Examination of Predictors for Discharge Disposition in Patients Aged 60 Years or Older with Acute Exacerbation of Heart Failure
Objective: To clarify the independent predictors of home discharge in patients with acute exacerbation of heart failure (HF) who underwent cardiac rehabilitation (CR).Methods: This was a single-center retrospective cohort study. In this study, 305 patients aged 60 years or older, who were admitted w...
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| Published in | Physical Therapy Japan Vol. 48; no. 1; pp. 79 - 86 |
|---|---|
| Main Authors | , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
Japanese Society of Physical Therapy
2021
日本理学療法士学会 |
| Subjects | |
| Online Access | Get full text |
| ISSN | 0289-3770 2189-602X |
| DOI | 10.15063/rigaku.11902 |
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| Abstract | Objective: To clarify the independent predictors of home discharge in patients with acute exacerbation of heart failure (HF) who underwent cardiac rehabilitation (CR).Methods: This was a single-center retrospective cohort study. In this study, 305 patients aged 60 years or older, who were admitted with acute exacerbation of HF, were included in the analysis. The patients were divided into a Home group and Non-Home group based on discharge disposition. Basic characteristics, HF severity, knee extension strength (KES), Short Physical Performance Battery (SPPB) and Barthel Index (BI) at the commencement of rehabilitation and at hospital discharge were compared between groups. Additionally, multivariate logistic regression analysis and a receiver operating characteristic curve were used to evaluate independent predictors of home discharge and cut-off value.Results: At the commencement of CR, KES, SPPB, and BI were significantly higher and age was significantly lower in the Home group. However, there were no significant differences in HF severity and nutritional status between the groups. At hospital discharge, KES, SPPB, and BI were significantly higher in the Home group. Multivariate analysis showed that predictors of home discharge and its cut-off value were KES at the commencement of CR (≥12.1 kg), SPPB at the commencement of CR (3/4 points), and BI at hospital discharge (≥80 points).Conclusion: These results may contribute to the early detection of older patients who may be difficult to discharge to home and to setting appropriate CR goals. |
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| AbstractList | Objective: To clarify the independent predictors of home discharge in patients with acute exacerbation of heart failure (HF) who underwent cardiac rehabilitation (CR).Methods: This was a single-center retrospective cohort study. In this study, 305 patients aged 60 years or older, who were admitted with acute exacerbation of HF, were included in the analysis. The patients were divided into a Home group and Non-Home group based on discharge disposition. Basic characteristics, HF severity, knee extension strength (KES), Short Physical Performance Battery (SPPB) and Barthel Index (BI) at the commencement of rehabilitation and at hospital discharge were compared between groups. Additionally, multivariate logistic regression analysis and a receiver operating characteristic curve were used to evaluate independent predictors of home discharge and cut-off value.Results: At the commencement of CR, KES, SPPB, and BI were significantly higher and age was significantly lower in the Home group. However, there were no significant differences in HF severity and nutritional status between the groups. At hospital discharge, KES, SPPB, and BI were significantly higher in the Home group. Multivariate analysis showed that predictors of home discharge and its cut-off value were KES at the commencement of CR (≥12.1 kg), SPPB at the commencement of CR (3/4 points), and BI at hospital discharge (≥80 points).Conclusion: These results may contribute to the early detection of older patients who may be difficult to discharge to home and to setting appropriate CR goals. Objective: To clarify the independent predictors of home discharge in patients with acute exacerbation of heart failure (HF) who underwent cardiac rehabilitation (CR).Methods: This was a single-center retrospective cohort study. In this study, 305 patients aged 60 years or older, who were admitted with acute exacerbation of HF, were included in the analysis. The patients were divided into a Home group and Non-Home group based on discharge disposition. Basic characteristics, HF severity, knee extension strength (KES), Short Physical Performance Battery (SPPB) and Barthel Index (BI) at the commencement of rehabilitation and at hospital discharge were compared between groups. Additionally, multivariate logistic regression analysis and a receiver operating characteristic curve were used to evaluate independent predictors of home discharge and cut-off value.Results: At the commencement of CR, KES, SPPB, and BI were significantly higher and age was significantly lower in the Home group. However, there were no significant differences in HF severity and nutritional status between the groups. At hospital discharge, KES, SPPB, and BI were significantly higher in the Home group. Multivariate analysis showed that predictors of home discharge and its cut-off value were KES at the commencement of CR (≥12.1 kg), SPPB at the commencement of CR (3/4 points), and BI at hospital discharge (≥80 points).Conclusion: These results may contribute to the early detection of older patients who may be difficult to discharge to home and to setting appropriate CR goals. 【目的】60 歳以上の高齢心不全患者における自宅退院の予測因子をリハビリテーション（以下，リハ）開始時および退院時のパラメータから明らかにする。【方法】急性期病院に心不全急性増悪で入院した患者305 例を，自宅群242 例と非自宅群63 例に分け，入院時および退院時の身体機能を比較した。また，自宅退院の予測因子およびカットオフ値を検討した。【結果】自宅群では，リハ開始時および退院時の膝伸展筋力，Short Physical Performance Battery（以下，SPPB），Barthel Index（以下，BI）は非自宅群よりも有意に高値であった。自宅退院の予測因子およびカットオフ値は，リハ開始時の膝伸展筋力（≥12.1 kg）とSPPB（3/4 点），退院時BI（≥80 点）であった。【結論】本結果は，自宅退院困難が予測される高齢心不全患者の抽出および自宅退院をめざしたゴール設定に寄与する可能性がある。 |
| Author | TAKAHASHI, Ren MATSUKAWA, Yuko YOKOTA, Junichi MATSUSHIMA, Keisuke |
| Author_FL | 松島 圭亮 TAKAHASHI Ren YOKOTA Junichi 松川 祐子 |
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| References | 15) Mahoney FI, Barthel DW: Functional Evaluation: The Barthel Index. Maryland State Med J. 1965; 14: 61–65. 17) Ignacio de Ulíbarri J, González-Madroño A, et al.: CONUT: a tool for controlling nutritional status. First validation in a hospital population. Nutr Hosp. 2005; 20: 38–45. 21) Covinsky KE, Palmer RM, et al.: Loss of independence in activities of daily living in older adults hospitalized with medical illnesses: increased vulnerability with age. J Am Geriatr Soc. 2003; 51: 451–458. 18) Massimo FP, Viviane C, et al.: Exercise training in heart failure: from theory to practice. A consensus document of the Heart Failure Association and the European Association for Cardiovascular Prevention and Rehabilitation. Eur J Heart Fail. 2011; 13: 347–357. 1) Shimokawa H, Miura M, et al.: Heart failure as a general pandemic in Asia. Eur J Heart Fail. 2015; 17: 884–892. 4) Giallauria F, Vigorito C, et al.: Cardiac rehabilitation in very old patients: data from the Italian Survey on Cardiac Rehabilitation-2008 (ISYDE-2008)-official report of the Italian Association for Cardiovascular Prevention, Rehabilitation, and Epidemiology. J Gerontol A Biol Sci Med Sci. 2010; 65: 1353–1361. 3) Sasanuma N, Takahashi K, et al.: Motor and cognitive function analysis for home discharge using the Functional Independence Measure in patients undergoing cardiac rehabilitation at a long-term acute-care hospital. Eur J Phys Rehabil Med. 2015; 51: 781–792. 22) Collin C, Wade DT, et al.: The Barthel ADL Index: a reliability study. Int Disabil Stud. 1988; 10: 61–63. 5) Tsutsui H, Isobe M, et al.: JCS 2017/JHFS 2017 Guideline on Diagnosis and Treatment of Acute and Chronic Heart Failure -Digest Version. Circ J. 2019; 83: 2084–2184. 29) Puthucheary ZA, Hart N: Skeletal muscle mass and mortality — but what about functional outcome? Crit Care. 2014; 18: 110. doi: 10.1186/cc13729. 9) Fleming LM, Zhao X, et al.: Early Ambulation Among Hospitalized Heart Failure Patients Is Associated with Reduced Length of Stay and 30-Day Readmissions. Circ Heart Fail. 2018; 11: e004634. doi: 10.1161/CIRCHEARTFAILURE.117.004634. 24) Ponikowski P, Voors AA, et al.: 2016 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure. The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure of the European Society of Cardiology (ESC) Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J. 2016; 37: 2129–2200. 7) Narumi T, Arimoto T, et al.: Prognostic importance of objective nutritional indexes in patients with chronic heart failure. J Cardiol. 2013; 62: 307–313. 11) United Nations [internet]. New York: World Population Ageing 2015 [updated 2015; cited 2020 Aug 12]. Available from: https://www.un.org/en/development/desa/population/publications/pdf/ageing/WPA2015_Report.pdf 26) Guralnik JM, Ferrucci L, et al.: Lower-extremity function in persons over the age of 70 years as a predictor of subsequent disability. N Engl J Med. 1995; 332: 556–561. 