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Examination of independent predictors of discharge disposition in acute phase hospitalized heart failure patients undergoing phase I cardiac rehabilitation.

BACKGROUND
Increasing acute heart failure (HF) population is very common. Discharge disposition is one of the major cardiac rehabilitation (CR) outcomes. However, there were few data exist on home discharge criteria in acute phase HF patients who were underwent CR.


AIM
To clarify the predictors of home discharge in acute phase hospitalized HF patients who were underwent guideline-based CR.


DESIGN
Intervention study.


SETTING
Acute hospital.


POPULATION
Participants were 320 hospitalized acute phase HF patients who were underwent Japanese guideline-based CR.


METHODS
Knee extension strength (KES), exercise tolerance, Short Physical Performance Battery (SPPB), Barthel Index (BI), Mini-Mental State Examination (MMSE), and controlling nutritional status (CONUT) were evaluated on hospital admission and at hospital discharge, respectively. At hospital discharge, patients were divided into the Home group (n=255) and the Non-home group (n=65) based on discharge disposition. The independent predictors of home discharge and cut-off value were evaluated using logistic regression analysis and receiver operating curve.


RESULTS
At the time of hospital admission, KES, exercise tolerance, SPPB, BI, and MMSE is significantly higher in the Home group. However, there were no significant differences in HF severity and CONUT on hospital admission between the groups. At hospital discharge, KES, exercise tolerance, SPPB, BI, and MMSE were significantly higher and CONUT was significantly lower in the Home group than in the Non-Home group. Multivariate analysis showed KES and SPPB on hospital admission, length of hospital stay, and BI at hospital discharge were the independent predictors of home discharge. Cut-off values for predicting home discharge were KES on hospital admission ≥12.1kg, SPPB on hospital admission ≥3 points, and BI at hospital discharge ≥80 points.


CONCLUSIONS
The present study suggested that KES and SPPB on hospital admission may contributed to early detection of the patients who are difficult to return home. Additionally, there is a possibility that CR goal setting of BI ≥80 points is effective to home discharge in acute phase hospitalized HF patients.


CLINICAL REHABILITATION IMPACT
This study may contribute to early detection of the patients who are predicted to be difficult to return home and to appropriate rehabilitation goals setting.