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Aims: The benefits of exercise in patients with heart failure are well documented. However, to date, the association between exercise habits and prognosis is yet to be evaluated. In this study, we investigated the association between pre-hospital exercise habits and post-discharge prognosis in older adult patients with heart failure., Methods: This post-hoc analysis utilised data from the FRAGILE-HF study, which included 1,262 patients aged ≥ 65 years who required hospitalisation for heart failure decompensation. Exercise habits before hospitalisation were assessed through a three-question physical activity assessment tool. The primary outcome was all-cause mortality., Results: Of the 1,262 patients, 587 (46.5%) reported no regular exercise habits before hospitalisation. No significant differences were observed in the histories of heart failure hospitalisations or other comorbidities. However, patients in the exercise habit group consistently exhibited better physical function, such as greater grip strength, gait speed, and short physical performance battery scores, than those in the non-exercise habit group. In addition to physical function, patients with exercise habits exhibited significantly lower all-cause mortality than those without exercise habits (log-rank test, p=0.019). The adjusted Cox regression models suggested that pre-hospital exercise was associated with a lower mortality risk (hazard ratio, 0.75; 95% confidence interval, 0.58-0.98; p=0.035)., Conclusion: Exercise habits before hospitalisation were significantly associated with better strength and physical function and lower post-discharge all-cause mortality in older adult patients with heart failure. These findings highlight the importance of assessing exercise habits for risk stratification among this population., (© The Author(s) 2025. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

Aims: The 6-min walk test (6MWT) is a widely accepted tool for evaluating exercise tolerance and physical capacity, and the 6-min walk distance (6MWD) is an established prognostic factor in patients with heart failure (HF). However, the prognostic implications of post-6MWT dyspnoea remain unknown. We aimed to investigate the prognostic value of Borg scores after the 6MWT in patients with HF., Methods and Results: Patients hospitalized for HF who underwent the 6MWT before discharge were included. Post-test dyspnoea was assessed using the Borg scale. Patients were stratified into low and high Borg score groups based on the median Borg score. The primary outcome was 2-year mortality. Among 1185 patients analysed, the median Borg score was 12. The 6MWD was significantly shorter in the high Borg score group than in the low Borg score group. The 2-year mortality rate was 20.2%. In the Kaplan-Meier analysis, the high Borg score group demonstrated an association with 2-year mortality, which remained significant even after adjustment for conventional risk factors, including the 6MWD. Furthermore, the Borg scale provided significant net reclassification improvement to the conventional risk model incorporating 6MWD., Conclusion: In hospitalized patients with HF, post-6MWT Borg scores were associated with 2-year mortality independent of the 6MWD, providing incremental prognostic value to the 6MWD. Even if patients are able to walk long distances for 6 min, it is essential to closely observe dyspnoea immediately thereafter., Competing Interests: Conflict of interest: N.K. is affiliated with a department funded by Philips Japan, Inter Reha Co., Ltd, KYOCERA Corporation, AMI Inc., and Fukuda Denshi Co. Ltd based on collaborative research agreements and received honorarium from Novartis Japan, Otsuka Pharmaceutical Co., Ltd, and Eli Lilly Japan K.K. K.K. received funding outside the submitted work from Eiken Chemical Co., Ltd, and SoftBank Corporation, Ltd. T.K. was affiliated with a department sponsored by Philips Respironics, ResMed, Teijin Home Healthcare, and Fukuda Denshi. Y.M. received an honorarium from Otsuka Pharmaceutical Co., Novartis Pharma K.K., Bayer Inc., and AstraZeneca and a collaborative research grant from Pfizer Japan Inc., Otsuka Pharmaceutical Co., EN Otsuka Pharmaceutical Co., Ltd, and Nippon Boehringer Ingelheim Co., Ltd. The other authors declare no conflicts of interest., (© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

