Exercise Capacity Characterization and Physical Activity Intensification Should Be Priorities in Heart Failure Patients

Hypothesis: insufficiently active heart failure patients will report poorer QoL, more fatigue and depressive mood compared to active patients. Aims: To characterize clinical characteristics and health-related behaviors according to physical activity (PA). Also, to explore predicting factors of quality of life (QoL). Methods: Cross-sectional analysis of a cohort of Stage B HF patients. PA classification was set as active, moderately active or insufficiently active, according to the LTEQ questionnaire. For QoL, the SF-36 questionnaire was used. ANOVAS, Chi-Square tests or likelihood ratios and unadjusted multiple regression models were calculated. Significance was set at p ≤ 0.05. Results: In this cohort, 277 HF patients completed the PA questionnaire. The prevalence of active patients was higher than moderately active and insufficiently active (53.3% vs 15.2% and 29.6%), respectively. Younger age (p = 0.044), lower waist circumference (WC) (p = 0.002), and lower waist-to-hip ratio (p = 0.046) were associated with being active. The prevalence of Type II diabetes mellitus (T2DM) in the active groups was significantly lower (p = 0.001). Physically active groups had cases of mild LV enlargement (1.4% and 7.5%, respectively), while no cases were observed among insufficiently active patients (p = 0.017). PA was positively associated with less fatigue (p= 0.002), more vigor (p = 0.001), more self-efficacy (p < 0.001), and better quality of life (p = 0.002). Patients who were less physically active had more inflammation (CRP, p = 0.015; IL-6, p <0.001; TNF-α: p = 0.033, and IL-1ra, p = 0.001). WC (β =-0.16, p = 0.008), glucose (β =-0.12, p < 0.001) and fatigue (β = - 0.39, p < 0.001) predicted general health perception (R 2 = 0.449). For physical functioning (high scores reflects performing PA without limitations due to health), WC (β = - 0.28, p = 0.001), sleep (β = - 1.50, p = 0.003) and fatigue (β = - 0.32, p = 0.018) were significant predictors (R 2 = 0.422); while age (β = 0.36, p <0.001) physical activity (β = 0.051, p = 0.055), sleep (β = 0.50, p =0.046), fatigue (β = -0.37, p <0.001) and depression (β = -1.12, p <0.001) predicted emotional well-being (R 2 = 0.696). Conclusion: Physically active heart failure patients had a better anthropometric profile and lower prevalence of T2DM. In this cohort, PA was not a significant predictor for general and physical functioning, but it remained relevant for predicting emotional well-being.

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P2610Increase in comfortable walking speed during hospitalization predicts the readmission due to decompensated heart failure in heart failure patients with preserved ejection fraction

European Heart Journal ◽

10.1093/eurheartj/ehz748.0934 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

M Tabata ◽

M Kato ◽

N Hamazaki ◽

T Masuda

Keyword(s):

Heart Failure ◽

Logistic Regression ◽

Ejection Fraction ◽

Exercise Capacity ◽

Walking Speed ◽

Decompensated Heart Failure ◽

Preserved Ejection Fraction ◽

Functional Classification ◽

Multivariate Logistic Regression ◽

Heart Failure Patients

Abstract Background Heart failure patients with preserved ejection fraction (HFpEF) have reduced exercise capacity and poor prognosis as well as those with reduced ejection fraction (HFrEF). Both cardiac function and exercise capacity have been known as prognostic factors for patients with HFrEF. However, few reports documented the relations of comfortable walking speed (CWS) during hospitalization to exercise capacity and prognosis. is used as a clinical measure to assess their exercise capacity and prognosis. However, few reports documented the correlations of CWS with exercise capacity and prognosis in patients with HFpEF. Purpose This study aimed to investigate whether CWS at hospital discharge and the increase in CWS during hospitalization predicted the readmission due to decompensated heart failure in patients with HFpEF and HFrEF. Methods Patients who were hospitalized due to heart failure with New York Heart Association (NYHA) Functional Classification III or IV were prospectively followed up for 3 years after hospital discharge. Consequently, 264 patients, 173 males and 92 females, aged 73.2±6.8 years were studied. Patients were divided into 3 groups based on their ejection fraction (EF): HFpEF group (EF≥50%; n=98), HFrEF group (EF<40%; n=138) and heart failure with mid-range ejection fraction (HFmrEF) group (40%≤EF≤49%; n=28). We assessed clinical characteristics including age, gender, height, NYHA functional classification, etiology of CHF, plasma brain natriuretic peptide and left ventricular ejection fraction (LVEF) on admission, and measured CWS several days after admission and at discharge. We determined significant factors affecting the readmission and their cut-off values using univariate and multivariate logistic regression analyses and the area under the receiver operating characteristics curves in the three groups. Results Forty patients (40.8%), 54 (39.1%) and 6 (21.4%) were readmitted in the HFpEF, HFrEF and HFmrEF groups, respectively, within 3 years after the discharge. Univariate logistic regression analysis detected the age, LVEF, CWS at discharge and the CWS increase during hospitalization as significant limiting factors for readmission in the HFpEF and HFrEF groups (P<0.05, respectively). The multivariate logistic regression analysis detected the CWS increase during hospitalization as significant limiting factor for readmission in the HFpEF and HFrEF groups (P<0.001 and P<0.05, respectively). The odds ratios of readmission were 1.86 (P<0.01) and 1.44 (P<0.001) with each 5-meter decrease of CWS increase during hospitalization and predictive cut-off values of the CWS increase were 7.5 and 8.5 meters/min in the HFpEF and HFrEF groups, respectively. Conclusion This study demonstrated that the CWS increase during hospitalization was a strong predictor for readmission due to decompensated heart failure in patients not only with HFrEF but also with HFpEF and each predictive the cut-off value was 7.5 and 8.5 meters/min.

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