Compared with those who spent most of their time in a single room, people with heart failure with preserved ejection fraction (HFpEF) who were able to travel outside of their home without assistance were significantly less likely to be hospitalized or die within a year, according to a study being presented at the American College of Cardiology's Annual Scientific Session (ACC.25). The findings underscore the value of supporting holistic care and encouraging people with heart failure to maintain an active lifestyle and engage with others in their community to the extent possible, researchers said.
The study used a metric known as life-space mobility to quantify the degree to which patients moved around in their communities over the course of one month. Life-space mobility has been shown to be a reliable marker of risk of adverse outcomes in people with a variety of chronic diseases, including chronic obstructive pulmonary disease, chronic kidney disease and peripheral artery disease, but the new study is the first to assess it in the context of HFpEF.
"Our results are consistent with other disease areas and highlight that, for patients with HFpEF, we have to address all domains of their care, which includes cognitive, physical and social domains," said Dylan Marshall, MD, MPH, assistant professor of medicine at Columbia University Irving Medical Center, who conducted the study during his cardiovascular disease fellowship at Weill Cornell Medical Center, both in New York. "Life-space mobility assessment is an all-encompassing measure of these multiple domains of health."
HFpEF is a type of heart failure in which the left ventricle becomes stiff and does not properly fill with blood, reducing the body's ability to effectively pump blood with each heartbeat. The condition is becoming more common in the United States as the population ages. It can be challenging to manage because it progresses differently in different patients, is often associated with other conditions like diabetes or obesity and has limited treatment options.
To assess whether life-space mobility could offer insights relevant to HFpEF care, researchers administered questionnaires to 175 consecutive patients treated for HFpEF at Weill Cornell Medical Center between 2019-2023. They then evaluated the relationship between patients' life-space mobility scores and their likelihood of dying or being hospitalized within one year, the study's composite primary endpoint.
On the questionnaire, patients reported how far they moved throughout five life-space levels (ranging from the room they sleep in to going out of town), the frequency of their movements and whether they required assistance during their movements over the previous month.
Analysis revealed that those who scored in the lowest tertile for life-space mobility were 2.4 times more likely to die or be hospitalized within one year compared with those in the highest tertile. The researchers found that patients who were less likely to leave their homes than those who were more independent were significantly more likely to suffer these outcomes even after accounting for race and MAGGIC score, a clinical calculator that has been demonstrated to predict adverse outcomes among patients with HFpEF on other validated risk assessment tools.
"As HFpEF becomes more prevalent with our aging population, we need to be able to recognize who is at highest risk of poor outcomes and may need closer follow-up," Marshall said. "For clinicians, who have very limited time and resources, I would encourage the use of this tool to identify which patients may need those extra couple of minutes versus those who are doing well and could perhaps have less frequent visits. This metric is easy and quick to use in the clinic."
Low life-space mobility scores were also correlated with cognitive and sensory impairments, falls and low quality of life scores. Marshall said that in addition to being a useful clinical tool, considering life-space mobility could encourage patients to engage in more social interactions, identify unaddressed gaps in their care and help them stay healthier longer.
"It's not just about providing excellent care in the clinic but making sure that in their home life patients are engaged in their community and have the support they need to live the fullest lives possible," Marshall said. "In my own clinic, I always remind patients that in addition to the medicines I'm prescribing, they need to engage in their community, go to the senior center, get out of the house and get moving, because all of that is protective for their health."
Multiple factors could influence whether a patient is able to move beyond their room or home, and researchers were not able to directly account for factors such as medication adherence that may play a role. In addition, since the study was conducted at a single medical center, Marshall said that a larger, national study could help to determine whether the approach is applicable to a broader population.
Marshall will present the study, "Association of Life-Space Mobility and All-Cause Hospitalization and Mortality Among Older Adults with HFpEF," on Saturday, March 29, 2025, at 2:30 p.m. CT / 19:30 UTC in Moderated poster Theater 10.
ACC.25 will take place March 29-31, 2025, in Chicago, bringing together cardiologists and cardiovascular specialists from around the world to share the newest discoveries in treatment and prevention. Follow @ACCinTouch , @ACCMediaCenter and #ACC25 for the latest news from the meeting.
The American College of Cardiology (ACC) is the global leader in transforming cardiovascular care and improving heart health for all. As the preeminent source of professional medical education for the entire cardiovascular care team since 1949, ACC credentials cardiovascular professionals in over 140 countries who meet stringent qualifications and leads in the formation of health policy, standards and guidelines. Through its world-renowned family of JACC Journals, NCDR registries, ACC Accreditation Services, global network of Member Sections, CardioSmart patient resources and more, the College is committed to ensuring a world where science, knowledge and innovation optimize patient care and outcomes. Learn more at ACC.org .
