Clinical Determinants of Functional Capacity at Hospital Discharge in Patients with Heart Failure: A Secondary Observational Analysis

Abstract

Introduction. Functional capacity is a key prognostic marker in heart failure (HF), yet it is frequently under-assessed at hospital discharge, and its clinical and demographic determinants during this critical period remain insufficiently characterized. This study aims to identify the clinical determinants of functional capacity at hospital discharge in patients with heart failure with reduced ejection fraction (HFrEF). Methods. Cross-sectional observational study conducted at a tertiary center in Brazil with 140 patients. Functional capacity was assessed using the Veterans Specific Activity Questionnaire (VSAQ) and expressed in metabolic equivalents (METs). Sociodemographic, clinical (congestion score and visual analogue scale for dyspnea), and laboratory variables were collected. Multiple linear regression was used to identify independent predictors of age-adjusted METs. Results. Mean age was 64.8 ± 14.0 years and mean left ventricular ejection fraction (LVEF) was 30.5 ± 6.5%. Mean functional capacity was 4.34 ± 3.43 METs, indicating severe impairment. In the multivariate analysis, NYHA functional class (β = −1.033; p = 0.015), congestion score (β = −0.235; p = 0.015), and dyspnea (β = −0.232; p = 0.012) were independent predictors of lower functional capacity. LVEF was not independently associated with functional capacity (p = 0.583). Discussion. Functional capacity at discharge is determined by symptom burden and functional class rather than LVEF alone. A substantial proportion of patients are discharged with significant functional impairment, underscoring the need for systematic functional assessment and early rehabilitation planning as part of heart failure care transition.