Kotaro Hirakawa

Key summary points Aim: To address the lack of predictive tools by developing and validating a novel scoring system to predict hospitalization-associated disability in older patients with heart failure. Findings: The J-Proof HAD score predicts hospitalization-associated disability based on medical information and physical and cognitive function, enabling risk stratification for functional decline. Message: Early screening after hospitalization may help identify patients at risk and prevent hospitalization-associated disability.

Background: There is no established method for early bed rehabilitation of patients after cardiogenic shock (CS) who require mechanical circulatory support (MCS). This study aimed to evaluate the safety of early upper limb extremity ergometer exercise in critically ill patients with CS or at risk for CS.Methods: The study was conducted as a prospective, single-center feasibility and observational study. Patients with CS or at risk for CS in the cardiac intensive care unit were enrolled. Upper limb extremity ergometer exercise was performed with alternating intervals of exercise and rest, in parallel with the rehabilitation program focused on early mobilization. A multidisciplinary team was established to determine the criteria for exercise initiation and cessation. Endpoint measures included exercise-related adverse events (circulatory or respiratory failure requiring new medical intervention, inability to continue device support, bleeding requiring hemostatic treatment at the insertion site, and exercise-related skeletal pain), vital signs, and subjective symptoms.Results: Forty-seven sessions in 28 patients (71 ± 15 years, 75% male) were included in the analysis. MCS was used in 86% of the patients, and rehabilitation was initiated within 3 ± 1 day. Two patients had temporary dyspnea, and none discontinued exercise. There was a significant increase in heart rate (p < 0.05) and respiratory rate (p < 0.001) during exercise compared with pre-excercise, but not in systolic or diastolic blood pressure and oxygen saturation.Conclusion: Early upper limb extremity ergometer exercises for critically ill patients with CS or at risk for CS resulted in changes in heart rate and respiratory rate during exercise. However, no exercise-related adverse events occurred. Upper limb extremity ergometer exercise can be a new tool of physical therapy in the acute phase of patients after CS or at risk for CS.

Hospital-acquired functional decline is an important outcome that affects the long-term prognosis of patients after cardiac surgery. Phase II cardiac rehabilitation (CR) for outpatients is expected to improve prognosis; however, this is not clear in patients with hospital-acquired functional decline after cardiac surgery. Therefore, this study evaluated whether phase II CR improved the long-term prognosis of patients with hospital-acquired functional decline after cardiac surgery. This single-center, retrospective observational study included 2371 patients who required cardiac surgery. Hospital-acquired functional decline occurred in 377 patients (15.9%) after cardiac surgery. The mean follow-up period was 1219 ± 682 days in all patients, and there were 221 (9.3%) cases with major adverse cardiovascular events (MACE) after discharge during the follow-up period. The Kaplan–Meier survival curves indicated that hospital-acquired functional decline and non-phase II CR was associated with a higher incidence of MACE than other groups (log-rank, p < 0.001), additionally exhibiting prognosticating MACE in multivariate Cox regression analysis (HR, 1.59; 95% CI, 1.01–2.50; p = 0.047). Hospital-acquired functional decline after cardiac surgery and non-phase II CR were risk factors for MACE. The participation in phase II CR in patients with hospital-acquired functional decline after cardiac surgery could reduce the risk of MACE.

The in-hospital mortality rate among patients after surgery for acute type A aortic dissection (ATAAD) has improved chronologically. However, the relationship between the incidence of hospitalisation-associated disability (HAD) and acute cardiac rehabilitation in patients after surgery for ATAAD has not been reported. Therefore, this study evaluated factors related to HAD in patients after surgery for ATAAD. This single-centre retrospective observational study included 483 patients who required emergency surgery for ATAAD. HAD occurred in 104 (21.5%) patients following cardiovascular surgery. Factors associated with HAD were age (odds ratio [OR], 1.05; 95% confidence interval [CI], 1.02–1.09; p = 0.001), noninvasive positive pressure ventilation (NPPV; OR, 2.15; 95% CI, 1.10–4.19; p = 0.025), postoperative delirium (OR, 2.93; 95% CI, 1.60–5.37; p = 0.001), and timing of walking onset (OR, 1.29; 95% CI, 1.07–1.56; p = 0.008). Furthermore, a late walking onset was associated with a higher risk of developing HAD and more severe functional decline. Early rehabilitation based on appropriate criteria has possibility of preventing HAD.