Association Between Early Rehabilitation and Mobility Status in Elderly Inpatients with Heart Failure: A Nationwide Retrospective Cohort Study

Objective: We set out to examine the effectiveness of early rehabilitation for maintaining mobility status during hospitalization in elderly patients with heart failure.

Methods: Using the Japanese Diagnosis Procedure Combination inpatient database, we retrospectively examined the eligibility of 527,440 consecutive patients aged ≥60 years who were diagnosed with heart failure with New York Heart Association class ≥ II at admission between July 2010 and March 2014. Of the 146,735 eligible subjects, 39,357 underwent early rehabilitation and 107,378 underwent non-early rehabilitation. Early rehabilitation was defined as rehabilitation starting within 3 days after admission. A multivariable logistic regression analysis and an instrumental variable analysis were carried out to examine the association of early rehabilitation with changes in mobility status during hospitalization.

Results: The proportion of heart failure patients with maintained or improved mobility status during hospitalization was higher in the early rehabilitation group. Multivariable logistic regression analysis revealed that the early rehabilitation group had a significantly higher proportion with maintained or improved mobility status (odds ratio, 1.32; 95% confidence interval, 1.21-1.43; P<0.001). The instrumental variable analysis showed that early rehabilitation was associated with an increased proportion of patients with maintained or improved mobility status (risk difference, 0.8%; 95% confidence interval, 0.4%-1.1%; P<0.001).

Conclusions: The present study suggests that early rehabilitation is associated with an increase in the proportion of patients with maintained or improved mobility status compared with non-early rehabilitation in elderly inpatients with heart failure.