Disability in activities of daily living before hospitalisation and clinical outcomes following acute-phase rehabilitation in older individuals with cardiovascular disease
Authors: Hamazaki N , Kamiya K , Nozaki K , Maekawa E , Kobayashi S , Shibuya M , Uchida S , Noda T , Ueno K , Ogura K , Miki T , Matsunaga A , Ako J 
Published: October 2024

Abstract

Background
Older individuals with cardiovascular disease (CVD) frequently complicate disability in activities of daily living (ADLs), defined as needing assistance performing ADLs, which is at risk for further functional decline and higher mortality. Although acute-phase physical rehabilitation has been recently highlighted for its effectiveness on functional outcomes in older individuals with CVD, the effectiveness in those with pre-hospitalization ADLs disability is uncertain.

Purpose
To investigate the association between the ADLs disability before hospitalisation and outcomes after acute-phase rehabilitation, including physical function changes during hospitalisation and clinical events after hospital discharge in older individuals with CVD.

Methods
We studied 2792 individuals aged ≥65 admitted to a university hospital for CVD treatment and received inpatient physical rehabilitation tailored for each patient. The information on disability in ADLs before admission was obtained through interviews about difficulty performing basic ADLs, including feeding, bathing, toileting, dressing, and ambulating. The primary outcome was the Short Physical Performance Battery (SPPB), measured at the initiation of inpatient rehabilitation as a baseline and at hospital discharge to assess the changes in physical function during hospitalisation. We also investigated the five-year composite events of all-cause death and/or rehospitalisation due to heart failure after discharge. The repeated analysis of covariance adjusted for clinical characteristics was used to examine the change in SPPB between ADLs status. We also analysed the association between SPPB change after acute-phase rehabilitation and incidences of composite events in individuals with or without ADLs disability.

Results
Individuals with ADLs disability before hospitalisation were observed in 163 (5.8%) patients, who showed older age, higher prevalence of heart failure and comorbidities, and lower SPPB at baseline than those with ADLs independent. Conversely, SPPB was significantly higher at hospital discharge than at baseline, even in patients with pre-hospitalization ADLs disability and without interaction between the ADL status (P=0.091, Figure 1). The negative change in SPPB was observed only in 240 (8.6%), and its rate was higher in individuals with ADLs disability than those without (14.2% vs 7.8%, P=0.007). During the median follow-up of 2.6years, the composite events occurred in 760 patients (27.2%), and the combination of negative change in SPPB with ADLs disability was only associated with higher incidences of composite events against preserved SPPB with ADLs independent as reference (adjusted hazard ratio: 2.57, 95% confidence intervals: 1.11–5.97, Figure 2).

Conclusions
Acute-phase rehabilitation may contribute to better changes in physical function, which is associated with a lower risk of clinical events in older individuals with CVD and pre-hospitalisation ADLs disability.Figure 2