Association of pre-admission exercise habit with post-discharge outcomes for older patients with heart failure

Abstract Aims The benefits of exercise in patients with heart failure are well documented. However, to date, the association between exercise habits and prognosis is yet to be evaluated. In this study, we investigated the association between pre-hospital exercise habits and post-discharge prognosis in older adult patients with heart failure. Methods This post-hoc analysis utilised data from the FRAGILE-HF study, which included 1,262 patients aged ≥ 65 years who required hospitalisation for heart failure decompensation. Exercise habits before hospitalisation were assessed through a three-question physical activity assessment tool. The primary outcome was all-cause mortality. Results Of the 1,262 patients, 587 (46.5%) reported no regular exercise habits before hospitalisation. No significant differences were observed in the histories of heart failure hospitalisations or other comorbidities. However, patients in the exercise habit group consistently exhibited better physical function, such as greater grip strength, gait speed, and short physical performance battery scores, than those in the non-exercise habit group. In addition to physical function, patients with exercise habits exhibited significantly lower all-cause mortality than those without exercise habits (log-rank test, p=0.019). The adjusted Cox regression models suggested that pre-hospital exercise was associated with a lower mortality risk (hazard ratio, 0.75; 95% confidence interval, 0.58–0.98; p=0.035). Conclusion Exercise habits before hospitalisation were significantly associated with better strength and physical function and lower post-discharge all-cause mortality in older adult patients with heart failure. These findings highlight the importance of assessing exercise habits for risk stratification among this population.