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-Cho, Toyoake, Aichi, 470-1192, Japan.
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Martinez M, Cerasale M, Baig M, Johnson JK, Dugan C, Brown A, Robinson M, Schram A, Greysen SR, Meltzer D, Baccile R, Arora VM. Reducing Physical Therapy Consults for Patients With High Functional Mobility in the Acute Medical Inpatient Setting: A Difference-in-Difference Analysis. Arch Phys Med Rehabil 2024; 105:125-130. [PMID: 37669704 PMCID: PMC10840724 DOI: 10.1016/j.apmr.2023.08.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 08/17/2023] [Accepted: 08/18/2023] [Indexed: 09/07/2023]
Abstract
OBJECTIVE To evaluate the effectiveness of clinical decision support for reducing misallocation of physical therapy (PT) consults. DESIGN A prospective quasi-experimental study. Between October 2018 and November 2021, routinely documented data on functional status and physical therapy referrals were collected from electronic medical records. SETTING Hospital Medicine and General Internal Medicine service lines at a large quaternary academic medical center. PARTICIPANTS 20,810 adult patients hospitalized on any of the included treatment (hospital medicine) or control (general internal medicine) service lines. MAIN OUTCOME MEASURE The primary outcome was "change in proportion of misallocated PT consults" measured as likelihood of PT consults for patients admitted with high functional mobility scores. Changes in the primary outcome from the pre-intervention to post-intervention period were compared in the control and treatment groups using propensity score-weighted difference-in-differences multivariable logit regression adjusting for clinically relevant covariates. INTERVENTION The intervention period was measured for 20 months and consisted of a clinical decision support tool embedded in the daily note templates for hospital medicine providers. The tool provided education on patient mobility scores and their relation to need for PT consult. The tool was rolled out without any further announcements or education. RESULTS Our cohort included 20,810 unique admissions (mean age 58.9, 55% women, 83% Black). Post-intervention, the likelihood of PT referrals for patients with high baseline mobility (AM-PAC >18) decreased by 7.3% (P<.001) for the treatment group compared with control, adjusted for age, sex, race, ethnicity, length-of-stay, and mobility change. CONCLUSION Mobility score-based clinical decision support can decrease unneeded PT consults in the inpatient setting. This could help allocate therapy time for at-risk patients while also having a positive effect on health care systems.
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Affiliation(s)
- Maylyn Martinez
- Section of Hospital Medicine, Department of Medicine, University of Chicago, Chicago, IL.
| | - Matthew Cerasale
- Section of Hospital Medicine, Department of Medicine, University of Chicago, Chicago, IL
| | | | - Joshua K Johnson
- Department of Physical Medicine and Rehabilitation, Cleveland Clinic, Cleveland, OH
| | - Claire Dugan
- Section of General Internal Medicine, Department of Medicine, University of Chicago, IL
| | | | - Marla Robinson
- Inpatient Therapy Services Department, University of Chicago, Chicago, IL
| | - Andrew Schram
- Section of Hospital Medicine, Department of Medicine, University of Chicago, Chicago, IL
| | - S Ryan Greysen
- Section of Hospital Medicine, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - David Meltzer
- Section of Hospital Medicine, Department of Medicine, University of Chicago, Chicago, IL
| | - Rachel Baccile
- Center for Health and Social Sciences, University of Chicago, Chicago, IL
| | - Vineet M Arora
- Department of Physical Medicine and Rehabilitation, Cleveland Clinic, Cleveland, OH
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de Moura TG, da Rocha IF, Guedes LS, Alves AT, Garcia PA. Is prehospital physical performance a predictor of functional capacity decline at discharge in hospitalized Brazilian older adults? Braz J Phys Ther 2024; 28:100576. [PMID: 38217948 PMCID: PMC10825594 DOI: 10.1016/j.bjpt.2023.100576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 11/17/2023] [Accepted: 11/28/2023] [Indexed: 01/15/2024] Open
Abstract
