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Predictors of activities of daily living at discharge in elderly patients with heart failure with preserved ejection fraction

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Abstract

The purpose of this study was to clarify the predictive factors of activities of daily living (ADL) at discharge in elderly patients with heart failure with preserved ejection fraction (HFpEF). Participants were selected from among 598 consecutive hospitalized HF patients based on certain criteria. We investigated patient characteristics, and ADL with the motor and cognitive items of the Functional Independence Measure (FIM). We analyzed the data with the unpaired t test, Mann–Whitney U test, χ2 test, logistic regression analysis, and receiver operating characteristic (ROC) curves. We included 154 patients for further analyses who were divided into the low ADL group (n = 75) and high ADL group (n = 79). There were significant differences between the two groups in age, long-term care insurance (LTCI) level, New York Heart Association class, creatinine level, albumin level, β-blocker, sitting, standing and walking exercise start days, length of hospital stay, and motor- and cognitive-FIM scores at admission and discharge (p < 0.05). The cutoff values of the ROC curves predicting ADL at discharge were LTCL: support level 2 (area under the curve [AUC]: 0.672, p < 0.001, sensitivity: 0.573, false-positive rate: 0.278); walking exercise start day: 4.5 days (AUC 0.694, p < 0.001, sensitivity: 0.609, false-positive rate: 0.299); motor FIM score: 34.5 points (AUC 0.710, p < 0.001, sensitivity: 0.633, false-positive rate: 0.280); and cognitive FIM score: 28.5 points (AUC 0.806, p < 0.001, sensitivity: 0.759, false-positive rate: 0.227). This study revealed several predictors of ADL at discharge and their associated cutoff values in elderly patients with HFpEF.

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Abbreviations

ACEI:

Angiotensin converting enzyme inhibitor

ADL:

Activities of daily living

ARB:

Angiotensin receptor blocker

AUC:

Area under the curve

BMI:

Body mass index

BNP:

Brain natriuretic peptide

EF:

Ejection fraction

eGFR:

Estimated by glomerular filtration rate

FIM:

Functional independence measure

GNRI:

Geriatric nutritional risk index

HF:

Heart failure

HFrEF:

Heart failure with reduced ejection fraction

HFpEF:

Heart failure with preserved ejection fraction

LTCI:

Long-term care insurance

NYHA:

New York Heart Association

ROC:

Receiver operating characteristic

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Acknowledgements

This study was benefitted by the support and encouragement of Dr. Masashi Kanai, Dr. Masato Ogawa, Ms. Asami Ogura, Mr. Ikkou Kubo, Mr. Yuji Kanejima, Mr. Hiroto Ogi and Dr. Shinichi Shimada, Department of Public Health, Graduate School of Health Sciences, Kobe University.

Funding

The present research received no specific grant from any funding agency in the commercial, public, or not-for-profit sectors.

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Authors and Affiliations

  1. Department of Physical Therapy, Fukuoka Wajiro Professional Training College, 2-1-13 Wajirooka, Higashi-ku, Fukuoka, 811-0213, Japan

    Masahiro Kitamura, Takashi Yoshizawa & Nobuhiro Okamoto

  2. Department of Public Health, Graduate School of Health Sciences, Kobe University, 7-10-2 Tomogaoka, Suma-ku, Kobe, 654-0142, Japan

    Masahiro Kitamura, Kazuhiro P. Izawa & Kodai Ishihara

  3. Department of Rehabilitation, Sakakibara Heart Institute of Okayama, 2-5-1 Nakaicho, Kita-ku, Okayama, 700-0804, Japan

    Kodai Ishihara

  4. Department of Rehabilitation, Shinyukuhashi Hospital, 1141 Dojoji, Yukuhashi, 824-0026, Japan

    Masakazu Yaekura & Hitomi Nagashima

  5. Cardiovascular Stroke Renal Project, 7-10-2 Tomogaoka, Suma-ku, Kobe, 654-0142, Japan

    Masahiro Kitamura, Kazuhiro P. Izawa & Kodai Ishihara

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  1. Masahiro Kitamura
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Contributions

MK conceptualized and designed the study, collected data, conducted initial analyses, and drafted the initial manuscript; KPI, KI, MY, HN, TY and NO reviewed and revised the manuscript. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of this work.

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Correspondence to Kazuhiro P. Izawa.

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Kitamura, M., Izawa, K.P., Ishihara, K. et al. Predictors of activities of daily living at discharge in elderly patients with heart failure with preserved ejection fraction. Heart Vessels 36, 509–517 (2021). https://doi.org/10.1007/s00380-020-01718-6

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