Is balance a marker of health status in patients with reduced left ventricular ejection fraction

Abstract

Abstract Funding Acknowledgements Type of funding sources: None. A significant percentage of patients hospitalized for the coronary disease have a decrease in left ventricular ejection fraction (LVEF), limiting their ability to perform their daily activities and increasing their dependence. Mobility is one of the most affected factors, namely postural balance, walking, transfers, hygiene care, among others. This fact can hinder the resolution of the underlying pathology, delay its resolution, facilitate the appearance of comorbidities, and cause prolonged hospitalization, causing a greater state of fragility. The implementation of measures that improve this dependence and fragility will hypothetically have effects on quality of life and prognosis. Exercise inertia is a well-defined cardiovascular (CV) risk factor, that causes greater physical dependence, greater frailty, and less responsiveness to disease. The authors consider that any improvement in this aspect will lead to a better CV prognosis. Purpose To assess the physical fitness of patients undergoing a phase I rehabilitation program to improve their cardiac condition Methods Longitudinal, prospective, and experimental study hospitalized for coronary disease. Physical fitness was evaluated: 1) dynamic balance and mobility (Fullerton test battery that already includes the 6-minute walk test and body composition), 2) upper body strength (handgrip strength test), 3) cardiorespiratory fitness, and 4) body composition. Morisky Medication Adherence Scale and STOP-Bang scale (Snoring, Tiredness, Observed apnea, high blood Pressure, Body mass index, Age, Neck circumference, and Gender) were also applied. The descriptive and inferential analysis was performed using the R version 4.2.2 program, all test results with p<0.05 are considered statistically significant. Results 65 patients were evaluated, with a median age of 63 and interquartile range (57, 72), of which 23% had LVEF≤40%; 86% had high blood pressure, 80% have dyslipidemia, 73% drank alcohol daily and only 23% practice regular physical exercise. When applying the Fullerton balance test, we found that: 74% cannot safely turn 360º, needing four or more steps in both directions; 92% cannot walk independently and without interruptions on a straight line on the ground; 74% cannot balance on one leg autonomously and maintain the position for 20 seconds. We also found that 68% had a high risk of sleep apnea (STOP-Bang scale). LVEF data were divided into classes (LVEF ≤40; LVEF 41-50; LVEF >50) and the association was evaluated using Fisher's exact test and Kruskal-Wallis test, and it was verified that there is a positive association between balance and LVEF (p-value = 0.2) and 6mTM and LVEF (p-value = 0.07). Conclusion The positive associations found between balance and mobility limitations in this sample suggest that specific programs may improve balance and, consequently, the patient's general state of health.