Clinical Investigation
Lower Extremity Performance Measures Predict Long-Term Prognosis in Older Patients Hospitalized for Heart Failure

https://doi.org/10.1016/j.cardfail.2010.01.004Get rights and content

Abstract

Background

In older heart failure (HF) patients, survival depends on the severity of their cardiac condition and on their functional status. Lower extremity performance, assessed with the Short Physical Performance Battery (SPPB), predicts survival in older persons, both in epidemiologic and clinical settings. We evaluated whether SPPB predicts long-term survival in older subjects hospitalized for HF, independent of traditional measures of HF severity.

Methods and Results

Subjects aged 65+ years were enrolled on discharge after hospitalization for decompensated HF. Participants underwent echocardiography, comprehensive geriatric assessment, and SPPB. Cox proportional hazards regression models were used to predict survival over a 30-month follow-up. Of 157 participants (mean age 80 years, range 65–101; 50% men), 61 died. After adjustment for potential confounders, including demographics, ejection fraction, New York Heart Association classification, and comorbidity, we found a graded independent association between SBBP score and mortality risk: compared with an SPPB score of 9–12, scores of 0, 1–4, and 5–8 were associated with hazard ratios (HR) and 95% confidence interval (CI) of death of 6.06 (2.19–16.76), 4.78 (1.63–14.02), and 1.95 (0.67–5.70), respectively.

Conclusions

SPPB is an independent predictor of long-term survival of older subjects hospitalized for decompensated HF.

Section snippets

Study Design and Participants

This study was conducted with a prospective cohort design in the Unit of Gerontology and Geriatric Medicine, University of Florence, and Azienda Ospedaliero-Universitaria Careggi (Florence, Italy), and in the Section of Internal Medicine and Geriatrics, University of Ferrara (Italy). All patients aged 65+ years, admitted to hospital in the 2 participating academic institutions for decompensation of a preexisting HF, between July 2005 and June 2006, were considered eligible. The diagnosis of HF

Results

Of 190 patients initially screened, after exclusion of those who died in-hospital and those with incomplete data, the final study sample included 157 subjects, 119 from Florence and 38 from Ferrara. Their baseline characteristics are reported in Table 1, Table 2 in the whole sample and by study site. Overall, participants were very old (mean age of 80 years, range 65 to 101 years) and in poor health status, both from cardiologic and geriatric standpoint. In particular, more than half of the

Discussion

As this study shows, physical performance, assessed at hospital discharge with such a simple test as SPPB, is an independent predictor of long-term survival in old subjects after hospitalization for decompensated HF. Survival decreased along with SPPB score after controlling for traditional cardiologic variables (such as NYHA class, LVEF, and prescription of βB and ACEI-ARB) and independent of comorbidity.

Previous studies showed that SPPB, originally developed and tested in population-based

Acknowledgments

We wish to thank Mrs. Rossella Del Bianco for her valuable secretarial support to this study.

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    Conflict of interest: none.

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