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Physical Function, Frailty, Cognition, Depression, and Quality of Life in Hospitalized Adults ≥60 Years With Acute Decompensated Heart Failure With Preserved Versus Reduced Ejection Fraction: Insights From the REHAB-HF Trial
Open accessAbstract
Background: Older hospitalized acute decompensated heart failure (HF) patients have persistently poor outcomes and delayed recovery regardless of ejection fraction (EF). We hypothesized that impairments in physical function, frailty, cognition, mood, and quality of life (QoL) potentially contributing to poor clinical outcomes would be similarly severe in acute decompensated HF patients ≥60 years of age with preserved versus reduced EF (HFpEF and HFrEF). Methods and Results: In 202 consecutive older (≥60 years) hospitalized acute decompensated HF patients in a multicenter trial, we prospectively performed at baseline: short physical performance battery, 6-minute walk distance, frailty assessment, Geriatric Depression Scale, Montreal Cognitive Assessment, and QoL assessments. Older acute decompensated HFpEF (EF ≥45%, n=96) and HFrEF (EF <45%, n=106) patients had similar impairments in all physical function measures (short physical performance battery [5.9±0.3 versus 6.2±0.2]; 6-minute walk distance [184±10 versus 186±9 m]; and gait speed [0.60±0.02 versus 0.61±0.02 m/s]) and rates of frailty (55% versus 52%; P =0.70) and cognitive impairment (77% versus 81%; P =0.56) when adjusted for differences in sex, body mass index, and comorbidities. However, depression and QoL were consistently worse in HFpEF versus HFrEF. Depression was usually unrecognized clinically with 38% having Geriatric Depression Scale ≥5 and no documented history of depression. Conclusions: Patients ≥60 years hospitalized with acute decompensated HF patients have broad, marked impairments in physical function and high rates of frailty and impaired cognition: these impairments are similar in HFpEF versus HFrEF. Further, depression was common and QoL was reduced, and both were worse in HFpEF than HFrEF. Depression was usually unrecognized clinically. These findings suggest opportunities for novel interventions to improve these important patient-centered outcomes. Clinical Trial Registration: URL: https://www.clinicaltrials.gov . Unique identifier: NCT02196038.
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“Patients with heart failure with preserved ejection fraction have an especially high burden of symptoms and physical limitations, as well as a poor quality of life. 2,19,20”
From Semaglutide in Patients with Heart Failure with Preserved Ejection Fraction and Obesity (2023) · cites this paper as [20]
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Self-citationFrailty Among Older Decompensated Heart Failure Patients
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“reduced ejection fraction [EF; HF with preserved ejection fraction (HFpEF) and HF with reduced ejection fraction (HFrEF)] when adjusted for sex, body mass index (BMI), and comorbidities (26).”
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Cognitive impairment in myocardial infarction and heart failure
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“96 In older adults with HF, CI is underdiagnosed, with only 48.5% of those with CI having a CI diagnosis documented by physicians.”
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Self-citationThe importance of physical activity and cardiorespiratory fitness for patients with heart failure
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“Patients with both HF and depression have worse physical and functional impairments (9).”
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“The findings of this study demonstrated that slowness and weakness were particularly strong factors and that stratification with the two factors and exhaustion and physical inactivity was associated with the prognosis in patients with HF.”
MethodInfluentialHamada, T., Kubo, T., Kawai, K., Nakaoka, Y., Yabe, T., Furuno, T., Yamada, E., Kitaoka, H., & study, K. Y. (2022) · ESC Heart Failure · doi:10.1002/ehf2.13885 · Cited by 37
“It has been reported that cardiac rehabilitation according to the individual domain of impaired physical function effectively improved physical function.25 Guideline-directed medical therapy and non-pharmacotherapy such as cardiac resynchronization therapy have been established for treatment of HFrEF.26 Recently, the…”
BackgroundResultInfluentialCharacteristics and Outcomes of Heart Failure with Recovered Left Ventricular Ejection Fraction
Zhang, X., Sun, Y., Zhang, Y., Chen, F., Dai, M., Si, J., Yang, J., Li, X., Li, J., Xia, Y., et al. (2021) · ESC Heart Failure · doi:10.1002/ehf2.13630 · Cited by 35
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“On a physiological level, depression can adversely affect patients’ cognitive functions, including memory, attention, cognitive sequencing ability, and information processing speed, which reduces the quality of life of hospitalized patients [59, 60].”
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Impaired Balance and Gait Characteristics in Patients With Chronic Heart Failure
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“Notably, patients with HFpEF bear an extremely debilitating symptoms and physical limitations [6].”
