Background:A strategy to predict mortality in elderly heart failure (HF) patients has not been established.

Methods and Results:We retrospectively enrolled 413 HF patients aged ≥65 years (mean age 78 years) who had received comprehensive cardiac rehabilitation (CR) during hospitalization. Basic activities of daily life were assessed before discharge using the Barthel index (BI). Of 413 HF patients, 116 (28%) died during a median follow-up period of 1.90 years (interquartile range 1.20–3.23 years). An adjusted dose-dependent association analysis showed that the hazard ratio (HR) of mortality increased in an almost linear manner as the BI score decreased, and that a BI score of 85 corresponded to an HR of 1.0. Kaplan-Meier survival curves showed that the survival rate was lower for patients with a low BI (<85) than for those with a high BI (≥85; 65% vs. 74%, respectively; P=0.007). In multivariate Cox regression analyses, low BI was independently associated with higher mortality after adjusting for predictors, including B-type natriuretic peptide. Inclusion of the BI into the adjusted model improved the accuracy of the prediction of mortality.

Conclusions:A BI score <85 at the time of discharge is associated with increased mortality independent of known prognostic markers, and achieving functional status with a BI score ≥85 by comprehensive CR during hospitalization may contribute to favorable outcomes in elderly HF patients.

背景：尚未建立预测老年心力衰竭 (HF) 患者死亡率的策略。

方法和结果：我们回顾性招募了 413 名 65 岁以上（平均年龄 78 岁）住院期间接受综合心脏康复 (CR) 的 HF 患者。出院前使用 Barthel 指数 (BI) 评估日常生活的基本活动。在 413 名 HF 患者中，116 名（28%）在中位随访 1.90 年（四分位距 1.20-3.23 年）期间死亡。调整后的剂量依赖性关联分析表明，死亡率的风险比 (HR) 随着 BI 评分的降低以几乎线性的方式增加，并且 BI 评分为 85 对应于 HR 为 1.0。Kaplan-Meier 生存曲线显示，低 BI（<85）患者的生存率低于高 BI 患者（≥85；分别为 65% 和 74%；P=0.007）。在多元 Cox 回归分析中，在调整预测因子（包括 B 型利钠肽）后，低 BI 与较高的死亡率独立相关。将 BI 纳入调整后的模型提高了死亡率预测的准确性。

结论：出院时 BI 评分 <85 与死亡率增加相关，独立于已知的预后标志物，住院期间通过综合 CR 达到 BI 评分≥85 的功能状态可能有助于老年 HF 患者的良好预后。