Izumi Keiichi, Kohno Takashi, Goda Ayumi, Takeuchi Shinsuke, Shiraishi Yasuyuki, Higuchi Satoshi, Nakamaru Ryo, Nagatomo Yuji, Kitamura Mitsunobu, Takei Makoto, Sakamoto Munehisa, Mizuno Atsushi, Nomoto Michiru, Soejima Kyoko, Kohsaka Shun, Yoshikawa Tsutomu
Department of Cardiovascular Medicine, Kyorin University Faculty of Medicine, 6-20-2 Shinkawa, Mitaka, Tokyo, 181-8611, Japan.
Department of Cardiology, Keio University School of Medicine, Tokyo, Japan.
Heart Vessels. 2025 Jun;40(6):471-483. doi: 10.1007/s00380-024-02486-3. Epub 2024 Nov 18.
Patients hospitalized for heart failure (HF) experience impairments in functional status, primarily affecting basic activities of daily living (ADL). We investigated the independent effect of functional status for ADL on patient-centered outcomes (i.e., home discharge) and conventional clinical outcomes in HF. We analyzed 2936 consecutive hospitalized patients with HF from a prospective multicenter registry. The functional status of ADL was assessed before discharge by using the Barthel index (BI). Patients were categorized into the lower BI group (≤85; the lowest tertile) and higher BI group (>85). We evaluated the risk-adjusted association between BI and non-home discharge, as well as the two-year all-cause mortality. Exploratory subgroups included patients categorized by age, sex, HF hospitalization, left ventricular ejection fraction, body mass index, and estimated glomerular filtration rate (eGFR). Of the participants (age: 79 [69-85] years; 41.1% women), 86.3% were discharged home. A lower BI was independently associated with non-home discharge (OR: 5.12, 95% CI 3.86-6.80) and higher all-cause mortality rates (HR: 1.96, 95% CI 1.58-2.45). Two-year cardiac and non-cardiac mortality rates were higher in the lower BI group; however, the proportion of cardiac causes in two-year deaths did not differ between the lower and higher BI groups (48.8% vs. 49.5%, P = 0.891). Subgroup analyses consistently demonstrated an association between two-year mortality and lower BI; however, this association was stronger among patients with a higher eGFR (P-value for interaction = 0.004). A lower BI was independently associated with non-home discharge and higher mortality rates because of cardiac- and non-cardiac-related causes in hospitalized patients with HF.
因心力衰竭（HF）住院的患者在功能状态方面存在障碍，主要影响日常生活基本活动（ADL）。我们研究了ADL功能状态对以患者为中心的结局（即出院回家）和HF传统临床结局的独立影响。我们分析了来自前瞻性多中心登记处的2936例连续住院的HF患者。出院前使用Barthel指数（BI）评估ADL的功能状态。患者被分为低BI组（≤85；最低三分位数）和高BI组（>85）。我们评估了BI与未出院回家之间的风险调整关联以及两年全因死亡率。探索性子组包括按年龄、性别、HF住院情况、左心室射血分数、体重指数和估计肾小球滤过率（eGFR）分类的患者。参与者（年龄：79[69 - 85]岁；41.1%为女性）中，86.3%出院回家。较低的BI与未出院回家独立相关（比值比：5.12，95%置信区间3.86 - 6.80）和较高的全因死亡率（风险比：1.96，95%置信区间1.58 - 2.45）。低BI组的两年心脏和非心脏死亡率较高；然而，低BI组和高BI组两年死亡中心脏原因的比例没有差异（48.8%对49.5%，P = 0.891）。亚组分析一致表明两年死亡率与较低的BI之间存在关联；然而，这种关联在eGFR较高的患者中更强（交互作用P值 = 0.004）。较低的BI与HF住院患者因心脏和非心脏相关原因导致的未出院回家和较高死亡率独立相关。