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“[14] In addition, after adjusting for covariates, the nurse-led program was associated with better MHS and QOL.”
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“…HF show poor compliance to self-care activities and engage in additional risks, such as smoking, sedentary lifestyle, and poor diet, which may lead to an increased risk of physical frailty and cognitive impairment (Gathright et al., 2017; Son & Seo, 2018) and vice versa (Warraich et al., 2018).”
BackgroundRecent Advances in Microbiota-Associated Metabolites in Heart Failure
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“Impairments in physical function and cognition, depression and reduced quality of life (QoL) is severely marked in older acute decompensated heart failure patients above 60 years of age [21].”
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“9 The current report also includes the following post hoc analyses: (1) evaluation of the effect of torsemide versus furosemide on KCCQ-CSS by subgroup, including LVEF phenotype, New York Heart Association class at randomization, and loop diuretic agent before index hospitalization; (2) effect of torsemide versus furo…”
MethodSelf-citationMultidomain Frailty in Heart Failure: Current Status and Future Perspectives
Tanaka, S., Yamashita, M., Saito, H., Kamiya, K., Maeda, D., Konishi, M., & Matsue, Y. (2021) · Current Heart Failure Reports · doi:10.1007/s11897-021-00513-2 · Cited by 26
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“***P 0.0167 comparison between HFpEF and HFrEF.”
ResultInfluentialCognitive Dysfunction in Heart Failure: Pathophysiology and Implications for Patient Management
Ye, S., Huynh, Q. L., & Potter, E. L. (2022) · Current Heart Failure Reports · doi:10.1007/s11897-022-00564-z · Cited by 21
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Prefrailty, impairment in physical function, and risk of incident heart failure among older adults
Segar, M. W., Singh, S., Goyal, P., Hummel, S. L., Maurer, M. S., Forman, D. E., Butler, J., & Pandey, A. (2021) · Journal of the American Geriatrics Society · doi:10.1111/jgs.17218 · Cited by 21
“Frailty is a state of increased vulnerability to endogenous and exogenous stress factors, resulting from decreased physiological reserves and dysfunction and dysregulation of multiple systems, which interfere with homeostasis and response to stress.(21,33) Importantly, it is a continuum characterized by an earlier pot…”
BackgroundMassussi, M., Bellicini, M. G., Adamo, M., Pilotto, A., Metra, M., Padovani, A., & Proietti, R. (2024) · ESC Heart Failure · doi:10.1002/ehf2.15144 · Cited by 23
“30 The link between LVEF and cognitive function may be nonlinear, suggesting a potentially exponential association, with a stronger impact observed at lower LVEF levels compared to higher ones.”
Rehman, A., Saidullah, S., Asad, M. B., Gondal, U. R., Ashraf, A., Khan, M. F., Akhtar, W., Mehmoodi, A., & Malik, J. (2024) · Clinical Cardiology · doi:10.1002/clc.24283 · Cited by 22
Psychological Disorders in Heart Failure
Palo, K. E. D. (2019) · Heart Failure Clinics · doi:10.1016/j.hfc.2019.08.011 · Cited by 20
Ovchinnikov, A. G., Potekhina, A. V., Filatova, A. Y., Николаевна, С. О., Zherebchikova, K., Ageev, F. T., & Belyavskiy, E. (2025) · Cardiovascular Diabetology · doi:10.1186/s12933-025-02756-y · Cited by 18
“Nevertheless, geriatric patients with HF have a high risk of developing frailty, cognitive and physical impairment, depression [29], which can make it challenging to perform the 6MWTD.”
Sladen, R. N., Shulman, M. A., Javaid, A., Hodgson, C. L., Myles, P. S., McGiffin, D. C., Nakagawa, S., Amlani, A., Hupf, J. C., Takeda, K., et al. (2021) · Journal of Cardiac Failure · doi:10.1016/j.cardfail.2021.07.019 · Cited by 18
Depressive Symptoms and Incident Hospitalization for Heart Failure: Findings From the REGARDS Study
Khodneva, Y. A., Goyal, P., Levitan, E. B., Jackson, E. A., Oparil, S., Sterling, M. R., Cherrington, A., Durant, R. W., & Safford, M. M. (2022) · Journal of the American Heart Association · doi:10.1161/jaha.121.022818 · Cited by 17
Hearing Loss and Physical Functioning Among Adults with Heart Failure: Data from NHANES
Cosiano, M. F., Jannat‐Khah, D., Lin, F. R., Goyal, P., McKee, M. M., & Sterling, M. R. (2020) · Clinical Interventions in Aging · doi:10.2147/cia.s246662 · Cited by 17
Heart failure and depression: A perspective from bibliometric analysis
Lam, M. I., Chen, P., Xie, X., Lok, K.-I., Liu, Y.-F., Si, T. L., Ungvari, G. S., Ng, C. H., & Xiang, Y. (2023) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2023.1086638 · Cited by 17
McNally, T. P., Tumelty, E. H., Chung, I., Hussain, S., Mookerjee, S., Ali, M. A., Anderson, L., Rosano, G. M. C., & Banerjee, D. (2024) · ESC Heart Failure · doi:10.1002/ehf2.14693 · Cited by 16
“27 However, these studies have been limited in small populations and have considered patients living with either CKD or HF, not both.”
