Introduction:
Older patients with acute decompensated heart failure (ADHF) have impaired physical function (PF) and reduced quality of life (QOL). However, the relationship between impairments in PF and QOL are unknown but relevant to clinical practice and design of targeted intervention trials in this high-risk population.
Methods:
We assessed 202 consecutive patients hospitalized with ADHF in the multicenter Rehabilitation Therapy in Older Acute HF Patients (REHAB-HF) Trial. Standard measures of PF included the Short Physical Performance Battery (SPPB), a validated PF outcome measure in frail elderly, and 6-minute Walking Distance (6MWD). QOL was assessed by Kansas City Cardiomyopathy Questionnaire (KCCQ). Pearson’s correlation statistics examined associations between PF and QOL. Stepwise regressions were performed to identify independent predictors of QOL including PF measures, demographics, and disease severity indicators (NYHA class, previous hospitalizations, duration of current hospitalization, and number of HF signs and symptoms).
Results:
Participants were 72±7.5 years, BMI 33.2±8.8 kg/m
2
, 54% women, 52% non-white, 52% with reduced ejection fraction, and 44% with previous hospitalizations within 6 months. Participants had marked deficits in PF (SPPB 6.0±2.5 units, 6MWD 185±99 meters) and low QOL (KCCQ Physical Limitation Score (PLS) 47.3±23.8). There were modest but highly significant correlations of QOL measures with SPPB, 6MWD, and number of HF symptoms and signs (Table). Using stepwise regressions, 6MWD and BMI were modest, significant independent predictors of QOL (partial r=0.18, p=0.012 and partial r=-0.27, p=0.0003, respectively), while SPPB, demographics, and HF severity indicators were not.
Conclusion:
In older, hospitalized ADHF patients, PF and QOL are both severely impaired, but are only modestly related. PF and QOL assess unique domains of impairment and provide complementary information for characterizing clinically meaningful patient-oriented outcomes in ADHF.
State-of-the-art Structural Interventions in Heart Failure
