Scholarlink

Background <p>Stage B heart failure (HF) requires precise risk stratification. Current guideline-recommended approaches focus on cardiac indicators, neglecting functional status. The Short Physical Performance Battery (SPPB) predicts outcomes in symptomatic HF, but its prognostic value for mortality in older adults with Stage B HF remains unexplored. This study aimed to evaluate this association, establish an optimal SPPB threshold, and determine the incremental value of SPPB and its subtests over conventional metrics.</p> Methods <p>This prospective cohort enrolled patients with Stage B HF aged ≥ 65&#xa0;years and followed them for 5&#xa0;years to evaluate all-cause mortality. Restricted cubic splines were applied to explore potential non-linear relationships between SPPB and mortality. Prognostic thresholds were identified using segmented regression. Associations with mortality were examined using multivariable Cox regression. Incremental predictive value of SPPB and its subtests over the base model was evaluated using area under the curve (AUC), integrated discrimination improvement (IDI), continuous net reclassification improvement (cNRI), and decision curve analysis (DCA).</p> Results <p>A total of 527 patients were included (mean age 75.3 ± 6.4&#xa0;years; 53.9% female). SPPB showed an L-shaped association with all-cause mortality, with a threshold of 6. After adjustment for age, sex, log-transformed NT-proBNP, and left atrial anteroposterior diameter, SPPB ≤ 6 was associated with a threefold higher risk of all-cause mortality (HR = 3.29, 95% CI: 1.90–5.70) compared with SPPB &gt; 6. Using the 6-point threshold of the SPPB, rather than the conventional 9, more effectively improved the predictive performance (AUC = 0.840; IDI = 0.061; cNRI = 0.433). DCA further showed higher net benefit for the 6-point model across threshold probabilities of 0.05–0.50. Among the subtests, gait speed provided the greatest incremental value (AUC = 0.833; IDI = 0.053; cNRI = 0.258).</p> Conclusion <p>SPPB was independently associated with mortality in older patients with Stage B HF. In this dataset, a 6-point threshold showed improved discrimination for identifying higher-risk individuals compared with the conventional 9-point threshold. Gait speed showed the strongest incremental prognostic value among the subtests. Incorporating SPPB into prognostic assessment may improve risk stratification in this population.</p> Trial registration <p>ChiCTR1800017204; 07/18/2018.</p>

错误：搜索内容不能为空，请输入英文关键词
错误：关键词超出字数限制，请精简
高级检索

Prognostic value of Short Physical Performance Battery in older patients with Stage B heart failure: a prospective cohort study

  • 期刊论文

  • 出版模式：

    开放获取

  • 发表日期：

    2025年12月7日

查看全文
  • Chen Ji,
  • Min Zeng,
  • Ning Sun,
  • Wei He,
  • Ting Wang,
  • Yin Mei,
  • Di Guo,
  • Lingling Cui,
  • Chen Meng,
  • Hua Wang

摘要

Background

Stage B heart failure (HF) requires precise risk stratification. Current guideline-recommended approaches focus on cardiac indicators, neglecting functional status. The Short Physical Performance Battery (SPPB) predicts outcomes in symptomatic HF, but its prognostic value for mortality in older adults with Stage B HF remains unexplored. This study aimed to evaluate this association, establish an optimal SPPB threshold, and determine the incremental value of SPPB and its subtests over conventional metrics.

Methods

This prospective cohort enrolled patients with Stage B HF aged ≥ 65 years and followed them for 5 years to evaluate all-cause mortality. Restricted cubic splines were applied to explore potential non-linear relationships between SPPB and mortality. Prognostic thresholds were identified using segmented regression. Associations with mortality were examined using multivariable Cox regression. Incremental predictive value of SPPB and its subtests over the base model was evaluated using area under the curve (AUC), integrated discrimination improvement (IDI), continuous net reclassification improvement (cNRI), and decision curve analysis (DCA).

Results

A total of 527 patients were included (mean age 75.3 ± 6.4 years; 53.9% female). SPPB showed an L-shaped association with all-cause mortality, with a threshold of 6. After adjustment for age, sex, log-transformed NT-proBNP, and left atrial anteroposterior diameter, SPPB ≤ 6 was associated with a threefold higher risk of all-cause mortality (HR = 3.29, 95% CI: 1.90–5.70) compared with SPPB > 6. Using the 6-point threshold of the SPPB, rather than the conventional 9, more effectively improved the predictive performance (AUC = 0.840; IDI = 0.061; cNRI = 0.433). DCA further showed higher net benefit for the 6-point model across threshold probabilities of 0.05–0.50. Among the subtests, gait speed provided the greatest incremental value (AUC = 0.833; IDI = 0.053; cNRI = 0.258).

Conclusion

SPPB was independently associated with mortality in older patients with Stage B HF. In this dataset, a 6-point threshold showed improved discrimination for identifying higher-risk individuals compared with the conventional 9-point threshold. Gait speed showed the strongest incremental prognostic value among the subtests. Incorporating SPPB into prognostic assessment may improve risk stratification in this population.

Trial registration

ChiCTR1800017204; 07/18/2018.