Cardiol Res

Cardiology Research, ISSN 1923-2829 print, 1923-2837 online, Open Access

Article copyright, the authors; Journal compilation copyright, Cardiol Res and Elmer Press Inc

Journal website https://www.cardiologyres.org

Original Article

Volume 12, Number 5, October 2021, pages 293-301

Clinical Characteristics of Older Heart Failure Patients With Hospital-Acquired Disability: A Preliminary, Single-Center, Observational Study

Figure 2. Comparisons of PA between the HAD and non-HAD groups. Steps per day (a). Moderate-intensity physical activity time (b). *P < 0.05, **P < 0.01. PA: physical activity; HAD: hospital-acquired disability.

Figure 3. Percent-reductions in BI items among patients with HAD. BI: Barthel Index; HAD: hospital-acquired disability.

**Table 1.** Patient Clinical Characteristics
	All (n = 70)	HAD (n = 29)	Non-HAD (n = 41)	P value
Data are presented as the median (interquartile range). HAD: hospital-acquired disability; BMI: body mass index; NYHA: New York Heart Association Functional Classification; LVEF: left ventricular ejection fraction; HFrEF: HF with reduced ejection fraction; HFmrEF: HF with midrange ejection fraction; HFpEF: HF with preserved ejection fraction; BNP: brain natriuretic peptide; Hb: hemoglobin; eGFR: estimated glomerular filtration rate; CRP: C-reactive protein; Na: serum sodium.
Age, years	78 (74 - 83)	81 (78 - 86)	78 (72 - 83)	0.034
Sex, female, n (%)	29 (41)	14 (48)	15 (37)	0.416
BMI, kg/m²	22 (20, 25)	21 (19, 25)	24 (20, 26)	0.110
Living alone, n (%)	24 (34)	8 (28)	16 (39)	0.506
Requiring care, n (%)	14 (41)	9 (31)	5 (12)	0.101
Etiology, n (%)
Ischemic heart disease, n (%)	19 (27)	8 (28)	11 (27)	0.999
Hypertensive heart disease, n (%)	25 (36)	9 (31)	16 (39)	0.664
Valvular heart disease, n (%)	26 (37)	12 (41)	14 (34)	0.714
NYHA class III/IV, n (%)	26 (37)/44 (63)	8 (28)/21 (72)	18 (44)/23 (56)	0.254
Hypertension, n (%)	68 (97)	28 (97)	40 (98)	0.999
Dyslipidemia, n (%)	28 (40)	14 (48)	14 (34)	0.347
Diabetes mellitus, n (%)	20 (29)	6 (21)	14 (34)	0.338
Atrial fibrillation, n (%)	26 (37)	11 (38)	15 (37)	0.999
Myocardial infarction, n (%)	8 (11)	4 (14)	4 (10)	0.887
Charlson Comorbidity Index	4 (3 - 5)	4 (3 - 5)	4 (3 - 5)	0.950
History of HF, n (%)	37 (53)	18 (62)	19 (48)	0.340
LVEF, %	43 (32 - 56)	43 (36 - 58)	42 (31 - 54)	0.349
HFrEF, n (%)	29 (41)	10 (35)	19 (46)	0.456
HFmEF, n (%)	15 (21)	6 (21)	9 (22)	0.999
HFpEF, n (%)	26 (37)	13 (45)	13 (33)	0.429
BNP, pg/dL	535 (344 - 927)	538 (393 - 1267)	527 (265 - 749)	0.285
Hb, g/dL	11.8 (10.2- 14.1)	11.5 (10.3- 12.7)	11.9 (9.7 - 14.4)	0.807
eGFR, mL/min/1.73 m²	33.8 (25.4 - 45.9)	32.4 (22.9 - 45.2)	34.5 (25.9 - 50)	0.788
CRP, mg/dL	0.6 (0.1 - 2.9)	0.8 (0.2 - 2.9)	0.5 (0.1 - 2.9)	0.725
Na, mEq/L	140 (136 - 141)	138 (138 - 141)	140 (138 - 141)	0.107

Table 1. Patient Clinical Characteristics

All (n = 70)

HAD (n = 29)

Non-HAD (n = 41)

P value

Data are presented as the median (interquartile range). HAD: hospital-acquired disability; BMI: body mass index; NYHA: New York Heart Association Functional Classification; LVEF: left ventricular ejection fraction; HFrEF: HF with reduced ejection fraction; HFmrEF: HF with midrange ejection fraction; HFpEF: HF with preserved ejection fraction; BNP: brain natriuretic peptide; Hb: hemoglobin; eGFR: estimated glomerular filtration rate; CRP: C-reactive protein; Na: serum sodium.

