Journal of Cardiology · Nov 6, 2025

Associations between modes of death and physical impairment in patients with heart failure with preserved or reduced ejection fraction

By Hamada T, Kubo T, Takabayashi K et al.

BACKGROUND: Physical frailty is a prognostic determinant in heart failure (HF) patients, but its association with the modes of death remains unclear. We investigated the associations between walking status and modes of death in patients with HF with preserved ejection fraction (HFpEF) and those with non-HFpEF. METHODS: We analyzed 2009 patients with acute HF enrolled in two Japanese HF registries. We compared post-discharge causes of death in HFpEF and non-HFpEF patients, classified into three walking status groups: robust, impaired walking (IW), and disability groups. RESULTS: HF was the predominant cause of death in non-HFpEF patients across all walking categories, whereas HF deaths in HFpEF patients increased with worsening walking status, accounting for 35 % of deaths among those with disability. In robust HFpEF patients, non-cardiovascular (CV) deaths, particularly from cancer, were as frequent as HF deaths. The risk of CV death was higher in the IW group [hazard ratio (HR): 1.639; 95 % confidence interval (CI): 1.050-2.559] and the disability group (HR: 2.678; 95 % CI: 1.382-5.189) among non-HFpEF patients, while the risk of non-CV death was higher only in the disability group (HR: 2.495; 95 % CI: 1.206-5.159). HFpEF patients with IW and those with disability had higher risks of both CV death (IW group, HR: 2.369; 95 % CI: 1.486-3.776; disability group, HR: 5.768; 95 % CI: 3.051-10.900) and non-CV death (IW group, HR: 2.444; 95 % CI: 1.468-4.068; disability group, HR: 2.732; 95 % CI: 1.246-5.989). CONCLUSION: Poor walking status at discharge was associated with higher risks of both CV and non-CV deaths, irrespective of HF type. HF was the predominant cause of mortality overall, whereas non-CV death, especially cancer death, was more common in robust HFpEF patients. These results highlight the clinical importance of walking status assessment in HF management.

doi.org/10.1016/j.jjcc.2025.10.013PubMed 41205911Populations