Protective effect of physical activity on mortality in older adults with advanced chronic heart failure: A prospective observational study

OBJECTIVES: The objective of this study was to evaluate the effect on mortality of self-reported physical activity evaluated by the physical activity scale for the elderly (PASE) in elderly patients with advanced heart failure enrolled in a cardiac rehabilitation unit after heart failure decompensation (NYHA class IIIB). METHODS: The study prospectively enrolled 314 elderly patients (≥65 years) with heart failure in NYHA class IIIB (symptomatic with a recent history of dyspnoea at rest) consecutively admitted to cardiac rehabilitation between January 2010 and July 2011. Comprehensive geriatric assessment was performed. Physical activity was evaluated by PASE and stratified in tertiles (0-15, 16-75 and >75). Mortality was collected from September to October 2015 in 300 patients. RESULTS: The mean age was 74.5 ± 6.1 (range 65-89); 74.7% were men, 132 patients (44.0%) died during the follow-up (44.1 ± 20.7 months). Univariate analysis shows that physical activity level conducted before heart failure decompensation was inversely related to mortality (from 76.0% to 8.2%, P = 0.000). Multivariate analysis confirms that the PASE score predicts mortality independently of several demographic and clinical variables (hazard rate 0.987, 95% confidence interval (CI) 0.980-0.994, P = 0.000). Notably, when considering PASE 0-15 versus 16-75 score and PASE 0-15 versus > 75 score, the hazard rate is 4.06 (95% CI 1.67-9.84, P < 0.001) and 7.25 (95% CI 2.7-19.5, P < 0.001), respectively. CONCLUSIONS: Physical activity level evaluated by the PASE score is inversely related to mortality in elderly patients with advanced heart failure confirming the reduction of mortality exerted by moderate physical activity in such patients.