Worsening Physical Function during Hospitalization is Associated with Poor Outcome in Patients with Acute Decompensated Heart Failure

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Gait speed (GS) is a simple assessment of physical function and a predictor of cardiovascular events in the elderly population with heart failure. In this study, 445 patients diagnosed with congestive heart failure were chosen to undergo exercise during hospitalization. Physical examinations and a 10 meters walking test was conducted to evaluate gait speed at the beginning of training and before discharge. Patients were evaluated after discharge on poor outcomes, hospital readmissions, and mortality.

At both time points, NT-proBNP and nutritional status was measured. In addition, an echocardiography was performed to determine changes in ejection fraction. Results found that 18% of patients showed a decline in GS, despite treatment for heart failure and exercise training. Nutritional status, hand grip strength and cardiac function were associated with the change in GS during hospitalization. A decline in GS was associated with a higher rate of poor outcomes, including rehospitalization and death.

Muscle strength and nutritional status were related to the GS change during hospitalization due to the prevalence of sarcopenia in those with heart failure. Sarcopenia progresses during hospitalization with heart failure, and leads to a loss of muscle mass and function. Malnutrition is also associated with heart failure and contributes to a greater risk of physical disability. LV diastolic function and RV function was associated with a decline in GS.

In conclusion, deterioration in physical function is associated with low skeletal muscle mass and function, low nutrition, and may contribute to poor prognosis in patients with low gait speed.