Background: Early ambulation (EA) is associated with improved outcomes for mechanically ventilated and stroke patients. Whether the same association exists for patients hospitalized with acute heart failure is unknown. We sought to determine whether EA among patients hospitalized with heart failure is associated with length of stay, discharge disposition, 30-day post discharge readmissions, and mortality.

Methods and Results: The study population included 369 hospitals and 285 653 patients with heart failure enrolled in the Get With The Guidelines-Heart Failure registry. We used multivariate logistic regression with generalized estimating equations at the hospital level to identify predictors of EA and determine the association between EA and outcomes. Sixty-five percent of patients ambulated by day 2 of the hospital admission. Patient-level predictors of EA included younger age, male sex, and hospitalization outside of the Northeast (P<0.01 for all). Hospital size and academic status were not predictive. Hospital-level analysis revealed that those hospitals with EA rates in the top 25% were less likely to have a long length of stay (defined as >4 days) compared with those in the bottom 25% (odds ratio, 0.83; confidence interval, 0.73–0.94; P=0.004). Among a subgroup of fee-for-service Medicare beneficiaries, we found that hospitals in the highest quartile of rates of EA demonstrated a statistically significant 24% lower 30-day readmission rates (P<0.0001). Both end points demonstrated a dose–response association and statistically significant P for trend test.

Conclusions: Multivariable-adjusted hospital-level analysis suggests an association between EA and both shorter length of stay and lower 30-day readmissions. Further prospective studies are needed to validate these findings.

背景：对于机械通气和中风患者，早期移动（EA）与改善预后相关。对于住院的急性心力衰竭患者是否存在相同的关联性尚不清楚。我们试图确定心力衰竭住院患者的EA是否与住院时间，出院安排，出院后30天再入院率和死亡率相关。

方法和结果：研究人群包括369所医院和285 653名心力衰竭患者，他们被纳入Get With the Guidelines-Heart Failure注册中心。我们在医院一级使用带有广义估计方程的多元逻辑回归分析来确定EA的预测因素，并确定EA与结局之间的关联。在住院第二天，有百分之六十五的患者走动。EA的患者水平预测因素包括年龄较小，男性和东北地区以外的地方住院（P<0.01）。医院规模和学业状况无法预测。医院级分析显示，EA比率最高的25％的医院的住院时间较长（定义为> 4天）的可能性要比底部25％的医院（优势比为0.83；置信区间为0.73–0.94；P = 0.004）。在付费服务的医疗保险受益人亚组中，我们发现，最高EA率四分位数的医院在30天内的再入院率上具有统计学意义的降低24％（P <0.0001）。两个终点均显示出剂量-反应相关性和趋势检验的统计学显着性P。

结论：经过多变量调整的医院水平分析表明，EA与较短的住院时间和较低的30天再入院率相关。需要进一步的前瞻性研究来验证这些发现。