Aims: This study aimed to investigate the prevalence, clinical characteristics, and prognostic value of bendopnea in older patients hospitalized for heart failure., Methods and Results: This post hoc analysis was performed using two prospective, multicentre, observational studies: the FRAGILE-HF (main cohort) and SONIC-HF (validation cohort) cohorts. Patients were categorized based on the presence of bendopnea, which was evaluated before discharge. The primary endpoint was 2-year all-cause mortality after discharge. Among the 1243 patients (median age, 81 years; 57.2% male) in the FRAGILE-HF cohort and 225 (median age, 79 years; 58.2% men) in the SONIC-HF cohort, bendopnea was observed in 31 (2.5%) and 10 (4.4%) patients, respectively. Over a 2-year follow-up period, all-cause death occurred in 20.8 and 21.9% of the patients in the FRAGILE-HF and SONIC-HF cohorts, respectively. Kaplan-Meier survival curves demonstrated significantly higher mortality rates in patients with bendopnea than in those without bendopnea in the FRAGILE-HF (log-rank P = 0.006) and SONIC-HF cohorts (log-rank P = 0.014). Cox proportional hazard analysis identified bendopnea as an independent prognostic factor for all-cause mortality in both the FRAGILE-HF [hazard ratio (HR) 2.11, 95% confidence interval (CI) 1.18-3.78, P = 0.012] and SONIC-HF cohorts (HR 4.20, 95% CI 1.63-10.79, P = 0.003), even after adjusting for conventional risk factors., Conclusion: Bendopnea was observed in a relatively small proportion of older patients hospitalized for heart failure before discharge. However, its presence was significantly associated with an increased risk of all-cause mortality., Competing Interests: Conflict of interest: Y.M. received an honorarium from Otsuka Pharmaceutical Co., Novartis Pharma K.K., Bayer Inc., and AstraZeneca and research grants from Pfizer Japan Inc., Otsuka Pharmaceutical Co., EN Otsuka Pharmaceutical Co., Ltd, and Nippon Boehringer Ingelheim Co., Ltd. T.K. (Takatoshi Kasai) was affiliated with a department sponsored by Philips Respironics, ResMed, Teijin Home Healthcare, and Fukuda Denshi. N.K. is affiliated with a department funded by Paramount Bed Ltd., and receives research grants from EchoNous Inc. and AMI Inc. and honorarium from Novartis Pharama, Otsuka Pharma, Boehringer Ingelheim, and Elli Lilly. K.K. received funding outside the submitted work from Eiken Chemical Co., Ltd and SoftBank Corp., Ltd. The other authors have no conflicts of interest to declare., (© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

Aims: Although an excessive drop in systolic blood pressure (SBP) during acute heart failure (AHF) negatively impacts prognosis, the association between changes in SBP and the diuretic response (DR) is unclear. We aimed to clarify the association between an early drop in SBP and DR/prognosis in patients with AHF., Methods and Results: This was a sub-analysis of the REALITY-AHF study, which registered patients with AHF admitted through emergency departments (EDs). An early SBP drop was defined as the difference between baseline SBP and the lowest value during the first 48 h of hospitalization. DR was defined as the urine output achieved per 40 mg of intravenous furosemide administered. SBP was measured on admission, at 90 min, and 6, 24, and 48 h after admission. Patients were divided into four groups according to their median SBP drop and DR: greater SBP drop/poor DR (n = 322), smaller SBP drop/poor DR (n = 409), greater SBP drop/good DR (n = 419), and smaller SBP drop/good DR (n = 314). The study included 1,464 patients. A greater SBP drop/poor DR was associated with higher baseline SBP and vasodilator use. Multivariable linear regression analysis showed that a greater drop in SBP was associated with poorer DR following adjustment for potential covariates. Cox proportional hazards analysis demonstrated that a greater SBP drop/poor DR was independently associated with 1-year mortality. Both SBP and DR changes were independently associated with prognosis., Conclusion: An early drop in SBP during the first 48 h of hospitalization was associated with poor DR and 1-year mortality in patients with AHF., Clinical Trial Registration: URL: http://www.umin.ac.jp/ctr/Unique identifier: UMIN000014105., Competing Interests: Conflict of interest: K.K. received an honorarium from Daichi Sankyo Co., Ono Pharmaceutical Co., Ltd., AstraZeneca, Otsuka Pharmaceutical Co., Ltd., and Novartis Pharmaceuticals Co., Ltd. T.O. has received research grants from Ono Pharmaceutical Co., Ltd., Bayer Pharmaceutical Co., Ltd., Daiichi-Sankyo Pharma Inc., and Amgen Astellas BioPharma. T.O. received honorariums from Novartis Pharma, Ono Pharmaceutical Co., Ltd., Otsuka Pharmaceutical Co., Ltd., and Medtronic Japan Co., Ltd. N.K. is affiliated with a department funded by Philips Healthcare; Asahi KASEI Corporation; Inter Reha Co., Ltd; and Toho Holdings Co., Ltd based on collaborative research agreements, and receives a research grant from EchoNous Inc. Y.M. is affiliated with a department endowed by Philips Respironics, ResMed, Teijin Home Healthcare, and Fukuda Denshi, and has received an honorarium from Otsuka Pharmaceutical Co. and Novartis Japan. The other authors have no other conflicts of interest to declare., (© The Author(s) 2022. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For permissions, please email: journals.permissions@oup.com.)