{
  "abstract": "Background Mobility limitation is prevalent in patients with heart failure (HF), but the dose-response relationship between its severity and adverse outcomes remains unquantified.Methods We conducted a patient-level pooled analysis of two prospective Japanese cohort studies, including 2103 hospitalised patients with HF with no exclusion criteria. Mobility limitation at discharge was categorised into four levels: category I (independent outdoor walking), category II (indoor independence but requiring outdoor assistance), category III (requiring indoor assistance) and category IV (unable to walk). The primary endpoint was a 2-year composite of HF rehospitalisation or all-cause mortality. Adjusted analyses accounted for age, sex, comorbidities, biomarkers and medications.Results Among 2820.7 person-years of follow-up, 998 composite outcomes occurred. Incidence rates per 100 person-years for the primary outcome increased with mobility limitation severity: 24.9 (category I), 47.0 (II), 59.3 (III) and 84.8 (IV) (p for trend <0.001). Adjusted HRs (95% CI) using category I as reference were 1.22 (95% CI 1.04 to 1.45) for II, 1.39 (95% CI 1.11 to 1.73) for III and 1.71 (95% CI 1.34 to 2.20) for IV. While the graded association was clear for mortality, it was less evident for HF rehospitalisation alone, likely reflecting competing mortality risks.Conclusions This study demonstrates a strong and graded association between mobility limitation severity and adverse outcomes in HF, suggesting its utility for refined risk stratification.",
  "authors": [
    {
      "affiliations": [
        "Department of Physical Therapy, Faculty of Health Science, Juntendo University, Bunkyo-ku, Japan"
      ],
      "name": "Kotaro Iwatsu"
    },
    {
      "affiliations": [
        "Department of Cardiology, Hirakata Kohsai Hospital, Hirakata, Japan"
      ],
      "name": "Kensuke Takabayashi"
    },
    {
      "affiliations": [
        "Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University, Kochi, Japan"
      ],
      "name": "Tomoyuki Hamada"
    },
    {
      "affiliations": [
        "Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University, Kochi, Japan"
      ],
      "name": "Toru Kubo"
    },
    {
      "affiliations": [
        "Department of Rehabilitation, Hirakata Kohsai Hospital, Hirakata, Japan"
      ],
      "name": "Tsutomu Ikeda"
    },
    {
      "affiliations": [
        "Department of Cardiology, Shirahama Hamayu Hospital, Nishimuro-gun, Japan"
      ],
      "name": "Shoji Kitaguchi"
    },
    {
      "affiliations": [
        "Department of Social and Environmental Medicine, Osaka University, Suita, Japan"
      ],
      "name": "Tetsuhisa Kitamura"
    },
    {
      "affiliations": [
        "Department of Cardiology, Hirakata Kohsai Hospital, Hirakata, Japan"
      ],
      "name": "Takeshi Kimura"
    },
    {
      "affiliations": [
        "Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University, Kochi, Japan"
      ],
      "name": "Hiroaki Kitaoka"
    },
    {
      "affiliations": [
        "Department of Cardiology, Takanohara Central Hospital, Nara, Japan"
      ],
      "name": "Ryuji Nohara"
    }
  ],
  "title": "Severity of mobility limitation and adverse outcomes in heart failure",
  "uid": "d61a4133-17ab-543a-a091-696f3c650d9a"
}