Archives of gerontology and geriatrics · 2026
Prognostic impact of residual symptoms under low and normal physical performance in older patients hospitalized for worsening heart failure.
СтатьяПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод пока не подготовлен
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Yamada Yu, Konishi Masaaki, Kagiyama Nobuyuki, Kasai Takatoshi, Kamiya Kentaro, Saito Hiroshi, Maekawa Emi, Kitai Takeshi, Iwata Kentaro, Jujo Kentaro, Wada Hiroshi, Momomura Shin-Ichi, Hibi Kiyoshi, Matsue Yuya
Аннотация
BACKGROUND: The New York Heart Association (NYHA) classification is well-established prognostic indicator and treatment goal in heart failure (HF). However, older patients may underreport subjective symptoms due to age-related physical decline. The prognostic significance of residual symptoms in older patients hospitalized for worsening HF, particularly across physical performance levels, remains unclear. We aimed to evaluate the significance of residual symptoms and physical performance at discharge on outcomes.
METHODS: This FRAGILE-HF sub-analysis included 1272 consecutive hospitalized patients with HF aged ≥ 65 years (mean age 80.1 ± 7.8 years; 57.2% men; left ventricular ejection fraction 46 ± 17%). Pre-discharge NYHA class and 4-meter gait speed assessed residual symptoms and physical performance. Patients were followed up for 2 years post-discharge, with all-cause death within 2 years as the primary outcome.
RESULTS: At discharge, 715 patients (56.2%) remained symptomatic (NYHA class 2-4) while 557 patients (43.8%) were asymptomatic (NYHA class 1). Patients were stratified into four groups based on residual symptoms and physical performance (slow gait speed: < 0.8 m/s; normal speed ≥ 0.8 m/s). During follow-up, 266 patients (20.9%) died. Compared with normal-asymptomatic patients, adjusted hazard ratios for all-cause death were 1.96, 1.81, and 2.77 for normal-symptomatic, slow-asymptomatic, and slow-symptomatic patients, respectively. Residual symptoms at discharge were associated with increased mortality, irrespective of gait speed (p-values for interaction: 0.393).
CONCLUSION: Residual symptoms at discharge were associated with higher all-cause death, regardless of physical performance. However, patients with low physical performance may require closer follow-up, even if symptoms are alleviated at discharge.
METHODS: This FRAGILE-HF sub-analysis included 1272 consecutive hospitalized patients with HF aged ≥ 65 years (mean age 80.1 ± 7.8 years; 57.2% men; left ventricular ejection fraction 46 ± 17%). Pre-discharge NYHA class and 4-meter gait speed assessed residual symptoms and physical performance. Patients were followed up for 2 years post-discharge, with all-cause death within 2 years as the primary outcome.
RESULTS: At discharge, 715 patients (56.2%) remained symptomatic (NYHA class 2-4) while 557 patients (43.8%) were asymptomatic (NYHA class 1). Patients were stratified into four groups based on residual symptoms and physical performance (slow gait speed: < 0.8 m/s; normal speed ≥ 0.8 m/s). During follow-up, 266 patients (20.9%) died. Compared with normal-asymptomatic patients, adjusted hazard ratios for all-cause death were 1.96, 1.81, and 2.77 for normal-symptomatic, slow-asymptomatic, and slow-symptomatic patients, respectively. Residual symptoms at discharge were associated with increased mortality, irrespective of gait speed (p-values for interaction: 0.393).
CONCLUSION: Residual symptoms at discharge were associated with higher all-cause death, regardless of physical performance. However, patients with low physical performance may require closer follow-up, even if symptoms are alleviated at discharge.