Associations of body mass index and hospital-acquired disability with post-discharge mortality in older patients with acute heart failure

OBJECTIVES To investigate the effect of hospital-acquired disability(HAD)on all-cause mortality after discharge according to the body mass index(BMI)in older patients with acute decompensated heart failure.METHODS We included 408 patients aged≥65 years who were hospitalized for acute decompensated heart failure and had undergone an acute phase of cardiac rehabilitation at the Sakakibara Heart Institute between April 2013 and September 2015(me-dian age:82 years,interquartile range(IQR):76-86;52%male).Patients were divided into three groups based on BMI at hospital admission:underweight(<18.5 kg/m^(2)),normal weight(18.5 to 25 kg/m^(2)),and overweight(≥25 kg/m^(2)).HAD was defined as a decrease of at least five points at discharge compared to before hospitalization according to the Barthel Index.RESULTS The median follow-up period was 475(IQR:292-730)days,and all-cause mortality during the follow-up period was 84 deaths(21%).According to multivariate Cox regression analysis,being underweight(HR:1.941,95%CI:1.134−3.321,P=0.016)or overweight(HR:0.371,95%CI:0.171−0.803,P=0.012),with normal BMI as the reference,and HAD(HR:1.857,95%CI:1.062−3.250,P=0.030)were independently associated with all-cause mortality.Patients with HAD exhibited a significantly lower cumulative survival rate in the underweight group(P=0.001)and tended to have a lower cumulative survival rate in the normal weight group(P=0.072).HAD was not significantly associated with cumulative survival in the overweight group(P=0.392).CONCLUSIONS BMI and HAD independently predicted all-cause mortality after discharge in older patients with acute de-compensated heart failure.Furthermore,HAD was significantly associated with higher all-cause mortality after discharge,espe-cially in the underweight group.