Variance analysis of rehabilitation progress in clinical pathway predicts poor prognoses for patients with heart failure

Abstract

　Early initiation of rehabilitation reduces the rate of rehospitalization and death and improves prognoses for patients with heart failure. We performed a retrospective study to evaluate the rate of rehospitalization for worsening heart failure and death during a median 111-day period after discharge using a variance analysis of rehabilitation progress with the sentinel method. One hundred three patients were divided into two groups according to the occurrence of rehospitalization for worsening heart failure and death (event group: n=22; non-event group: n=81) using the clinical pathway. “Able to walk 50 m” was set as one of the outcomes on the fifth day of hospitalization. Factors investigated included CONUT score, GNRI and blood test results.

　“Unable to walk 50 m” on the fifth day of hospitalization, higher BNP and higher CONUT score were associated with higher event occurrence rates. Using multivariate logistic regression analysis, only “unable to walk 50 m” on the 5th day of hospitalization was associated with event occurrence (p=0.027, OR 6.02, 95% CI 1.22–29.66). Kaplan-Meier curves showed that the “unable to walk 50 m” group had a significantly higher event rate (log-rank test, p=0.001). Using multivariate analysis, lower GNRIs and lower Barthel Indices were associated with the inability to walk 50 m on the fifth day of hospitalization.

　In conclusion, a variance analysis of rehabilitation progress in the clinical pathway predicts poor prognoses for patients with heart failure. Multi-disciplinary team care should be introduced at the outset of hospitalization and early ambulation should be encouraged.