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Background: The impact of body mass index (BMI) on hospital mortality in patients with acute heart failure has been well documented in Asian populations. However, the relationship between BMI, hospital-associated disability (HAD), and hospitalization costs in patients with heart failure is poorly understood. This study aimed to explore the impact of BMI on HAD and hospitalization costs for acute heart failure in Japan., Methods: From April 2012 to March 2020, the Japanese Registry of All Cardiac and Vascular Disease Diagnosis Procedure Combination (JROAD-DPC) database was used to identify patients with acute heart failure. All patients were categorized into five groups according to the World Health Organization Asian BMI criteria. The hospitalization costs and HAD were evaluated., Results: Among the 238,160 eligible patients, 15.7% were underweight, 42.2% were normal, 16.7% were overweight, 19.3% were obese I, and 6.0% were obese II, according to BMI. The prevalence of HAD was 7.43% in the total cohort, and the risk of HAD increased with a lower BMI. Restricted cubic spline analysis showed a U-shaped relationship between BMI and hospitalization costs for all ages. Furthermore, developing HAD was associated with greater costs compared with non-HAD, regardless of BMI category., Conclusions: We found that the lower the BMI, the higher the incidence of HAD. A U-shaped association was confirmed between BMI and hospitalization costs, indicating that hospitalization costs increased for both lower and higher BMI regardless of age. BMI could be an important and informative risk stratification tool for functional outcomes and economic burdens., Competing Interests: Declaration of Competing Interest None., (Copyright © 2022. Published by Elsevier B.V.)

Objective: To clarify the impacts of health literacy on mortality, readmission, and quality of life (QOL) in the secondary or tertiary prevention of cardiovascular diseases (CVD) through a meta-analysis., Methods: Six electronic databases were searched on June 11, 2020. Observational studies involving patients with CVD, health literacy as an exposure factor and mortality, readmission, or QOL as outcomes were included in this study. Two researchers screened the retrieved articles and extracted data independently. The meta-analysis calculated the pooled relative risk of mortality and readmission. We also assessed the body of evidence based on Grading of Recommendations Assessment, Development and Evaluation (GRADE)., Results: Following screening of 1616 studies, 16 observational studies were included. The mean rate of low health literacy was 32.8%. All studies focusing on QOL showed significant impacts of health literacy. Pooled relative risk was 1.621 (95% confidence interval: 1.089-2.412) for mortality and 1.184 (95% confidence interval: 1.035-1.355) for readmission, indicating significant effects of health literacy. GRADE assessment showed "LOW" certainty for each outcome., Conclusion: Low health literacy was significantly associated with increased mortality and hospital readmission and decreased QOL in patients with CVD., Practice Implications: Considering low health literacy in clinical practice is very important to improve prognosis of CVD patients., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Background: Although more children with congenital heart disease (CHD) are reaching adulthood, they generally have some impairment compared to their healthy peers. Few studies have investigated the effect of exercise training on health-related quality of life (HRQOL) and/or physical activity in children with CHD., Purpose: The purpose of this study was to systematically review the effect of exercise training on HRQOL and/or physical activity and the types of training used in general., Methods: We searched relevant articles published from 2000 to 2021 in English and included intervention studies for children with CHD younger than 20 years who underwent exercise training. Afterwards, we excluded the studies not using HRQOL or physical activity as outcome measures, classified the extracted information according to outcome measures and types of interventions, and assessed the risk of bias of the included studies., Results: Finally, 10 articles were selected, and HRQOL in 3 articles and physical activity in 3 articles showed improvement after exercise training. However, 4 articles did not show improvement in these outcome measures, and 9 of the articles had a high risk of bias in blinding. Sport-based or play-based interventions were used in 5 articles, and prescribed or structured ones were used in 5 articles., Conclusion: Although exercise training for children with CHD may improve their HRQOL and/or physical activity, more studies are needed to assess the effect statistically. In children with CHD, sport-based or play-based interventions could be used as well as prescribed or structured interventions., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2022 The Authors.)

Background: We aimed to examine the relationship between the difficulty of activity using the arms and mild cognitive impairment (MCI), the relationship between the difficulty of activity using the arms and manual function, and cognitive function in patients with coronary artery disease (CAD)., Methods: We conducted a cross-sectional study of 263 non-dementia patients who met the study criteria from 2328 CAD patients. MCI was estimated with the Japanese version of the Montreal Cognitive Assessment (MoCA-J). The difficulty of activity using the arms was evaluated using the Disability of the Arm, Shoulder, Disability of the Arm, Shoulder and Hand and Hand (DASH) questionnaire. Manual function was evaluated by pinch strength and handgrip strength., Results: Age (odds ratio, 1.10), three-fingered pinch strength (odds ratio, 0.69), and DASH score (odds ratio, 1.03) were independently associated with MCI in the multivariable logistic regression analysis. Hemoglobin (β=-0.15), handgrip strength (β=-0.37), and MoCA-J score (β=-0.15) were independently associated with DASH score (Model 1: p<0.001, adjusted R 2 =0.33); hemoglobin (β=-0.17), eGFR (β=-0.14), three-fingered pinch strength (β=-0.25), and MoCA-J score (β=-0.14) were independently associated with DASH score in the multivariate regression analysis (Model 2: p<0.001, adjusted R 2 =0.31)., Conclusions: The difficulty of activity using the arms was independently associated with manual and cognitive function and MCI in CAD patients., (Copyright © 2020. Published by Elsevier Ltd.)

Background: The relationship between mild cognitive impairment (MCI) and pinch strength in patients with cardiovascular disease is unclear. The purpose of the present study was to examine the associations among MCI and pinch strength and to determine a pinch strength cut-off value for use in the assessment of MCI., Methods: We conducted a cross-sectional study of 135 patients with cardiovascular disease but without probable dementia. MCI was estimated with the Japanese version of the Montreal Cognitive Assessment. We classified patients into the normal cognitive group and MCI group and compared their clinical characteristics, handgrip strength, and pinch strength. The relation between MCI and pinch strength was clarified with logistic regression analysis, and the cut-off value for three-fingered pinch strength was determined by receiver operating characteristic curve analysis., Results: The incidence of MCI was 37.0 %. Significant differences between the two groups were identified for age, body mass index, hemoglobin, estimated glomerular filtration rate, albumin, dyslipidemia, use of nitrates, educational background, handgrip strength, and pinch strength. After multivariate analysis, three-fingered pinch strength was significantly associated with MCI (odds ratio 0.77, p= 0.02). The cut-off value of three-fingered pinch strength for predicting MCI was 6.75 kgf (area under the curve = 0.71; p< 0.001)., Conclusions: Pinch strength was one independent factor significantly associated with MCI in patients with cardiovascular disease. The determination of a cut-off value for three-fingered pinch strength that can predict MCI may be one important factor in the early screening for MCI in the daily clinical setting., (Copyright © 2020 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.)