Hospital-acquired disability in older heart failure patients decreases independence and increases difficulties in activities of daily living.

AIMS: The aim of this study was to clarify whether worsening of independence in activities of daily living (ADL) and also difficulties in ADL are triggered by hospitalization in older patients with heart failure (HF) and whether difficulties in ADL can predict readmission for HF regardless of independence in ADL in these patients. METHODS AND RESULTS: We enrolled 241 HF patients in the present multi-institutional, prospective, observational study. The patients were divided according to age into the non-older patient group (<75 years, n = 137) and the older patient group (≥75 years, n = 104). The Katz index and the Performance Measure for Activities of Daily Living-8 (PMADL-8) were used to evaluate independence and difficulties in ADL, respectively. The endpoint of this study was rehospitalization for HF. Independence as indicated by the Katz index at discharge was significantly lower than that before admission only in the older patient group, and the value of the PMADL-8 at discharge was significantly higher than that before admission (P < 0.001). In all patients, after adjusting for the Katz index and other variables, PMADL-8 score was a significant predictor of rehospitalization for HF (hazard ratio 1.50; 95% confidence interval 1.07-2.13; P = 0.021). CONCLUSIONS: Worsening of both independence and difficulties in ADL was triggered by hospitalization in older HF patients, and difficulties in ADL were relevant factors for risk of rehospitalization regardless of independence in ADL. These findings indicate the importance of preventing not only decreased independence but also increased difficulties in ADL during and after hospitalization.

Relevant factors of leg strength at hospital discharge in patients hospitalized due to acute decompensated heart failure: multi-institutional prospective observational study.

BACKGROUND: Lower leg strength at hospital discharge is strongly associated with poor prognosis in older patients with acute decompensated heart failure (ADHF). Improving leg strength is important in acute-phase cardiac rehabilitation (CR). AIMS: This study aimed to clarify whether a change in leg strength occurs during hospitalization of older ADHF patients receiving CR and whether it affects leg strength at discharge. METHODS AND RESULTS: We enrolled 247 ADHF patients who underwent CR during hospitalization. They were divided into the non-older patient group (<75 years; n = 142) and older patient group (≥75 years; n = 105). Quadriceps isometric strength (QIS), body mass-corrected QIS (%BM QIS), and change in QIS during hospitalization (QIS ratio) were evaluated in all patients. Physical function in the stable phase was measured by the Performance Measure for Activities of Daily Living-8 (PMADL-8). The QIS value increased during hospitalization in the non-older patient group (30.0 ± 11.1 vs. 31.6 ± 10.9 kgf, P < 0.001) but did not increase in the older patient group (19.1 ± 6.3 vs. 19.5 ± 6.1 kgf, P = 0.275). Multiple regression analysis revealed that PMADL-8 significantly predicted %BM QIS at discharge in the non-older patient group (ß = -0.254, P = 0.004), whereas in the older patient group, QIS ratio and PMADL-8 significantly predicted %BM QIS at discharge (ß = 0.264, P = 0.008 for QIS ratio and ß = -0.307, P = 0.003 for PMADL-8). CONCLUSIONS: Leg strength was not improved in older ADHF patients during hospitalization even if they received CR, and this affected leg strength at discharge, suggesting that careful skeletal muscle intervention should be provided during hospitalization, and patients need to continue exercise after discharge.

Maximal calf circumference reflects calf muscle mass measured using magnetic resonance imaging.

BACKGROUND: Calf circumference (CC) has been used as a surrogate for calf muscle mass, which facilitates venous blood return to the heart through active skeletal muscle. However, the correlation between CC and calf muscle mass has not been extensively examined. This study aimed to examine the relationship between CC and calf muscle mass considering differences in sex and physique in elderly individuals. METHODS: A total of 124 community-dwelling elderly individuals ≥60 years of age (61 men, mean [±SD] age 74.3 ± 5.7 years) were enrolled. Maximal CC was measured using a tape measure with the subject supine. The cross-sectional area of skeletal muscle tissues was measured using magnetic resonance imaging from the point of greatest calf circumference to 5 cm proximal and distal. Calf muscle mass was calculated by multiplying the area of each slice by slice thickness (5 mm). RESULTS: CC was strongly correlated with calf muscle mass in male and female subjects (male: r = 0.908, P < 0.001; female: r = 0.892, P < 0.001). Multiple regression analysis revealed that CC and body mass index (BMI) were independent associate factors of calf muscle mass. The following estimation formulae were derived: (male) calf muscle mass (cm3) = 47.82 × CC (cm)-12.50 × BMI (kg/m2) -732.80; (female) calf muscle mass (cm3) = 32.23 × CC (cm) -4.85 × BMI (kg/m2) -429.94. CONCLUSIONS: A strong correlation was found between CC and calf muscle mass according to magnetic resonance imaging. Sex differences and BMI should be considered for accurate estimation of calf muscle mass using CC.

Predictive impact of daily physical activity on new vascular events in patients with mild ischemic stroke.

BACKGROUND: Daily physical inactivity is associated with a substantially increased risk of cardiovascular events. However, the target level of daily physical activity remains unclear. AIM: We aimed to evaluate the impact of physical activity on long-term vascular events in patients with mild ischemic stroke. METHODS: We designed a single hospital-based prospective observational study and studied 166 ischemic stroke patients (mean age: 63.9 ± 9.2) who had a modified Rankin Scale 0-1. We measured the daily step count as a variable of the daily physical activity after three-months from the stroke onset. Other clinical characteristics including age, body mass index, blood pressure, blood laboratory tests, vascular function and medications were also assessed. The primary outcomes were hospitalization due to stroke recurrence, myocardial infarction, angina pectoris and peripheral artery disease. Survival curves were calculated by a Kaplan-Meier survival analysis, and the hazard ratios for recurrences were determined by univariate and multivariate Cox proportional hazards regression models. RESULTS: After a median follow-up periods of 1332 days, 34 vascular events (23 stroke recurrences, 11 coronary artery disease) and 7 drop-outs occurred, and the remaining patients were divided into two groups: the without recurrence group (n = 125) and the with recurrence group (n = 34). The daily step count was lower in the nonsurvivor group than in the survivor group. Univariate and multivariate Cox proportional hazards analyses revealed that the daily step counts was independent predictors of new vascular events. A daily step count cutoff value of 6025 steps per day was determined by analyzing the receiver-operating characteristics that showed a sensitivity of 69.4% and a specificity of 79.4%. The Kaplan-Meier survival curves after a log-rank test showed a significantly lower event rate in the more than 6025 steps per day group compared with the less than 6025 steps per day group (P = 0.0002). The positive and negative predictive values of less than 6025 steps were 38.0% and 91.6%, respectively. CONCLUSION: Our data indicate that daily physical activity evaluated by step counts may be useful for forecasting the prognosis in patients with mild ischemic stroke. Daily step counts of approximately 6000 steps per day may be an initial target level for reducing new vascular events.