Lower Extremity Performance Measures Predict Long-Term Prognosis in Older Patients Hospitalized for Heart Failure

Chiarantini, Daniela; Volpato, Stefano; Sioulis, Fotini; Bartalucci, Francesca; Del Bianco, Laura; Mangani, Irene; Pepe, Giuseppe; Tarantini, Francesca; Berni, Andrea; Marchionni, Niccolo; Di Bari, Mauro

doi:10.1016/j.cardfail.2010.01.004

« Previous Next »Journal of Cardiac Failure
Volume 16, Issue 5 , Pages 390-395, May 2010

Lower Extremity Performance Measures Predict Long-Term Prognosis in Older Patients Hospitalized for Heart Failure

Daniela Chiarantini, MD
- Department of Critical Care Medicine and Surgery, Unit of Gerontology and Geriatric Medicine, University of Florence and Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
Stefano Volpato, MD, MPH
- Department of Clinical and Experimental Medicine, University of Ferrara, Ferrara, Italy
Fotini Sioulis, MD
- Department of Clinical and Experimental Medicine, University of Ferrara, Ferrara, Italy
Francesca Bartalucci, MD
- Department of Critical Care Medicine and Surgery, Unit of Gerontology and Geriatric Medicine, University of Florence and Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
Laura Del Bianco, MD
- Department of Critical Care Medicine and Surgery, Unit of Gerontology and Geriatric Medicine, University of Florence and Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
Irene Mangani, MD
- Department of Critical Care Medicine and Surgery, Unit of Gerontology and Geriatric Medicine, University of Florence and Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
Giuseppe Pepe, MD
- Emergency Department, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
Francesca Tarantini, MD, PhD
- Department of Critical Care Medicine and Surgery, Unit of Gerontology and Geriatric Medicine, University of Florence and Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
Andrea Berni, MD
- Department of Critical Care Medicine and Surgery, Unit of Internal Medicine, University of Florence and Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
Niccolo Marchionni, MD
- Department of Critical Care Medicine and Surgery, Unit of Gerontology and Geriatric Medicine, University of Florence and Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
Mauro Di Bari, MD, PhD
- Department of Critical Care Medicine and Surgery, Unit of Gerontology and Geriatric Medicine, University of Florence and Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
- Reprint requests: Mauro Di Bari, MD, PhD, Department of Critical Care Medicine and Surgery, Unit of Gerontology and Geriatrics Medicine, University of Florence, Viale Pieraccini, 650139 Florence-Italy. Tel: +39 055 4271468; Fax: +39 055 4271469.

Received 4 October 2009; received in revised form 12 January 2010; accepted 19 January 2010. published online 04 March 2010.

Abstract

Background

In older heart failure (HF) patients, survival depends on the severity of their cardiac condition and on their functional status. Lower extremity performance, assessed with the Short Physical Performance Battery (SPPB), predicts survival in older persons, both in epidemiologic and clinical settings. We evaluated whether SPPB predicts long-term survival in older subjects hospitalized for HF, independent of traditional measures of HF severity.

Methods and Results

Subjects aged 65+ years were enrolled on discharge after hospitalization for decompensated HF. Participants underwent echocardiography, comprehensive geriatric assessment, and SPPB. Cox proportional hazards regression models were used to predict survival over a 30-month follow-up. Of 157 participants (mean age 80 years, range 65–101; 50% men), 61 died. After adjustment for potential confounders, including demographics, ejection fraction, New York Heart Association classification, and comorbidity, we found a graded independent association between SBBP score and mortality risk: compared with an SPPB score of 9–12, scores of 0, 1–4, and 5–8 were associated with hazard ratios (HR) and 95% confidence interval (CI) of death of 6.06 (2.19–16.76), 4.78 (1.63–14.02), and 1.95 (0.67–5.70), respectively.