Predicting the Future Need of Walking Device or Assistance by Moderate to Vigorous Physical Activity: A 2-Year Prospective Study of Women Aged 75 Years and Above

Objective. To examine the association between daily moderate to vigorous physical activity (MVPA) and the change in mobility function among community-dwelling Japanese women aged 75 years and above. Methods. This prospective study included 330 older women aged 75 years and above who could walk without a walking device or assistance. MVPA and light-intensity physical activity (LPA) were assessed using an accelerometer for seven consecutive days. MVPA was defined as an activity with an intensity of >3 metabolic equivalents. The study outcome was a change in mobility function, defined as the need of walking device or assistance, during the two-year period. Results. The results of the logistic regression analysis showed that MVPA was inversely associated with a decline in mobility function after controlling for LPA and potential confounders (adjusted odds ratio (OR) = 0.93 per 1 min/d, 95% confidence interval (CI) = 0.88–0.99; P = 0.017), whereas LPA was not when adjusted for MVPA and confounders (adjusted OR = 0.99 per 1 min/d, 95% CI = 0.96–1.01; P = 0.245). The receiver operating characteristics analysis identified a 7.9 min/d of MVPA as the cut-off value. Conclusions. The results of this study suggest the importance of promoting daily MVPA for preventing mobility limitation in older women aged 75 years and above

Prognostic effects of cardiac rehabilitation in heart failure patients classified according to physical frailty: A propensity score–matched analysis of a nationwide prospective cohort study

Background: Research regarding cardiac rehabilitation (CR) in the prognosis of heart failure (HF) patients and frailty remains lacking. Here, the effects of CR on the 2-year prognosis of HF patients were examined according to their frailty status. Methods: This multicenter prospective cohort study enrolled patients hospitalized for HF. Patients who underwent ≥1 session per 2 weeks of CR within 3 months after discharge were categorized in the CR group. Patients were divided in a non-frailty (≤8 points) and physical frailty group (≥9 points) based on their FLAGSHIP frailty score. The score is based on HF prognosis, with a higher score indicating worsened physical frailty. A propensity score-matched analysis was performed to compare survival rates between the two groups according to their physical frailty status. Endpoints included HF re-hospitalization and all-cause mortality during a 2-year follow-up period. Results: Of 2697 patients included in the analysis, 285 and 95 matched pairs were distributed in the non-frailty and physical frailty groups, respectively, after propensity-score matching. CR was associated with lower incidence of HF rehospitalization in both non-frailty (hazard ratio 0.65; 95% confidence interval 0.44–0.96; p = 0.032) and physical frailty (0.54; 0.32–0.90; p = 0.019) groups. CR was not associated with all-cause mortality in either group (log-rank test, p > 0.05). Conclusion: These findings suggest the effects of CR on reduced HF rehospitalization, regardless of physical frailty status

Prognostic impact of nutrition measures in patients with heart failure varies with coexisting physical frailty

Abstract Aims Malnutrition is prevalent among patients with heart failure (HF); however, the effects of coexisting malnutrition and frailty on prognosis are unknown. This study examines the impact of malnutrition and frailty on the prognosis of patients with HF. Methods and results We examined 1617 patients with HF aged 65 years or older (age: 78.6 ± 7.4; 44% female) from a Japanese multicentre prospective cohort study. The nutritional status was evaluated using the Geriatric Nutritional Risk Index (GNRI), Controlling Nutritional Status (CONUT), and Mini Nutritional Assessment Short Form on discharge. Frailty was assessed using the criteria determined in a previous study on patients with HF. The prognostic impact of each nutrition measure on the risk of composite all‐cause mortality and cardiac readmissions within 2 years of hospital discharge was assessed using Kaplan–Meier survival curves and Cox proportional hazards model analysis for non‐frail and frail groups. Over 2324.2 person‐years of follow‐up, 88 patients died and 448 patients experienced readmission due to HF. In the non‐frail group, poor nutritional status assessed using the GNRI and CONUT was associated with an increased hazard ratio (HR) of composite outcomes in the crude model; however, adjustment for potential confounders diminished the association. In the frail group, all three nutritional indicators were associated with the cumulative incidence of the study outcome (log‐rank test, P < 0.05). In multivariate analysis, only the CONUT score was associated with an increased HR even after adjustment for confounders. Conclusions The CONUT score predicted a poor prognosis in HF patients with coexisting physical frailty, highlighting the potential clinical benefit of nutritional assessment based on biochemical data for further risk stratification

Clinical characteristics and outcomes of heart failure patients with long-term care insurance ― Insights from the kitakawachi clinical background and outcome of heart failure registry

Kensuke Takabayashi, Kotaro Iwatsu, Tsutomu Ikeda, Yuko Morikami, Tahei Ichinohe, Takashi Yamamoto, Kotoe Takenaka, Hiroyuki Takenaka, Hiroyuki Muranaka, Ryoko Fujita, Miyuki Okuda, Osamu Nakajima, Hitoshi Koito, Yuka Terasaki, Tetsuhisa Kitamura, Shouji Kitaguchi, Ryuji Nohara, Clinical Characteristics and Outcomes of Heart Failure Patients With Long-Term Care Insurance　― Insights From the Kitakawachi Clinical Background and Outcome of Heart Failure Registry ―, Circulation Journal, 2020, Volume 84, Issue 9, Pages 1528-1535, Released August 25, 2020, [Advance publication] Released July 21, 2020, Online ISSN 1347-4820, Print ISSN 1346-9843, https://doi.org/10.1253/circj.CJ-20-0017, https://www.jstage.jst.go.jp/article/circj/84/9/84_CJ-20-0017/_article/-char/e

Clinical characteristics and social frailty of super-elderly patients with heart failure: The Kitakawachi clinical background and outcome of heart failure registry

Kensuke Takabayashi, Akihiro Ikuta, Yoshinori Okazaki, Mariko Ogami, Kotaro Iwatsu, Koichi Matsumura, Tsutomu Ikeda, Tahei Ichinohe, Yuko Morikami, Takashi Yamamoto, Ryoko Fujita, Kotoe Takenaka, Hiroyuki Takenaka, Yoshisumi Haruna, Hiroyuki Muranaka, Masaaki Ozaki, Tetsuhisa Kitamura, Shouji Kitaguchi, Ryuji Nohara, Clinical Characteristics and Social Frailty of Super-Elderly Patients With Heart Failure　― The Kitakawachi Clinical Background and Outcome of Heart Failure Registry ―, Circulation Journal, 2017, Volume 81, Issue 1, Pages 69-76, Released December 22, 2016, [Advance publication] Released November 30, 2016, Online ISSN 1347-4820, Print ISSN 1346-9843, https://doi.org/10.1253/circj.CJ-16-0914, https://www.jstage.jst.go.jp/article/circj/81/1/81_CJ-16-0914/_article/-char/e