BACKGROUND Hospitalization contributes to functional decline in older adults. OBJECTIVE To assess the relationship between physical performance on admission and functional capacity and functional capacity decline at discharge, and to investigate tools capable of predicting this decline. METHODS Prospective longitudinal study with 75 older adults admitted to a public hospital between July 2021 and February 2022. The independent variable was physical performance evaluated on admission by handgrip strength (HGS) and the Short Physical Performance Battery (SPPB). The dependent variables were functional capacity for basic activities of daily living (BADLs) and instrumental activities of daily living (IADLs) and their decline between admission and discharge. Statistical analyses were performed using linear and logistic regression and ROC curves. RESULTS The median time between admission and participant assessment was 1 day (IQR=1-2 days). Median hospitalization time was 18 days (IQR= 7.5-30 days). Functional capacity for BADLs and IADLs declined in 39% and 79% of the participants, respectively. Performance in HGS and the SPPB at baseline, in adjusted models, explained 29.3 to 35.3% of functional capacity at discharge. One additional point in the SPPB decreased the risk of functional capacity decline for BADLs by 20.9% (OR=0.79, 95% CI: 0.68, 0.91). The AUC values for the SPPB (AUC=0.67) and HGS (AUC=0.65) were significant in identifying functional decline for BADLs, but not IADLs. CONCLUSION In Brazilian older adults, physical performance on admission was related to functional capacity and its decline at discharge. Physical performance on admission is predictive of functional decline at discharge.
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Affiliation(s)
- Tayla Gomes de Moura
- Postgraduate Program in Rehabilitation Sciences, Faculty of Ceilândia, Universidade de Brasilia, Centro Metropolitano, Brasília, DF, Brazil.
| | | | | | - Aline Teixeira Alves
- Postgraduate Program in Rehabilitation Sciences, Faculty of Ceilândia, Universidade de Brasilia, Centro Metropolitano, Brasília, DF, Brazil
| | - Patrícia Azevedo Garcia
- Postgraduate Program in Rehabilitation Sciences, Faculty of Ceilândia, Universidade de Brasilia, Centro Metropolitano, Brasília, DF, Brazil
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Kito K, Mori Y, Watanabe D, Onoda H, Fujiyama K, Toda M, Kato M. Relationship between instrumental activities of daily living decline during hospitalization and one-year mortality in elderly patients with heart failure: A multi-center prospective cohort study. Arch Gerontol Geriatr 2023; 110:104985. [PMID: 36948093 DOI: 10.1016/j.archger.2023.104985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 02/18/2023] [Accepted: 02/28/2023] [Indexed: 03/08/2023]
Abstract
BACKGROUND It remains unclear whether instrumental activities of daily living (IADL) decline during hospitalization is related to mortality rates. This study examined the relationship between IADL decline during hospitalization and the one-year mortality rate in elderly heart failure (HF) patients. METHODS Five hundred seventy-six consecutive patients who were hospitalized for acute decompensated HF and underwent rehabilitation were divided into groups based on changes in IADL during hospitalization: IADL maintained and IADL decline. IADL was assessed by the National Center for Geriatrics and Gerontology-Activities of Daily Living Scale (NCGG-ADL). IADL decline was defined as Δ NCGG-ADL ≤ -1 point. The primary outcome was one-year all-cause mortality rate after discharge. Outcomes were examined using the Kaplan-Meier method with the log-rank test and Cox proportional hazards models using the existing prognostic risk factors for HF. RESULTS Of 576 patients, 20% (n = 113) had IADL decline during hospitalization, and 9.2% (n = 35) and 6.0% (n = 18) died of all-cause and cardiovascular disease within one year after discharge, respectively. The IADL-decline group had significantly higher one-year all-cause mortality rates after adjusting for risk factors (hazard ratio: 1.923, 95% confidence interval 1.085-3.409; P = 0.023). Among the IADL subcategories, outdoor activity items such as "go out by oneself," "take a bus or train," and "shop for necessities" were more likely to change from independent to dependent during hospitalization. CONCLUSION IADL decline during hospitalization was associated with an increased all-cause mortality rate at one-year after discharge in elderly HF patients.
