Improving Physical Performance During Hospitalization Has an Impact on Reducing the Risk of Clinical Events in Frail Older Patients With Acutely Decompensated Heart Failure.

Background: Physical performance during hospitalization is a central target of inpatient cardiac rehabilitation and is associated with the prognosis in patients with heart failure (HF). However, the prognostic significance of longitudinal changes in physical performance during acute hospitalization remains uncertain. We aimed to examine the association between in-hospital changes in the Short Physical Performance Battery (SPPB; ∆SPPB) and post-discharge outcomes among older, frail patients hospitalized for acutely decompensated HF (ADHF). Methods and Results: This study included 504 older, frail patients with ADHF and baseline SPPB scores ≤9 (mean age 81.1±9.6 years; 49% male). SPPB was reassessed at discharge, and patients with ∆SPPB ≥3 and <3 were classified into the Improvement and Minimal Change groups, respectively. Kaplan-Meier and Cox regression analyses evaluated the association between ∆SPPB ≥3 and HF readmission and all-cause mortality. During a median follow up of 1.8 years (range 1.0-3.0 years), 294 (58.3%) patients had HF readmission and 161 (31.9%) died. The Improvement group had significantly lower HF readmission rates (P<0.05), whereas all-cause mortality showed a non-significant downward trend. Conclusions: Improvement in physical performance during hospitalization was associated with a lower risk of HF readmission among older, frail patients with ADHF. These findings suggest that longitudinal functional recovery during acute care provides clinically relevant prognostic information.