Background:
A hallmark of clinically manifest heart failure (HF) is reduced levels of exercise tolerance and physical function. It is unclear, however, whether an association exists between poor physical function and future development of HF, particularly at older ages.
Methods:
Women (n=5327; mean±SD age = 79±7) with no history of HF completed the Short Physical Performance Battery (SPPB) to measure physical function. The SPPB consists of three timed tasks that assess standing balance (with 3 progressively difficult balance tests), strength (with 5 unassisted chair stands), and gait (with a 4m usual-pace walk), and is scored 0 (worst) to 12 (best). Four previously-defined categories were used: very low (SPPB 0-3; n=237); low (4-6; n=900), moderate (7-9; n=2139), and high (10-12; n=1767; referent group). Women were followed for up to 8 years for incident physician-adjudicated HF hospitalization. Cox proportional hazards regression models were adjusted for age, race-ethnicity, education, smoking, alcohol, diabetes, hypertension, COPD, osteoarthritis, depression, BMI, and accelerometer-measured moderate to vigorous physical activity (MVPA) and sedentary time.
Results:
The number of HF cases (crude rate/1000 person-years) across the above SPPB categories (very low to high) were 41 (33.5), 78 (15.5), 96 (7.8), and 41 (4.0). Covariate-adjusted HRs (95% CIs) were 3.39 (2.05-5.84), 2.20 (1.47-3.31), 1.74 (1.20-2.51) and 1.00 (ref), trend P<.001. After additional adjustment for MVPA and sedentary time, the fully-adjusted HRs (95% CIs) were 2.85 (1.71-4.75), 1.94 (1.29-2.93), 1.61 (1.10, 2.32) and 1.00 (ref), trend P<.001. When modeled continuously (per 3-unit decrement in SPPB score), fully-adjusted associations were consistent over stratum of age (<80: HR=1.72; ≥80: HR=1.56; interaction P=.05), race-ethnicity (white: HR=1.59; black: HR=1.59; Hispanic: HR=1.18; P=.57), and accelerometer-measured total physical activity (<5.6 hr/d: HR=1.54; ≥5.6 hr/d: HR=1.51; P=.81).
Conclusions:
A significant inverse association between SPPB score and HF incidence was observed in ambulatory older women, independent of age, physical activity levels, and other HF predictors. Physical function is a modifiable factor that may be important for HF prevention in later life.
A propensity-matched study of the association of physical function and outcomes in geriatric heart failure