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Affiliation(s)
- Kazuya Kito
- Department of Rehabilitation, Shizuoka Medical Center, Shizuoka, Japan
| | - Yuji Mori
- Department of Rehabilitation, Shizuoka Medical Center, Shizuoka, Japan
| | - Daisuke Watanabe
- Department of Rehabilitation, Juntendo University Shizuoka Hospital, Shizuoka, Japan
| | - Hiroshige Onoda
- Department of Rehabilitation, Shizuoka City Shizuoka Hospital, Shizuoka, Japan
| | - Keita Fujiyama
- Department of Rehabilitation, Fujinomiya City General Hospital, Shizuoka, Japan
| | - Masahiro Toda
- Department of Rehabilitation, Hamamatsu University School of Medicine, Shizuoka, Japan
| | - Michitaka Kato
- Department of Shizuoka Physical Therapy, Faculty of Health Science, Tokoha University, Shizuoka, Japan.
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Wang PY, Lin WC, Hsieh PC, Lin SH, Liu PY, Chao TH, Hsu CH. The Effects of Post-Acute Care in Patients with Heart Failure in Taiwan: A Single Center Experience. ACTA CARDIOLOGICA SINICA 2023; 39:287-296. [PMID: 36911546 PMCID: PMC9999181 DOI: 10.6515/acs.202303_39(2).20220923b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 09/23/2022] [Indexed: 03/14/2023]
Abstract
Background The National Health Insurance Administration in Taiwan has promoted the heart failure post-acute care (HF-PAC) program as a means to provide proactive integrated care within the optimal treatment timeframe to enhance functional recovery after acute decompensated heart failure (HF). Objectives The aim of this program was to reduce HF readmission rates, improved medication prescription rates, and improve the quality of life in HF patients. Methods Patients who had a reduced left ventricular ejection fraction (LVEF) of ≤ 40% were included and followed up for 6 months after discharge. They underwent cardiac rehabilitation and physiological, and nutritional status evaluations. The main clinical outcomes of the HF-PAC program were guideline-directed medical therapy prescription rate and 6-month readmission rate. Results A total of 122 patients were recruited from June 2018 to December 2020 at a medical center in southern Taiwan. The patients' activities of daily living, nutritional status, quality of life and LVEF were significantly improved during the HF-PAC program. More than 95% of the patients received guideline-directed medical prescriptions at the end of the HF-PAC program. The cardiovascular-related 6-month re-admission rate after the HF-PAC program ended was 27.7%, and it could be predicted by the New York Health Association functional class [hazard ratio (HR) 95% confidence interval (95% CI) = 4.12 (1.36-12.46)], value of the Mini Nutritional Assessment - Short Form [HR (95% CI) = 0.46 (0.31-0.68)] and LVEF [HR (95% CI) = 0.95 (0.91-0.99)]. Conclusions By incorporating multidisciplinary healthcare teams, the HF-PAC program improves the guideline- directed medical therapy prescription rate, thus improving patients' cardiac function, physical activity recovery, the quality of life, and also reduces their readmission rate.