InfluentialVu, K., Claggett, B., John, J., Skali, H., Solomon, S., Mosley, T., Williams, J. E., Kucharska-Newton, A., Biering-Sørensen, T., & Shah, A. (2021) · Journal of the American Heart Association : Cardiovascular and Cerebrovascular Disease · doi:10.1161/jaha.120.020094 · Cited by 15
“Men, n (%) 928 (47) 377 (44) 401 (37) 279 (32) 92 (32) 0.”
Justice, J. N., Pajewski, N. M., Espeland, M. A., Brubaker, P. H., Houston, D. K., Marcovina, S. M., Nicklas, B. J., Kritchevsky, S. B., & Kitzman, D. W. (2022) · GeroScience · doi:10.1007/s11357-021-00509-9 · Cited by 16
“Moreover, > 90% of hospitalized obese HFpEF patients meet criteria for pre-frail (48%) or frailty (50%), and have poorer physical and cognitive function, and greater rates of depression [41, 42].”
BackgroundSelf-citationPatient-Reported Frailty and Functional Status in Heart Failure With Preserved Ejection Fraction
Kaul, P., Rathwell, S., Lam, C. S. P., Westerhout, C. M., Spertus, J. A., Anstrom, K. J., Blaustein, R. O., Ezekowitz, J. A., Pieske, B. M., Roessig, L., et al. (2023) · JACC Heart Failure · doi:10.1016/j.jchf.2022.11.015 · Cited by 15
The concurrent impact of mild cognitive impairment and frailty syndrome in heart failure
Uchmanowicz, I., Rosano, G. M. C., Piepoli, M. F., Vellone, E., Czapla, M., Lisiak, M., Diakowska, D., Prokopowicz, A., Aleksandrowicz, K., Nowak, B., et al. (2023) · Archives of Medical Science · doi:10.5114/aoms/162369 · Cited by 16
“It was also shown that cardiac comorbidities are more likely in HFrEF, but non-cardiac comorbidities are more probable in HFpEF [56].”
ResultInfluentialXu, J., Xiang, L., Zhang, H., Sun, X., Xu, D., Wu, D., Chen, C., Zhang, Y., & Gu, Z. (2024) · BMC Cardiovascular Disorders · doi:10.1186/s12872-024-03753-x · Cited by 15
“Previous studies indicated that CF could be reversible [13], thus, identifying and responding to risk factors for CF can help to slow down or even reverse its progression.”
BackgroundInvestigating the Interplay between Cardiovascular and Neurodegenerative Disease
Cousineau, J., Dawe, A. M., & Alpaugh, M. (2024) · Biology · doi:10.3390/biology13100764 · Cited by 15
Kitamura, M., Izawa, K. P., Ishihara, K., Yaekura, M., Nagashima, H., Yoshizawa, T., & Okamoto, N. (2020) · Heart and Vessels · doi:10.1007/s00380-020-01718-6 · Cited by 15
Cornelissen, V., Hanssen, H., Hurst, C., Knaier, R., Marqués‐Sulé, E., Moholdt, T. T., Neunhäeuserer, D., Norman, K., Pedretti, R. F. E., Salzwedel, A., et al. (2025) · European Journal of Preventive Cardiology · doi:10.1093/eurjpc/zwaf432 · Cited by 14
Managing Older Patients with Heart Failure Calls for a Holistic Approach
Wiersinga, J. H. I., Rhodius‐Meester, H. F. M., Kleipool, E. E. F., Handoko, M. L., van Rossum, A. C., Liem, S., Trappenburg, M. C., Peters, M. J. L., & Muller, M. (2021) · ESC Heart Failure · doi:10.1002/ehf2.13292 · Cited by 14
“When comparing our results with studies in hospitalized settings, prevalence of geriatric domains seems to be less prevalent and less severe in the outpatient HF population.(19,20) This is in line with our expectations that an outpatient population is in better health than those hospitalized.”
