Abstract 11606: Critical Pathway for Elderly Patients With Heart Failure Based on Physical Activity Reduces Length of Hospital Stay
Background: Heart failure (HF) is the most common cause of hospitalization in elderly patients and contributes to high morbidity, mortality, and economic cost. Physical activity is often restricted in elderly patients with HF, and closely related to prolonged hospital stay. Critical pathway has been developed and implemented to improve guideline compliance and save cost in patients with cardiovascular disease. However, little controlled research has been performed on the effectiveness of critical pathway for elderly HF patients. We thus investigated whether the physical activity-based critical pathway reduced the length of hospital stay in elderly HF patients.
Methods: We developed critical pathway for HF patients aged 65 years and older categorized in 7 stages based on their physical activities (Figure 1). 114 inpatients with HF (83±8 years, NYHA functional class II-III) were randomly assigned to conventional care (control group, n=64) or care by critical pathway (pathway group, n=50) after the treatment of acute decompensated HF. Physical therapist decided the stages regularly according to cardiac rehabilitation guideline.
Results: Critical pathway was safely implemented in all patients. The age, gender, NYHA functional class, activity of daily living, medications, and left ventricular ejection fraction were comparable between groups at baseline. There was no difference in mortality rates (pathway vs. control; 4 vs. 11%). Length of hospital stay was significantly reduced, and the proportion of patients discharged home were significantly increased in pathway group compared to control group (31±24 vs. 48±33 days, 78 vs. 55%, respectively, p<0.01). Furthermore, Barthel Activities of Daily Living Index was significantly increased in pathway group compared to control group (65±36 vs. 47±34, p<0.01).
Conclusions: Critical pathway for HF management based on physical activity is useful for reducing the length of hospital stay in elderly patients with HF.
Author Disclosures: N. Kakutani: None. A. Fukushima: None. R. Nakamura: None. S. Mori: None. T. Oikawa: None. R. Ishimoto: None. I. Yoshida: None.
- © 2014 by American Heart Association, Inc.