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Affiliation(s)
- Pei-Yi Wang
- Department of Nursing, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan.,Department of Nursing, National Taiwan University Hospital, Taipei
| | - Wen-Chih Lin
- Department of Nursing, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan.,Division of Cardiology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Pei-Chun Hsieh
- Department of Physical Medicine and Rehabilitation, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University
| | - Sheng-Hsiang Lin
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University
| | - Ping-Yen Liu
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University.,Division of Cardiology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Ting-Hsing Chao
- Division of Cardiology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chih-Hsin Hsu
- Division of Cardiology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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Sex Differences in Frequency of Instrumental Activities of Daily Living after Cardiac Rehabilitation and Its Impact on Outcomes in Patients with Heart Failure. J Cardiovasc Dev Dis 2022; 9:jcdd9090289. [PMID: 36135434 PMCID: PMC9502306 DOI: 10.3390/jcdd9090289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 08/19/2022] [Accepted: 08/29/2022] [Indexed: 11/26/2022] Open
Abstract
Although instrumental activities of daily living (IADL) are included in the outcomes of cardiac rehabilitation (CR), the relationship between IADL frequency at the end of CR and outcomes between the sexes remains unclear. We aimed to investigate the differences in frequency of IADL between the sexes and its impact on the outcomes. We retrospectively investigated 490 consecutive patients who were admitted for heart failure (HF) and participated in CR post-discharge. IADL frequency was assessed using the questionnaire-based Frenchay Activities Index (FAI). The primary endpoint was all-cause death, and the secondary endpoint was a composite of all-cause death and readmission due to HF. The cut-off values of the FAI for all-cause death in the overall cohort, females, and males were 23, 22, and 23 points, respectively. After adjusting for several factors, IADL assessed using the FAI was independently associated with all-cause mortality (hazard ratio [HR]: 0.961, 95% confidence interval [CI]: 0.937–0.986) and combined events (HR: 0.968, 95% CI: 0.952–0.985), respectively. Additionally, there was no interaction between sex and all-cause mortality. In conclusion, higher IADL frequency after CR was associated with favourable outcomes in patients with HF.
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Ogawa M, Yoshida N, Nakai M, Kanaoka K, Sumita Y, Kanejima Y, Emoto T, Saito Y, Yamamoto H, Sakai Y, Hirota Y, Ogawa W, Iwanaga Y, Miyamoto Y, Yamashita T, Izawa KP, Hirata KI. Hospital-associated disability and hospitalization costs for acute heart failure stratified by body mass index- insight from the JROAD/JROAD-DPC database. Int J Cardiol 2022; 367:38-44. [PMID: 36029847 DOI: 10.1016/j.ijcard.2022.08.044] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Revised: 08/13/2022] [Accepted: 08/22/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND The impact of body mass index (BMI) on hospital mortality in patients with acute heart failure has been well documented in Asian populations. However, the relationship between BMI, hospital-associated disability (HAD), and hospitalization costs in patients with heart failure is poorly understood. This study aimed to explore the impact of BMI on HAD and hospitalization costs for acute heart failure in Japan. METHODS From April 2012 to March 2020, the Japanese Registry of All Cardiac and Vascular Disease Diagnosis Procedure Combination (JROAD-DPC) database was used to identify patients with acute heart failure. All patients were categorized into five groups according to the World Health Organization Asian BMI criteria. The hospitalization costs and HAD were evaluated. RESULTS Among the 238,160 eligible patients, 15.7% were underweight, 42.2% were normal, 16.7% were overweight, 19.3% were obese I, and 6.0% were obese II, according to BMI. The prevalence of HAD was 7.43% in the total cohort, and the risk of HAD increased with a lower BMI. Restricted cubic spline analysis showed a U-shaped relationship between BMI and hospitalization costs for all ages. Furthermore, developing HAD was associated with greater costs compared with non-HAD, regardless of BMI category. CONCLUSIONS We found that the lower the BMI, the higher the incidence of HAD. A U-shaped association was confirmed between BMI and hospitalization costs, indicating that hospitalization costs increased for both lower and higher BMI regardless of age. BMI could be an important and informative risk stratification tool for functional outcomes and economic burdens.
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Affiliation(s)
- Masato Ogawa
- Department of Public Health, Graduate School of Health Sciences, Kobe University, Hyogo, Japan; Division of Rehabilitation Medicine, Kobe University Hospital, Hyogo, Japan
| | - Naofumi Yoshida
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Hyogo, Japan; Division of Endocrinology, Diabetes and Metabolism, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Michikazu Nakai
- Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center, Osaka, Japan; Department of Biostatistics, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Koshiro Kanaoka
- Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Yoko Sumita
- Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Yuji Kanejima
- Department of Public Health, Graduate School of Health Sciences, Kobe University, Hyogo, Japan
| | - Takuo Emoto
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Hyogo, Japan
| | - Yoshihiro Saito
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Hyogo, Japan
| | - Hiroyuki Yamamoto
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Hyogo, Japan
| | - Yoshitada Sakai
- Division of Rehabilitation Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yushi Hirota
- Division of Diabetes and Endocrinology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Hyogo, Japan
| | - Wataru Ogawa
- Division of Diabetes and Endocrinology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Hyogo, Japan
| | - Yoshitaka Iwanaga
- Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Yoshihiro Miyamoto
- Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Tomoya Yamashita
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Hyogo, Japan
| | - Kazuhiro P Izawa
- Department of Public Health, Graduate School of Health Sciences, Kobe University, Hyogo, Japan.