Age, years

78 (74 - 83)

81 (78 - 86)

78 (72 - 83)

0.034

Sex, female, n (%)

29 (41)

14 (48)

15 (37)

0.416

BMI, kg/m²

22 (20, 25)

21 (19, 25)

24 (20, 26)

0.110

Living alone, n (%)

24 (34)

8 (28)

16 (39)

0.506

Requiring care, n (%)

14 (41)

9 (31)

5 (12)

0.101

Etiology, n (%)

Ischemic heart disease, n (%)

19 (27)

8 (28)

11 (27)

0.999

Hypertensive heart disease, n (%)

25 (36)

9 (31)

16 (39)

0.664

Valvular heart disease, n (%)

26 (37)

12 (41)

14 (34)

0.714

NYHA class III/IV, n (%)

26 (37)/44 (63)

8 (28)/21 (72)

18 (44)/23 (56)

0.254

Hypertension, n (%)

68 (97)

28 (97)

40 (98)

0.999

Dyslipidemia, n (%)

28 (40)

14 (48)

14 (34)

0.347

Diabetes mellitus, n (%)

20 (29)

6 (21)

14 (34)

0.338

Atrial fibrillation, n (%)

26 (37)

11 (38)

15 (37)

0.999

Myocardial infarction, n (%)

8 (11)

4 (14)

4 (10)

0.887

Charlson Comorbidity Index

4 (3 - 5)

0.950

History of HF, n (%)

37 (53)

18 (62)

19 (48)

0.340

LVEF, %

43 (32 - 56)

43 (36 - 58)

42 (31 - 54)

0.349

HFrEF, n (%)

29 (41)

10 (35)

19 (46)

0.456

HFmEF, n (%)

15 (21)

6 (21)

9 (22)

0.999

HFpEF, n (%)

26 (37)

13 (45)

13 (33)

0.429

BNP, pg/dL

535 (344 - 927)

538 (393 - 1267)

527 (265 - 749)

0.285

Hb, g/dL

11.8 (10.2- 14.1)

11.5 (10.3- 12.7)

11.9 (9.7 - 14.4)

0.807

eGFR, mL/min/1.73 m²

33.8 (25.4 - 45.9)

32.4 (22.9 - 45.2)

34.5 (25.9 - 50)

0.788

CRP, mg/dL

0.6 (0.1 - 2.9)

0.8 (0.2 - 2.9)

0.5 (0.1 - 2.9)

0.725

Na, mEq/L

140 (136 - 141)

138 (138 - 141)

140 (138 - 141)

0.107

**Table 2.** Progress of Acute Treatment
	All (n = 70)	HAD (n = 29)	Non-HAD (n = 41)	P value
Data are presented as the median (interquartile range). HAD: hospital-acquired disability; IABP: intra-aortic balloon pumping; NPPV: non-invasive positive pressure ventilation; CRRT: continuous renal replacement therapy; ICU: intensive care unit; MRA: mineralocorticoid receptor antagonist; ACEI: angiotensin-converting enzyme inhibitor; ARB: angiotensin II receptor blocker; CCB: calcium channel blocker.
Inotropes use, n (%)	2 (4)	2 (7)	1 (2)	0.758
IABP, n (%)	1 (1)	0 (0)	1 (2)	0.999
Ventilator, n (%)	1 (1)	1 (3)	0 (0)	0.999
NPPV, n (%)	15 (21)	8 (28)	7 (17)	0.861
CRRT, n (%)	3 (4)	2 (7)	1 (2)	0.447
Patients admitted to the ICU, n (%)	9 (13)	6 (21)	3 (7)	0.199
ICU length of stay, days	0 (0 - 0)	0 (0 - 0)	0 (0 - 0)	0.124
Physical therapy start date	2 (1 - 3)	2 (1 - 3)	1 (1 - 3)	0.389
Rehabilitation time, min	180 (100 - 240)	200 (80 - 260)	160 (100 - 220)	0.693
Walking exercise, days	2 (1 - 4)	3 (2 - 4)	2 (1 - 4)	0.015
Urinary-catheter-placement period, days	2 (0 - 4)	3 (1 - 5)	1 (0 - 2)	0.019
Intravenous therapy started, days	4 (2 - 6)	4 (3 - 6)	3 (1 - 6)	0.244
Medication at discharge
Beta-blocker, n (%)	52 (74)	22 (76)	30 (73)	0.999
MRA, n (%)	36 (37)	18 (62)	18 (44)	0.209
ACEI/ARB, n (%)	22 (31)	9 (31)	13 (32)	0.999
CCB, n (%)	19 (27)	7 (24)	12 (29)	0.839
Length of stay, days	11 (7 - 14)	12 (7 - 15)	10 (7 - 14)	0.470
Return to home rate, n (%)	61 (87)	20 (67)	41 (100)	< 0.01

Table 2. Progress of Acute Treatment

All (n = 70)

HAD (n = 29)

Non-HAD (n = 41)

P value

Data are presented as the median (interquartile range). HAD: hospital-acquired disability; IABP: intra-aortic balloon pumping; NPPV: non-invasive positive pressure ventilation; CRRT: continuous renal replacement therapy; ICU: intensive care unit; MRA: mineralocorticoid receptor antagonist; ACEI: angiotensin-converting enzyme inhibitor; ARB: angiotensin II receptor blocker; CCB: calcium channel blocker.

