Association of early acute‐phase rehabilitation initiation on outcomes among patients aged ≥90 years with acute heart failure

• Published in: Journal of the American Geriatrics Society (JAGS) Vol. 71; no. 6; pp. 1840 - 1850
• Main Authors: Ueno, Kensuke, Kaneko, Hidehiro, Kamiya, Kentaro, Okada, Akira, Itoh, Hidetaka, Konishi, Masaaki, Sugimoto, Tadafumi, Suzuki, Yuta, Matsuoka, Satoshi, Fujiu, Katsuhito, Michihata, Nobuaki, Jo, Taisuke, Takeda, Norifumi, Morita, Hiroyuki, Ako, Junya, Node, Koichi, Yasunaga, Hideo, Komuro, Issei
• Format: Journal Article
• Language: English
• Published: Hoboken, USA John Wiley & Sons, Inc 01.06.2023
• Subjects: acute heart failure; early rehabilitation; epidemiology; very old; epidemiology; acute heart failure; very old; early rehabilitation
• ISSN: 0002-8614; 1532-5415
• DOI: 10.1111/jgs.18283

Background Data on the potential benefit of acute‐phase rehabilitation initiation in very old (aged ≥90) patients with acute heart failure (AHF) have been scarce. Methods We retrospectively analyzed data from the Diagnosis Procedure Combination database, which is a nationwide inpatient database. This study included patients hospitalized for heart failure (HF) from January 2010 to March 2018, those aged ≥90 years, who had a length of stay of ≥3 days, New York Heart Association (NYHA) class of ≥II, and had not undergone major procedures under general anesthesia. Propensity score matching and generalized linear models were used to compare in‐hospital mortality, length of stay, 30‐day readmission rate due to HF, all‐cause 30‐day readmission, and improvement in activities of daily living (ADL) between patients with and without an acute‐phase rehabilitation initiation, which is defined as the rehabilitation initiation within 2 days after hospital admission. Results Acute‐phase rehabilitation was initiated in 8588 of 41,896 eligible patients. Propensity score matching created 8587 pairs. Patients with acute‐phase rehabilitation initiation have lower in‐hospital mortality (9.0% vs. 11.2%, p < 0.001). Acute‐phase rehabilitation initiation was associated with lower in‐hospital mortality (odds ratio, 0.778; 95% confidence interval, 0.704–0.860). Patients with acute‐phase rehabilitation initiation have a shorter median length of stay (17 days vs. 18 days, p < 0.001), lower 30‐day readmission rate due to HF (5.5% vs. 6.4%, p = 0.011) and all‐cause 30‐day readmission (10.2% vs. 11.2%, p = 0.036), and better ADL improvement (49.7% vs. 46.9%, p < 0.001). Subgroup analysis revealed consistent results (sex, body mass index, NYHA class, and Barthel Index). Conclusions The acute‐phase rehabilitation initiation was associated with improved short‐term clinical outcomes in patients aged ≥90 years with AHF.