| | - Ken-Ichi Hirata
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Hyogo, Japan
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Kato M, Mori Y, Watanabe D, Onoda H, Fujiyama K, Toda M, Kito K. Discharge disposition and 1-year readmission in acute-phase hospitalized patients with heart failure: a retrospective observational multi-center study. Heart Vessels 2022; 37:1551-1561. [PMID: 35391584 DOI: 10.1007/s00380-022-02059-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 03/11/2022] [Indexed: 11/24/2022]
Abstract
Patients hospitalized for acute heart failure (HF) tend to experience declines in physical function and activities of daily living (ADL) due to bed rest and restricted mobilization. This could result in some patients being transferred to rehabilitation hospitals. This study aims to examine the relationship between discharge disposition and 1-year readmission and mortality rates in HF patients. Nine hundred fifty six consecutive HF patients who were hospitalized for acute decompensated HF and underwent rehabilitation were divided into two groups: home (returned home) or transfer (transferred to rehabilitative or long-term care hospital units due to decline in physical function and/or ADL) groups. The primary and secondary outcomes were 1-year readmission and mortality rates after discharge, respectively. Of the 956 patients, 8.6% (n = 82) were transferred to rehabilitative or long-term care hospital units. Over a 1-year follow-up period, all-cause and HF readmission rates were 50.1% (n = 479) and 27.2% (n = 260), respectively. The transfer group had significantly lower readmission rates compared to home group after adjusting for the pre-existing risk factors (hazard ratio for all-cause and HF readmission: 0.600 and 0.552, 95% CI 0.401-0.897 and 0.314-0.969; P = 0.013 and P = 0.038, respectively). There was no significant relationship between discharge disposition and all-cause mortality rate. Low ADL defined as Barthel index < 60 points was identified as a predictor of all-cause and HF readmission among the home group (odds ratio for all-cause and HF readmission rates: 2.156 and 1.847, 95% CI 1.026-4.531 and 1.036-2.931; P = 0.043 and P = 0.037, respectively). This multi-center study demonstrated that HF patients transferred to rehabilitative or long-term care hospital units after an acute hospitalization had a significantly decreased 1-year all-cause and HF readmission rates compared to patients who returned to their home. These findings may help in selecting a discharge disposition for older HF patients with ADL decline.
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Affiliation(s)
- Michitaka Kato
- Department of Shizuoka Physical Therapy, Faculty of Health Science, Tokoha University, 1-30 Mizuochi-cho, Aoi-ku, Shizuoka, Shizuoka, 420-0831, Japan.