Inotropes use, n (%)

2 (4)

2 (7)

1 (2)

0.758

IABP, n (%)

1 (1)

0 (0)

1 (2)

0.999

Ventilator, n (%)

1 (1)

1 (3)

0 (0)

0.999

NPPV, n (%)

15 (21)

8 (28)

7 (17)

0.861

CRRT, n (%)

3 (4)

2 (7)

1 (2)

0.447

Patients admitted to the ICU, n (%)

9 (13)

6 (21)

3 (7)

0.199

ICU length of stay, days

0 (0 - 0)

0.124

Physical therapy start date

2 (1 - 3)

1 (1 - 3)

0.389

Rehabilitation time, min

180 (100 - 240)

200 (80 - 260)

160 (100 - 220)

0.693

Walking exercise, days

2 (1 - 4)

3 (2 - 4)

2 (1 - 4)

0.015

Urinary-catheter-placement period, days

2 (0 - 4)

3 (1 - 5)

1 (0 - 2)

0.019

Intravenous therapy started, days

4 (2 - 6)

4 (3 - 6)

3 (1 - 6)

0.244

Medication at discharge

Beta-blocker, n (%)

52 (74)

22 (76)

30 (73)

0.999

MRA, n (%)

36 (37)

18 (62)

18 (44)

0.209

ACEI/ARB, n (%)

22 (31)

9 (31)

13 (32)

0.999

CCB, n (%)

19 (27)

7 (24)

12 (29)

0.839

Length of stay, days

11 (7 - 14)

12 (7 - 15)

10 (7 - 14)

0.470

Return to home rate, n (%)

61 (87)

20 (67)

41 (100)

< 0.01

**Table 3.** Physical Function and Cognitive Function, Physical Activity
	All (n=70)	HAD (n=29)	Non-HAD (n=41)	P value
Data are presented as the median (interquartile range). HAD: hospital-acquired disability; BI: Barthel Index; KCL: Kihon checklist; Multi-faceted frailty: KCL scores ≥ 8; SPPB: Short physical performance battery; Physical frailty: SPPB scores < 10; MMSE: mini-mental state examination; PA: physical activity.
Before admission
BI, score	100 (90 - 100)	95 (90 - 100)	100 (90 - 100)	0.050
KCL, score	12 (7 - 15)	14 (11 - 17)	9 (6 - 13)	< 0.01
Multi-faceted frailty, n (%)	62 (89)	26 (90)	36 (29)	< 0.01
At discharge
SPPB, score	9 (6 - 11)	6 (4 - 10)	10 (8 - 12)	< 0.01
Physical frailty, n (%)	39 (58)	22 (76)	17 (42)	< 0.01
Handgrip strength, kg	19 (16 - 26)	18 (14 - 19)	22 (18 - 30)	< 0.01
MMSE, score	26 (21 - 26)	21 (17 - 24)	24 (22 - 27)	0.022
BI, score	95 (85 - 100)	85 (70 - 90)	100 (100 - 100)	< 0.01
PA during hospitalization
Steps per day, step	1,239 (452 - 1,878)	457 (301 - 997)	1,692 (1,227 - 2,418)	< 0.01
Moderate-intensity PA time, min	0 (0 - 1)	0 (0 - 1)	1 (0 - 3)	0.021

Table 3. Physical Function and Cognitive Function, Physical Activity

All (n=70)

HAD (n=29)

Non-HAD (n=41)

P value

Data are presented as the median (interquartile range). HAD: hospital-acquired disability; BI: Barthel Index; KCL: Kihon checklist; Multi-faceted frailty: KCL scores ≥ 8; SPPB: Short physical performance battery; Physical frailty: SPPB scores < 10; MMSE: mini-mental state examination; PA: physical activity.

Before admission

BI, score

100 (90 - 100)

95 (90 - 100)

100 (90 - 100)

0.050

KCL, score

12 (7 - 15)

14 (11 - 17)

9 (6 - 13)

< 0.01

Multi-faceted frailty, n (%)

62 (89)

26 (90)

36 (29)

< 0.01

At discharge

SPPB, score

9 (6 - 11)

6 (4 - 10)

10 (8 - 12)

< 0.01

Physical frailty, n (%)

39 (58)

22 (76)

17 (42)

< 0.01

Handgrip strength, kg

19 (16 - 26)

18 (14 - 19)

22 (18 - 30)

< 0.01

MMSE, score

26 (21 - 26)

21 (17 - 24)

24 (22 - 27)

0.022

BI, score

95 (85 - 100)

85 (70 - 90)

100 (100 - 100)

< 0.01

PA during hospitalization

Steps per day, step

1,239 (452 - 1,878)

457 (301 - 997)

1,692 (1,227 - 2,418)

< 0.01

Moderate-intensity PA time, min

0 (0 - 1)

1 (0 - 3)

0.021