Abstract
ObjectiveReduced functional capacity is a hallmark of early pre-clinical stages of heart failure (HF). The Short Physical Performance Battery (SPPB) is a valid measure of lower extremity physical function, has relatively low implementation burden, and is associated with cardiovascular disease and mortality. However, the SPPB-HF association is understudied in older women among whom HF burden is high. MethodsWomen (n = 5325; mean age 79 ± 7 years; 34% Black, 18% Hispanic, and 49% White) without prior HF completed the SPPB consisting of standing balance, strength, and walking tests that were summarized as a composite score from 0 (lowest) to 12 (highest), categorized as very low (0–3), low (4–6), medium (7–9), or high (10–12). Participants were followed for up to 8 years for incident HF (306 cases identified). Cox proportional hazards regression estimated hazard ratios (HR) adjusting for age, race/ethnicity, education, smoking, alcohol, diabetes, hypertension, COPD, osteoarthritis, depression, BMI, systolic blood pressure, lipids, glucose, and accelerometer-measured moderate-vigorous physical activity (MVPA) and sedentary time. ResultsIncident HF cases (crude rate per 1000 person-years) in the four SPPB categories (very low to high) were 34 (26.0), 79 (14.5), 128 (9.3), and 65 (5.6). Corresponding multivariable-adjusted HRs (95% CIs) were 2.22 (1.34–3.66), 1.63 (1.11–2.38), 1.39 (1.00–1.94), and 1.00 (referent; P-trend<0.001). Higher HF risk was associated with lower SPPB in women with major modifiable HF risk factors including obesity (HR per 3-unit SPPB decrement: present HR = 1.41, absent HR = 1.41), hypertension (present HR = 1.45, absent HR = 1.30), diabetes (present HR = 1.32, absent HR = 1.44), and lower accelerometer-measured MVPA (<45 min/day HR = 1.29, ≥45 min/day HR = 1.60); all P-interaction>0.10. ConclusionLower SPPB scores were associated with greater risk of incident HF in older women even after accounting for differences in HF risk factors and objectively measured PA. Implementing the SPPB in clinical settings could potentially enhance individual-level HF risk assessment, which should be further explored.
Highlights
Heart failure is a major public health challenge that increases morbidity, mortality, and healthcare costs [1]
We examined whether the Short Physical Performance Battery (SPPB)-heart failure association differed by age, body mass index (BMI), cardiovascular disease risk based on the Reynolds Risk Score, physical activity, diabetes, hypertension, and race/ethnicity
Compared to women with very low SPPB scores (0–3), those with high SPPB scores (10–12) were younger, were more likely to be of Hispanic/Latina ethnicity, were more likely to be a college graduate, were less likely to consume alcohol, had a lower BMI, were more likely to report excellent or very good health, and were less likely to have a history of treated diabetes or hypertension, chronic obstructive pulmonary disease (COPD), osteoarthritis, or depression
Summary
Heart failure is a major public health challenge that increases morbidity, mortality, and healthcare costs [1]. Heart failure prevalence is estimated to be 3.9% in women aged 60-79 and 11.0% in women aged 80 or older [1]. From 2011–2017, deaths from heart failure increased by 38%, and the estimated lifetime risk of heart failure from age 45 to 95 was 32–39% in White women and 24–46% in Black women [1,2]. Higher SPPB scores have been consistently associated with lower risks of allcause and cardiovascular mortality and with incident cardiovascular disease events [5,6]. The extent to which SPPB is related to incident heart failure is understudied [7]. There have been relatively few studies in racially/ethnically diverse older women, among whom heart failure risk is high [1]
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