| | - Yuji Mori
- Department of Rehabilitation, Shizuoka Medical Center, Shizuoka, Japan
| | - Daisuke Watanabe
- Department of Rehabilitation, Juntendo University Shizuoka Hospital, Shizuoka, Japan
| | - Hiroshige Onoda
- Department of Rehabilitation, Shizuoka City Hospital, Shizuoka, Japan
| | - Keita Fujiyama
- Department of Rehabilitation, Fujinomiya City General Hospital, Shizuoka, Japan
| | - Masahiro Toda
- Department of Rehabilitation, Hamamatsu University Hospital, Shizuoka, Japan
| | - Kazuya Kito
- Department of Rehabilitation, Shizuoka Medical Center, Shizuoka, Japan
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10
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Yingtong M, Wei Z, Hanjun H, Tingting Z, Xiaohua G. The effects of early exercise on cardiac rehabilitation-related outcome in acute heart failure patients: a systematic review and meta-analysis. Int J Nurs Stud 2022; 130:104237. [DOI: 10.1016/j.ijnurstu.2022.104237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 03/17/2022] [Accepted: 03/19/2022] [Indexed: 10/18/2022]
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Hamana T, Fujimoto W, Konishi A, Takemoto M, Kuroda K, Yamashita S, Imanishi J, Iwasaki M, Todoroki T, Okuda M, Hayashi T, Otake H, Tanaka H, Shinohara M, Toh R, Hirata KI. Differences in Prognostic Factors among Patients Hospitalized for Heart Failure According to the Age Category: From the KUNIUMI Registry Acute Cohort. Intern Med 2022; 61:3171-3180. [PMID: 36328584 PMCID: PMC9683819 DOI: 10.2169/internalmedicine.9023-21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Objective Previous studies have described several prognostic factors for heart failure (HF); however, these results were derived from registries consisting of conventional age groups, which might not represent the increasingly aging society. The present study explored the prognostic factors for all-cause death in hospitalized patients with HF across different age categories using an acute HF registry that included relatively old patients. Methods From a total of 1,971 consecutive patients with HF, 1,136 patients were enrolled. We divided the patients into 4 groups (≤65, 66-75, 76-85, and >85 years old) to evaluate all-cause death and prognostic factors of all-cause death. Results During the mean follow-up period of 1,038 days, 445 patients (39.2%) had all-cause death. A Kaplan-Meier analysis demonstrated significantly higher incidence of all-cause death in the elderly groups than in the younger groups (log-rank p<0.001). A Cox proportional-hazard regression analysis revealed that the presence of atrial fibrillation [hazard ratio (HR): 23.3, 95% confidence interval (CI): 2.36-231.1, p=0.007] was a notable predictive factor for all-cause death in the ≤65 years old group, whereas the Clinical Frailty Scale score (HR: 1.33, 95% CI: 1.16-1.52, p<0.001) and hypoalbuminemia (HR: 0.49, 95% CI: 0.31-0.78, p=0.003) were predictors in the >85 years old group. Conclusions Atrial fibrillation was a notable predictor of HF in young patients, whereas frailty and low-grade albuminemia were essential predictive factors of HF in elderly patients. With the increasing number of elderly patients with HF, comprehensive multidisciplinary treatment will be necessary.
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Affiliation(s)
- Tomoyo Hamana
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Japan
| | - Wataru Fujimoto
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Japan
- Department of Cardiology, Hyogo Prefectural Awaji Medical Center, Japan
| | - Akihide Konishi
- Clinical and Translational Research Center, Kobe University Hospital, Japan
| | - Makoto Takemoto
- Department of Cardiology, Hyogo Prefectural Awaji Medical Center, Japan
| | - Koji Kuroda
- Department of Cardiology, Hyogo Prefectural Awaji Medical Center, Japan
| | | | - Junichi Imanishi
- Department of Cardiology, Hyogo Prefectural Awaji Medical Center, Japan
| | - Masamichi Iwasaki
- Department of Cardiology, Hyogo Prefectural Awaji Medical Center, Japan
| | - Takashi Todoroki
- Department of Cardiology, Hyogo Prefectural Awaji Medical Center, Japan
| | - Masanori Okuda
- Department of Cardiology, Hyogo Prefectural Awaji Medical Center, Japan
| | - Takatoshi Hayashi
- Department of Cardiology, Hyogo Prefectural Awaji Medical Center, Japan
| | - Hiromasa Otake
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Japan
| | - Hidekazu Tanaka
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Japan
| | - Masakazu Shinohara
- Division of Epidemiology, Kobe University Graduate School of Medicine, Japan
| | - Ryuji Toh
- Division of Evidence-based Laboratory Medicine, Kobe University Graduate School of Medicine, Japan
| | - Ken-Ichi Hirata
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Japan
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