6) Konishi M, Ishida J, et al.: Heart failure epidemiology and novel treatments in Japan: facts and numbers. ESC Heart Fail. 2016; 3: 145–151. 13) Toonstra J, Mattacola CG: Test-retest reliability and validity of isometric knee-flexion and -extension measurement using 3 methods of assessing muscle strength. J Sport Rehabil. 2013; 22. doi: 10.1123/jsr.2013.TR7. 20) Glantz SA, Palmer RM, et al.: Multicollinearity and What to Do About It. In: Glantz SA, Slinker BK, (eds): Primer of Applied Regression and Analysis of Variance, 2nd ed, McGraw-Hill Education, New York, 2001, pp. 185–240. 25) Kakutani N, Fukushima A, et al.: Progressive Mobilization Program for Patients with Acute Heart Failure Reduces Hospital Stay and Improves Clinical Outcome. Circ Rep. 2019; 1: 123–130. 30) Shiba N, Nochioka K, et al.: Trend of Westernization of Etiology and Clinical Characteristics of Heart Failure Patients in Japan –First Report From the CHART-2 Study–. Circ J. 2011; 75: 823–833. 16) Folstein MF, Folstein SE, et al.: “Mini-mental state”: a practical method of grading the cognitive function of patients for the clinician. J Psychiatr Res. 1975; 12: 189–198. 10) 日本心臓リハビリテーション学会ホームページ 心不全の心臓リハビリテーション標準プログラム（2017 年版）． http://www.jacr.jp/web/wp-content/uploads/2015/04/shinfuzen2017_2.pdf（2020 年6月19日引用） 19) 日本循環器学会：心血管疾患におけるリハビリテーションに関するガイドライン（2012 年改訂版），2012．https://www.j-circ.or.jp/old/guideline/pdf/JCS2012_nohara_h.pdf （2020年6月19日引用） 12) Yancy CW, Jessup M, et al.: 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines. Circulation. 2013; 128: e240–e327. 14) Guralnik JM, Simonsick EM, et al.: A short physical performance battery assessing lower extremity function: Association with self-reported disability and prediction of mortality and nursing home admission. J Gerontol. 1994; 49: M85–M94. 8) Zuccalà G, Cattel C, et al.: Left ventricular dysfunction: a clue to cognitive impairment in older patients with heart failure. J Neurol Neurosurg Psychiatry. 1997; 63: 509–512. 28) Kinugawa S, Takada S, et al.: Skeletal muscle abnormalities in heart failure. Int Heart J. 2015; 56: 475–484. 23) Piepoli MF, Conraads V, et al.: Exercise training in heart failure: From theory to practice. A consensus document of the Heart Failure Association and the European Association for Cardiovascular Prevention and Rehabilitation. Eur J Heart Fail. 2011; 13: 347–357. 2) Sansone GR, Alba A, et al.: Analysis of FIM instrument scores for patients admitted to an inpatient cardiac rehabilitation program. Arch Phys Med Rehabil. 2002; 83: 506–512. 27) Fulster S, Tacke M, et al.: Muscle wasting in patients with chronic heart failure: Results from the studies investigating co-morbidities aggravating heart failure (SICA-HF). Eur Heart J. 2013; 34: 512–519. |
| References_xml | – reference: 5) Tsutsui H, Isobe M, et al.: JCS 2017/JHFS 2017 Guideline on Diagnosis and Treatment of Acute and Chronic Heart Failure -Digest Version. Circ J. 2019; 83: 2084–2184. – reference: 19) 日本循環器学会：心血管疾患におけるリハビリテーションに関するガイドライン（2012 年改訂版），2012．https://www.j-circ.or.jp/old/guideline/pdf/JCS2012_nohara_h.pdf （2020年6月19日引用） – reference: 20) Glantz SA, Palmer RM, et al.: Multicollinearity and What to Do About It. In: Glantz SA, Slinker BK, (eds): Primer of Applied Regression and Analysis of Variance, 2nd ed, McGraw-Hill Education, New York, 2001, pp. 185–240. – reference: 6) Konishi M, Ishida J, et al.: Heart failure epidemiology and novel treatments in Japan: facts and numbers. ESC Heart Fail. 2016; 3: 145–151. – reference: 23) Piepoli MF, Conraads V, et al.: Exercise training in heart failure: From theory to practice. A consensus document of the Heart Failure Association and the European Association for Cardiovascular Prevention and Rehabilitation. Eur J Heart Fail. 2011; 13: 347–357. – reference: 11) United Nations [internet]. New York: World Population Ageing 2015 [updated 2015; cited 2020 Aug 12]. Available from: https://www.un.org/en/development/desa/population/publications/pdf/ageing/WPA2015_Report.pdf – reference: 13) Toonstra J, Mattacola CG: Test-retest reliability and validity of isometric knee-flexion and -extension measurement using 3 methods of assessing muscle strength. J Sport Rehabil. 2013; 22. doi: 10.1123/jsr.2013.TR7. – reference: 14) Guralnik JM, Simonsick EM, et al.: A short physical performance battery assessing lower extremity function: Association with self-reported disability and prediction of mortality and nursing home admission. J Gerontol. 