ResultEffects of Sotagliflozin on Health Status in Patients With Worsening Heart Failure
Bhatt, A. S., Bhatt, D. L., Steg, P. G., Szarek, M. J., Cannon, C. P., Leiter, L. A., McGuire, D. K., Lewis, J. B., Riddle, M. C., Voors, A. A., et al. (2024) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2024.06.036 · Cited by 14
Toyoshima, K., Seino, S., Tamura, Y., Ishikawa, J., Chiba, Y., Ishizaki, T., Fujiwara, Y., Shinkai, S., Kitamura, A., & Araki, A. (2022) · The journal of nutrition health & aging · doi:10.1007/s12603-022-1786-8 · Cited by 14
“HDL-C‡ (mg/dl) 57 [26, 127] 59 [31, 127] 57[26, 125] 0.”
Scrutinio, D., Guida, P., Passantino, A., Scalvini, S., Bussotti, M., Forni, G., Tibollo, V., Vaninetti, R., & Rovere, M. T. L. (2022) · International Journal of Cardiology · doi:10.1016/j.ijcard.2022.01.040 · Cited by 13
Forsyth, F., Mulrennan, S., Burt, J., Hartley, P., Kuhn, I. L., Lin, H., Mant, J., Tan, S., Zhang, R., & Deaton, C. (2022) · European Journal of Cardiovascular Nursing · doi:10.1093/eurjcn/zvac062 · Cited by 13
Chew, D. S., Li, Y., Zeitouni, M., Whellan, D. J., Kitzman, D. W., Mentz, R. J., Duncan, P. W., Pastva, A. M., Reeves, G. R., Nelson, M. B., et al. (2021) · JAMA Cardiology · doi:10.1001/jamacardio.2021.4836 · Cited by 12
Self-citationJiang, Y., Wang, L., Lu, Z., Chen, S., Teng, Y., Li, T., Li, Y., Xie, Y., & Zhao, M. (2022) · Frontiers in Cardiovascular Medicine · doi:10.3389/fcvm.2021.838680 · Cited by 15
“Similar results were obtained from the other two observational studies (33, 36).”
ResultZheng, P., Yao, S.-M., Shi, J. C., Wan, Y., Guo, D., Cui, L.-L., Sun, N. L., Wang, H., & Yang, J.-F. (2020) · Frontiers in Cardiovascular Medicine · doi:10.3389/fcvm.2020.607439 · Cited by 12
“However, previous studies have mainly focused on frailty and acute HF (13), chronic HF (14), and HF with reduced or preserved ejection fraction (13)—that is, frailty and stage C/D HF rather than stage A/B HF.”
BackgroundSaka, K., Konishi, M., Kagiyama, N., Kamiya, K., Saito, H., Saito, K., Ogasahara, Y., Maekawa, E., Misumi, T., Kitai, T., et al. (2021) · Experimental Gerontology · doi:10.1016/j.exger.2021.111626 · Cited by 12
Zhang, G., Cui, J., Zhang, X., Chair, S. Y., Liu, W. Y., Liu, Y. J., Cheng, Y. X., Liu, Q., Yang, B. X., & Zou, H. (2024) · European Journal of Cardiovascular Nursing · doi:10.1093/eurjcn/zvae030 · Cited by 14
Alnsasra, H., Khalil, F. M., Perue, R. K., & Azab, A. N. (2023) · International Journal of Molecular Sciences · doi:10.3390/ijms241411270 · Cited by 14
Predicting post-LVAD outcome: Is there a role for cognition?
Pavol, M. A., Boehme, A. K., Willey, J. Z., Festa, J. R., Lazar, R. M., Nakagawa, S., Casida, J. M., yuzefpolskaya, M., & Colombo, P. C. (2020) · The International Journal of Artificial Organs · doi:10.1177/0391398820956661 · Cited by 11
Cardiac Rehabilitation in Older Adults with Heart Failure
Flint, K. M., Pastva, A. M., & Reeves, G. R. (2019) · Clinics in Geriatric Medicine · doi:10.1016/j.cger.2019.07.008 · Cited by 11
Self-citationWhellan, D. J., McCarey, M. M., Chen, H., Nelson, M. B., Pastva, A. M., Duncan, P. W., Mentz, R. J., Kitzman, D. W., Reeves, G. R., & Reed, S. D. (2022) · Circulation Heart Failure · doi:10.1161/circheartfailure.122.009695 · Cited by 10
Self-citationMatsuo, T., Morisawa, T., Yamamoto, S., Nyuba, K., Maehata, M., Fujii, D., Iwaki, H., Ueno, K., IWATA, K., Saitoh, M., et al. (2023) · Heart and Vessels · doi:10.1007/s00380-023-02310-4 · Cited by 10
“A certain number of patients hospitalized for cardiovascular disease do not recover their ADL to that of their prehospital state due to HAD in addition to advanced age [7], frailty [8, 9], and multi-morbidities.”
