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Dysphagia and malnutrition limit activities of daily living improvement in phase i cardiac rehabilitation: a prospective cohort study for acute phase heart failure patients

Heart and Vessels volume 36, pages 1306–1316 (2021)Cite this article

Abstract

Dysphagia and malnutrition combinations in hospitalized patients with acute heart failure (AHF) may affect activities of daily living (ADL) after hospital discharge more than dysphagia or malnutrition alone. The aim of the present study to clarify the impact of the combination of dysphagia and malnutrition on ADL in hospitalized patients with acute phase heart failure who have undergone cardiac rehabilitation (CR). Prospective cohort study. Acute care hospital. Participants were 224 AHF patients undergoing CR. Barthel index (BI), functional oral intake scale (FOIS), controlling nutritional status (CONUT), short physical performance battery (SPPB), and mini-mental state examination were evaluated at baseline. We examined primary effects of predictors (CONUT) and the moderator (FOIS) and the interaction effect of FOIS and CONUT (FOIS × CONUT) using hierarchical linear regression model and simple-slope tests. The ADL independence dropped in 29.5% of the patients on hospitalization; however, 82.6% of the patients successfully regained their independence at discharge. Based on the FOIS score and nutritional status on admission, 58.5% of the patients were classified into the non-dysphagia and non-malnutrition categories, 21.0% into non-dysphagia and malnutrition, 15.2% into dysphagia and non-malnutrition, and 5.3% into dysphagia and malnutrition. Lower FOIS and SPPB scores as well as the FOIS × CONUT interaction predicted a significantly lower BI but not CONUT. Simple slope test revealed a negative association between CONUT and BI with low-level FOIS (B =  − 2.917, P < .001) but not with high-level FOIS (B = .476, P = .512). Thus, patients with dysphagia and malnutrition in combination had a greater risk of failed recovery of ADL after cardiac rehabilitation than those without this combination. In hospitalized AHF patients, FOIS and CONUT had an interactive effect on BI at hospital discharge in cases with low-level FOIS. Early detection of dysphagia might improve the accurate identification of hospitalized AHF patients at higher risk of ADL dependence at discharge.

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Acknowledgements

The authors gratefully acknowledge the participation of all study patients and thank all colleagues in our department for their contribution to the medical care of the patients. We would also like to thank Editage (www.editage.jp) for English language editing.

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Affiliations

  1. Department of Internal Medicine and Rehabilitation Science, Tohoku University Graduate School of Medicine, Sendai, Japan

    Junichi Yokota

  2. Department of Clinical Research, National Hospital Organization Sendai Medical Center, Sendai, Japan

    Junichi Yokota

  3. Division of Comprehensive Rehabilitation Sciences, Hirosaki University Graduate School of Health Sciences, 66-1, Hon-cho, Hirosaki, Aomori, 036-8564, Japan

    Junichi Yokota & Ryunosuke Endo

  4. Department of Rehabilitation, National Hospital Organization Sendai Medical Center, Sendai, Japan

    Ren Takahashi, Yuko Matsukawa & Keisuke Matsushima

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  1. Junichi Yokota
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  2. Ryunosuke Endo
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Correspondence to Junichi Yokota.

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Yokota, J., Endo, R., Takahashi, R. et al. Dysphagia and malnutrition limit activities of daily living improvement in phase i cardiac rehabilitation: a prospective cohort study for acute phase heart failure patients. Heart Vessels 36, 1306–1316 (2021). https://doi.org/10.1007/s00380-021-01814-1

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Keywords

  • Cardiac rehabilitation
  • Dysphagia
  • Malnutrition
  • Heart failure
  • Activities of daily living