1994; 49: M85–M94. – reference: 25) Kakutani N, Fukushima A, et al.: Progressive Mobilization Program for Patients with Acute Heart Failure Reduces Hospital Stay and Improves Clinical Outcome. Circ Rep. 2019; 1: 123–130. – reference: 30) Shiba N, Nochioka K, et al.: Trend of Westernization of Etiology and Clinical Characteristics of Heart Failure Patients in Japan –First Report From the CHART-2 Study–. Circ J. 2011; 75: 823–833. – reference: 29) Puthucheary ZA, Hart N: Skeletal muscle mass and mortality — but what about functional outcome? Crit Care. 2014; 18: 110. doi: 10.1186/cc13729. – reference: 10) 日本心臓リハビリテーション学会ホームページ 心不全の心臓リハビリテーション標準プログラム（2017 年版）． http://www.jacr.jp/web/wp-content/uploads/2015/04/shinfuzen2017_2.pdf（2020 年6月19日引用） – reference: 28) Kinugawa S, Takada S, et al.: Skeletal muscle abnormalities in heart failure. Int Heart J. 2015; 56: 475–484. – reference: 8) Zuccalà G, Cattel C, et al.: Left ventricular dysfunction: a clue to cognitive impairment in older patients with heart failure. J Neurol Neurosurg Psychiatry. 1997; 63: 509–512. – reference: 18) Massimo FP, Viviane C, et al.: Exercise training in heart failure: from theory to practice. A consensus document of the Heart Failure Association and the European Association for Cardiovascular Prevention and Rehabilitation. Eur J Heart Fail. 2011; 13: 347–357. – reference: 1) Shimokawa H, Miura M, et al.: Heart failure as a general pandemic in Asia. Eur J Heart Fail. 2015; 17: 884–892. – reference: 3) Sasanuma N, Takahashi K, et al.: Motor and cognitive function analysis for home discharge using the Functional Independence Measure in patients undergoing cardiac rehabilitation at a long-term acute-care hospital. Eur J Phys Rehabil Med. 2015; 51: 781–792. – reference: 2) Sansone GR, Alba A, et al.: Analysis of FIM instrument scores for patients admitted to an inpatient cardiac rehabilitation program. Arch Phys Med Rehabil. 2002; 83: 506–512. – reference: 9) Fleming LM, Zhao X, et al.: Early Ambulation Among Hospitalized Heart Failure Patients Is Associated with Reduced Length of Stay and 30-Day Readmissions. Circ Heart Fail. 2018; 11: e004634. doi: 10.1161/CIRCHEARTFAILURE.117.004634. – reference: 15) Mahoney FI, Barthel DW: Functional Evaluation: The Barthel Index. Maryland State Med J. 1965; 14: 61–65. – reference: 22) Collin C, Wade DT, et al.: The Barthel ADL Index: a reliability study. Int Disabil Stud. 1988; 10: 61–63. – reference: 7) Narumi T, Arimoto T, et al.: Prognostic importance of objective nutritional indexes in patients with chronic heart failure. J Cardiol. 2013; 62: 307–313. – reference: 4) Giallauria F, Vigorito C, et al.: Cardiac rehabilitation in very old patients: data from the Italian Survey on Cardiac Rehabilitation-2008 (ISYDE-2008)-official report of the Italian Association for Cardiovascular Prevention, Rehabilitation, and Epidemiology. J Gerontol A Biol Sci Med Sci. 2010; 65: 1353–1361. – reference: 26) Guralnik JM, Ferrucci L, et al.: Lower-extremity function in persons over the age of 70 years as a predictor of subsequent disability. N Engl J Med. 1995; 332: 556–561. – reference: 12) Yancy CW, Jessup M, et al.: 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines. Circulation. 2013; 128: e240–e327. – reference: 21) Covinsky KE, Palmer RM, et al.: Loss of independence in activities of daily living in older adults hospitalized with medical illnesses: increased vulnerability with age. J Am Geriatr Soc. 2003; 51: 451–458. – reference: 27) Fulster S, Tacke M, et al.: Muscle wasting in patients with chronic heart failure: Results from the studies investigating co-morbidities aggravating heart failure (SICA-HF). Eur Heart J. 2013; 34: 512–519. – reference: 16) Folstein MF, Folstein SE, et al.: “Mini-mental state”: a practical method of grading the cognitive function of patients for the clinician. J Psychiatr Res. 1975; 12: 189–198. – reference: 17) Ignacio de Ulíbarri J, González-Madroño A, et al.: CONUT: a tool for controlling nutritional status. First validation in a hospital population. Nutr Hosp. 2005; 20: 38–45. – reference: 24) Ponikowski P, Voors AA, et al.: 2016 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure. The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure of the European Society of Cardiology (ESC) Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J. 2016; 37: 2129–2200. |
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| SubjectTerms | Goal setting Heart failure Home discharge Predictor ゴール設定 予測因子 心不全 自宅退院 |
| Title | Examination of Predictors for Discharge Disposition in Patients Aged 60 Years or Older with Acute Exacerbation of Heart Failure |
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