Association Between the Short Physical Performance Battery and Hospitalization-Associated Disability in Older Patients With Heart Failure

IMPORTANCE: Hospitalization-associated disability (HAD), defined as a decline in activities of daily living following hospitalization, is a common complication in older patients with heart failure (HF) and is associated with adverse clinical outcomes. Early identification of patients at high risk for HAD may facilitate timely rehabilitation and discharge planning. OBJECTIVE: The objective was to evaluate whether baseline physical function, assessed using the Short Physical Performance Battery (SPPB), is associated with HAD onset in older patients hospitalized with HF. DESIGN: This was a prospective cohort study. SETTING: The study was conducted at a single-center acute care hospital. PARTICIPANTS: The study included 417 patients aged 65 years or older who were hospitalized with HF and prescribed physical therapy between June 2023 and December 2025. EXPOSURE: Baseline SPPB was assessed within 3 days after transfer to the general ward. MAIN OUTCOMES AND MEASURES: The primary outcome was HAD, defined as a decline of 5 or more points in the Barthel Index from prehospitalization to hospital discharge. RESULTS: Multivariable logistic regression identified baseline SPPB score as independently associated with HAD onset. Receiver operating characteristic analysis demonstrated good discrimination (AUC = 0.811), with an optimal cutoff value of 6.5 points (<7 points). Decision tree analysis identified the baseline 4-meter walk score as the SPPB subitem most strongly associated with HAD onset. Supplementary logistic regression showed that a low baseline 4-meter walk score was independently associated with HAD onset. CONCLUSIONS: Baseline SPPB scores assessed after transfer to the general ward were independently associated with HAD onset and may help identify older patients hospitalized with HF who are at increased risk for HAD. External validation is warranted before clinical implementation. RELEVANCE: The SPPB is a simple and feasible bedside assessment that may support early risk stratification for HAD in older patients hospitalized with HF.