Tele-rehabilitation for Type II diabetics with heart failure with preserved ejection fraction
Yuan, M., Xu, H., Zhao, D., Shi, D., Su, L., Zhu, H., Lu, S., & Wei, J. (2024) · Frontiers in Endocrinology · doi:10.3389/fendo.2024.1433297 · Cited by 10
Geriatric Vulnerabilities Among Adults With Heart Failure With Preserved Ejection Fraction
Goyal, P., Zainul, O., Sharma, Y., Reich, A., Osma, P., Lau, J. D., Massou, E., Turchioe, M. R., Russell, D., Creber, R. M., et al. (2025) · JACC Advances · doi:10.1016/j.jacadv.2025.101602 · Cited by 13
Physical Functioning in Heart Failure With Preserved Ejection Fraction
Cosiano, M. F., Tobin, R. S., Mentz, R. J., & Greene, S. J. (2021) · Journal of Cardiac Failure · doi:10.1016/j.cardfail.2021.04.013 · Cited by 10
Self-citationKolben, Y., Kessler, A., Puris, G., Nachman, D., Alvarez, P. A., Briasoulis, Α., & Asleh, R. (2022) · Reviews in Cardiovascular Medicine · doi:10.31083/j.rcm2301016 · Cited by 11
Geriatric Domains in Patients with Heart Failure with Preserved Ejection Fraction
Goyal, P., Zainul, O., Marshall, D., & Kitzman, D. W. (2022) · Cardiology Clinics · doi:10.1016/j.ccl.2022.06.006 · Cited by 10
Self-citationKeeney, T., Lake, D. T., Varma, H., Resnik, L. J., Teno, J. M., Grabowski, D. C., & Gozalo, P. L. (2022) · Journal of the American Geriatrics Society · doi:10.1111/jgs.18109 · Cited by 10
“Consequently, the functional decline is more pronounced among patients with frailty at admission(17) and is prevalent among patients who discharge home.(18) Prior estimates of PAC use following HF hospitalization vary by population, data source, and studies have not evaluated how utilization is impacted by frailty sta…”
BackgroundArmentaro, G., Condoleo, V., Pelaia, C., Cassano, V., Miceli, S., Maio, R., Salzano, A., Pelle, M. C., Perticone, M., Succurro, E., et al. (2022) · Internal and Emergency Medicine · doi:10.1007/s11739-022-03130-6 · Cited by 10
“Therefore, this evidence suggests need for more suitable interventions to improve these crucial patient-centered outcomes [59].”
Background
Metadata
- Authors
- Warraich, H. J., Kitzman, D. W., Whellan, D. J., Duncan, P. W., Mentz, R. J., Pastva, A. M., Nelson, M. B., Upadhya, B., & Reeves, G. R.
- Affiliations
- Duke University (US)
- Wake Forest University Health Sciences (US)
- Thomas Jefferson University (US)
- Atrium Health Wake Forest Baptist (US)
- ORCID
- Venue
- Circulation: Heart Failure
- Published
- 2018-11
- Volume
- 11
- Issue
- 11
- Pages
- e005254-e005254
- ISSN
- 1941-3289 (ISSN-L)
- 1941-3297
- PMC
- PMC6380360
- OpenAlex
- W2900728651
- Cited by
- 194
- References
- 55
- Citations by year
- 2026: 14 · 2025: 20 · 2024: 30 · 2023: 34 · 2022: 36 · 2021: 28 · 2020: 22 · 2019: 9 · 2018: 1
- FWCI
- 11.33
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Circulation Heart Failure (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health (UL1TR001420, KL2TR001421)
- National Institute on Aging (R01AG018915, R01AG045551, P30AG021332, U24AG059624, P30AG028716)
- National Center for Advancing Translational Sciences
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Failure Treatment and Management
- Health Sciences › Medicine › Geriatrics and Gerontology › Frailty in Older Adults
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Function and Risk Factors
- Keywords
- acute decompensated heart failure, heart failure with preserved ejection fraction, heart failure with reduced ejection fraction, older adults, physical function, frailty, cognitive impairment, depression, quality of life, hospitalized patients, Short Physical Performance Battery, 6-minute walk distance, walking speed, patient-centered outcomes
- MeSH terms
- Adult, Aged, Aged, 80 and over, Cognition, Depression, Female, Heart Failure, Hospitalization, Humans, Male, Middle Aged, Quality of Life, Stroke Volume, Ventricular Dysfunction, Left
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