Life-Space Mobility in Heart Failure With Preserved Ejection Fraction

Background Life-space mobility quantifies an individual's movement within their environment, ranging from one's bedroom to outside of one's geographic region. This makes life-space mobility an appealing yet understudied summary evaluation that can effectively integrate multiple health domains inclusive of conditions that are prevalent in heart failure with preserved ejection fraction (HFpEF). Whether life-space mobility is associated with adverse outcomes among ambulatory HFpEF patients is unknown. Methods We examined 175 consecutive HFpEF patients seen at the Weill Cornell Medicine HFpEF program (November 2018 through March 2022). Life-space mobility was quantified via the Life-Space Assessment (LSA) and a simplified version of the LSA. The Kansas City Cardiomyopathy Questionnaire-12 (KCCQ-12) and EuroQol 5-Dimension 5-level (EQ-5D-5L) were used to examine quality of life. The primary outcome was a 12-month composite of all-cause mortality and hospitalization. A Cox proportional-hazard model was used to examine the association between life-space mobility and the primary outcome, adjusting for race and Meta-Analysis Global Group in Chronic Heart Failure (MAGGIC) score. Results The median age was 76.8 years [interquartile range (IQR) [69.7-84.6])] . Most were female (67.4%) and white (65.1%). Those with low life-space mobility (based on both the LSA and simplified LSA) reported worse quality of life (as measured by KCCQ-12 and EQ-5D-5L). In addition, low life-space mobility (based on both the LSA and simplified LSA) was independently associated with all-cause hospitalization at 12-months in a fully-adjusted model (LSA: hazard ratio [HR], 2.41, 95% confidence interval [CI] 1.23-4.69, p= 0.01; simplified LSA: HR 2.46, 95% CI [1.19-4.31], p = 0.013). Conclusion Among adults with HFpEF, life-space mobility tracks with multiple health deficits, parallels quality of life, and is associated with adverse clinical outcomes. The LSA and simplified LSA provide comparable prognostic information, suggesting that either could serve as a summary score of health and prognostic indicator among HFpEF.