Abstract 12535: Decreased Six-Minute Walk Distance at Hospital Discharge, Its Cut-off Value of 370 Meters, is an Independent Predictor for Poor Activities of Daily Living After Discharge in Elderly Patients With Chronic Heart Failure

Abstract

Background: Elderly patients with chronic heart failure (CHF) is well known to have poor activities of daily living (ADL) after hospital discharge because of their prolonged hospital stays and subsequent physical deconditioning. Although many studies demonstrated that decreased six-minute walk distance (6MWD) was an independent predictor of rehospitalization and mortality in them, the relationship between decreased 6MWD and poor ADL is not thoroughly evaluated. The purpose of this study was to investigate whether decreased 6MWD measured at hospital discharge reflected poor ADL after discharge in elderly patients with CHF. Methods: We recruited 290 patients, 179 males and 111 females, who were 65 years or more and admitted to our hospital because of first heart failure. We excluded the patients who had needed assistance with ADL or walking aid before admission. Plasma brain natriuretic peptide, left ventricular ejection fraction, 6MWD and motor functions including isometric quadriceps strength and one-leg standing time were measured at hospital discharge. ADL was evaluated using the performance measure for ADL-8 (PMADL-8) 3 months after discharge, while PMADL-8 score of 20 or more indicated poor ADL. To determine significant predictors affecting poor ADL and their cut-off values, a multivariate logistic regression analysis and the area under the receiver operating characteristics (ROC) curve were performed. Results: Patients’ mean age was 75.4 ± 6.4 years old and their mean PMADL-8 and 6MWD were 18.9 ± 5.9 points and 379 ± 109 meters, respectively. The univariate logistic regression analysis showed that age, 6MWD, quadriceps strength, one-leg standing time were significant predictors for PMADL-8 of ≥20 points (P<0.05, respectively). The multivariate logistic regression analysis detected only 6MWD as a significant and independent predictor for PMADL-8 of ≥20 points (P<0.001). The odds ratio of poor ADL was 1.16 (95% confidence interval: 1.10-1.25, P<0.001) with each 10-meter decrease of 6MWD. The ROC curve showed 370 meters as a cut-off value of 6MWD. Conclusions: Decreased 6MWD at hospital discharge was identified as an independent strong predictor for poor ADL after discharge in elderly patients with CHF, and its cut-off value was 370 meters.