The short physical performance battery and incident heart failure among older women: the OPACH study

John Bellettiere; Steve Nguyen; Charles B Eaton; Sandy Liles; Deepika Laddu-Patel; Chongzhi Di; Marcia L Stefanick; Andrea Z LaCroix; Michael J LaMonte

doi:10.1016/j.ajpc.2021.100247

The short physical performance battery and incident heart failure among older women: the OPACH study

Am J Prev Cardiol. 2021 Aug 20:8:100247. doi: 10.1016/j.ajpc.2021.100247. eCollection 2021 Dec.

Authors

John Bellettiere^{1

2}, Steve Nguyen¹, Charles B Eaton³, Sandy Liles^{1

2}, Deepika Laddu-Patel⁴, Chongzhi Di⁵, Marcia L Stefanick⁶, Andrea Z LaCroix¹, Michael J LaMonte⁷

Affiliations

¹ Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla CA, USA.
² Center for Behavioral Epidemiology and Community Health (C-BEACH), School of Public Health, San Diego State University, San Diego, CA, USA.
³ Departments of Family Medicine and Epidemiology, Schools of Medicine and Public Health, Brown University, Providence, RI, USA.
⁴ College of Applied Health Sciences, University of Illinois, Chicago, IL, USA.
⁵ Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
⁶ Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA.
⁷ Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, SUNY, Buffalo, NY, USA.

Abstract

Objective: Reduced functional capacity is a hallmark of early pre-clinical stages of heart failure (HF). The Short Physical Performance Battery (SPPB) is a valid measure of lower extremity physical function, has relatively low implementation burden, and is associated with cardiovascular disease and mortality. However, the SPPB-HF association is understudied in older women among whom HF burden is high.

Methods: Women (n = 5325; mean age 79 ± 7 years; 34% Black, 18% Hispanic, and 49% White) without prior HF completed the SPPB consisting of standing balance, strength, and walking tests that were summarized as a composite score from 0 (lowest) to 12 (highest), categorized as very low (0-3), low (4-6), medium (7-9), or high (10-12). Participants were followed for up to 8 years for incident HF (306 cases identified). Cox proportional hazards regression estimated hazard ratios (HR) adjusting for age, race/ethnicity, education, smoking, alcohol, diabetes, hypertension, COPD, osteoarthritis, depression, BMI, systolic blood pressure, lipids, glucose, and accelerometer-measured moderate-vigorous physical activity (MVPA) and sedentary time.

Results: Incident HF cases (crude rate per 1000 person-years) in the four SPPB categories (very low to high) were 34 (26.0), 79 (14.5), 128 (9.3), and 65 (5.6). Corresponding multivariable-adjusted HRs (95% CIs) were 2.22 (1.34-3.66), 1.63 (1.11-2.38), 1.39 (1.00-1.94), and 1.00 (referent; P-trend<0.001). Higher HF risk was associated with lower SPPB in women with major modifiable HF risk factors including obesity (HR per 3-unit SPPB decrement: present HR = 1.41, absent HR = 1.41), hypertension (present HR = 1.45, absent HR = 1.30), diabetes (present HR = 1.32, absent HR = 1.44), and lower accelerometer-measured MVPA (<45 min/day HR = 1.29, ≥45 min/day HR = 1.60); all P-interaction>0.10.

Conclusion: Lower SPPB scores were associated with greater risk of incident HF in older women even after accounting for differences in HF risk factors and objectively measured PA. Implementing the SPPB in clinical settings could potentially enhance individual-level HF risk assessment, which should be further explored.

Keywords: Frailty; Geriatric cardiology; Healthy cardiovascular aging; Physical functioning.

Abstract

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