Impact of Physical Function and Acute-Phase Treatment on Hospitalization-Associated Disability in Sarcopenic Patients With Cardiovascular Disease

Abstract

Background

Factors associated with hospitalization-associated disability (HAD) in older patients with cardiovascular disease (CVD) and sarcopenia remain unclear.

Methods and Results

We retrospectively analyzed 202 older patients with CVD and sarcopenia. HAD occurred in 81 patients (40.1%). Multivariable analysis identified prehospitalization Barthel Index, initial Short Physical Performance Battery score, and intensive care unit stay as independent factors associated with HAD. Physical function was associated with HAD only in patients with high levels of prehospitalization activities of daily living.

Conclusions

Factors associated with HAD may differ according to prehospitalization functional status.

Central Figure.

Hospitalization-associated disability (HAD) is common in older patients with cardiovascular disease (CVD) and is associated with poor outcomes.¹ Sarcopenia is associated with reduced physical reserve and adverse hospital outcomes,² potentially increasing vulnerability to HAD. In addition, HAD-associated factors may differ according to baseline functional status, but remain unclear for sarcopenic patients with cardiovascular disease according to their prehospitalization level of activities of daily living (ADL). Therefore, in this study we investigated HAD-associated factors according to prehospitalization ADL.

Methods

This single-center retrospective study included 202 patients aged ≥65 years with CVD and sarcopenia who underwent in-hospital physical therapy. The study protocol was approved by the Ethics Committee of Seirei Hamamatsu General Hospital (approval no. 4577) and conducted in accordance with the Declaration of Helsinki.

Sarcopenia was defined according to the Asian Working Group for Sarcopenia 2025 criteria using low grip strength (<28 kg for men and <18 kg for women) and low skeletal muscle mass index measured by bioelectrical impedance analysis (BIA: <7.0 kg/m² for men and <5.7 kg/m² for women).³ HAD was defined as a decline ≥5 points in the Barthel Index (BI) at discharge compared with prehospitalization BI.¹ Prehospitalization BI was confirmed through interviews with patients or family members by physical therapists and nursing staff. Physical function was assessed using the Short Physical Performance Battery (SPPB).

Comparisons, multivariable logistic regression, and interaction analyses were performed. Statistical significance was defined as P<0.05.

Results

Among 202 patients, HAD occurred in 81 (40.1%). Patients with HAD had lower initial SPPB scores and longer stays in the intensive care unit (ICU) than those without HAD.

Multivariable logistic regression identified prehospitalization BI (odds ration (OR) 1.06, 95% confidence interval (CI) 1.02–1.10, P=0.004), initial SPPB score (OR 0.71, 95% CI 0.61–0.82, P<0.001), and ICU stay (OR 1.30, 95% CI 1.09–1.56, P=0.004) as independently associated with HAD (Figure A).

Figure.

(A) Multivariable logistic regression analysis for hospitalization-associated disability (HAD). Forest plot showing odds ratios (ORs) and 95% confidence intervals (CIs) for factors independently associated with HAD. The dashed vertical line indicates OR=1. (B) Stratified analyses according to prehospitalization ADL status. P for interaction is shown. ADL, activities of daily living; ICU, intensive care unit; SPPB, Short Physical Performance Battery.

Interaction analysis showed a significant interaction between prehospitalization BI and initial SPPB (P for interaction <0.001), with no interaction for ICU stay. In the stratified analyses, initial SPPB was associated with HAD only in the high-ADL group (Figure B).

Discussion

The results of this study demonstrated that factors associated with HAD may differ according to prehospitalization ADL status in older patients with CVD and sarcopenia. Initial SPPB was associated with HAD only in the high-ADL group, whereas ICU stay was associated with HAD regardless of ADL level.

HAD is associated with subsequent functional decline in ICU survivors.⁴ Early mobilization during acute care has been associated with improved outcomes in older patients with heart failure.⁵ These findings suggest that physical function may contribute differently to HAD according to the patient’s baseline level of ADL, whereas ICU-related factors may consistently influence HAD.

Study limitations include the retrospective single-center design and possible selection bias, as only patients able to undergo BIA at discharge were included. In addition, sarcopenia was assessed only at discharge, raising the possibility of reverse causation due to HAD-related inactivity and prolonged bed rest.

Conclusions

In patients with CVD and sarcopenia, factors associated with HAD differed according to prehospitalization ADL status. Physical function was associated with HAD primarily in the high-ADL group, whereas ICU stay was associated regardless of ADL level.

Disclosures

All authors declare that they have no conflicts of interest to disclose. T.T. is a member of Circulation Reports’ Editorial Team.

IRB Information

IRB approval was given by the Seirei Hamamatsu General Hospital Ethics Committee (Approval No. 4577).

Data Availability

The deidentified participant data will not be shared.