Prognostic Impact of Hospitalization-Associated Disability and Care Level in Older Heart Failure Patients　- Findings From the J-Proof HF Registry.

Background: Hospitalization-associated disability (HAD) is associated with poor prognosis in patients with heart failure (HF); however, the impact of HAD in older HF patients who require long-term care remains unclear. Therefore, the aim of this study was to determine the prognostic impact of the care level and HAD onset in older HF patients. Methods and Results: This study included 9,973 patients (mean age 82.6±7.7 years; 50.8% male) out of 10,062 older HF patients enrolled in a nationwide multicenter registry (Japanese Physical Therapy Multicenter Registry of Older Frail Patients With Heart Failure) for analysis. Patients were classified into 4 groups according to the level of care required under long-term care insurance (LTCI) during hospitalization. The level of care required was a risk factor for all-cause mortality and composite outcomes. In the HAD group, the adjusted hazard ratio for all-cause mortality increased with care level severity There was no interaction between the level of care required and HAD in relation to the outcomes. Conclusions: In older HF patients, both the level of care required and HAD are poor prognostic factors. In the HAD group, the level of care required is an important indicator for planning interventions to prevent poor outcomes under the LTCI system.