B108-02 Functional Capacity Across Disease Clinical Stages in Isolated Chronic Obstructive Pulmonary Disease (COPD) and Heart Failure (HF) and COPD-HF Coexistence: Evidence to Optimize Rehabilitation Approaches

Abstract Background Exercise intolerance is a cardinal feature of Chronic Obstructive Pulmonary Disease (COPD) and Chronic Heart Failure (HF) and a focus of rehabilitative strategies. Exacerbations of COPD (ECOPD) and Acute Decompensated HF (ADHF) and presence of comorbidities further worsen physical performance and are associated with negative outcomes. However, the magnitude of functional impairment in different clinical stages of the diseases remains poorly characterized. Aim: To compare functional capacity across disease clinical stages in isolated COPD, HF, and COPD-HF coexistence. Methods This observational cohort study included patients assessed during hospitalization - acute stage (T1), subacute stage (30-days after discharge) (T2) and in a chronic stable stage (T3) (at least six months without hospitalization), matched by age and sex. Functional capacity was assessed using the six-minute walk test (6MWT), Duke Activity Status Index (DASI), and handgrip strength. Differences between disease groups and clinical stages were analyzed using two-way, with post-hoc Tukey comparisons. Results 178 patients were assessed and allocated into three groups and clinical conditions at acute (A), subacute (S) and chronic (C) - A/S/C were: HF: N = 21/12/22; COPD N = 19/10/19; and COPD+HF: N = 25/25/25. Patients assessed during acute clinical stage revealed markedly reduced 6-minute walk distance (6MWD) compared with those the chronic stable condition to all diseases (HF: 225.5±145.2 vs 385.4±112.1 m, p 0.001; COPD: 219.2±123.8 vs 365.8±102.7 m, p 0.001) (Figure 1-A). Higher values were observed in the subacute stage, although values generally remained lower than chronic stage (HF: 225.5±145.2 vs 320.1±140.5 m, p = 0.03). HF patients presented significantly higher values from acute to subacute in DASI score (mean difference −11.1, p = 0.028), partial recovery chronic values, whereas COPD patients remained with lower values at subacute compared with chronic COPD (−20.7, p = 0.003). At subacute, HF outperformed COPD (difference +18.1, p = 0.008) (Figure 1-B). At the chronic HF stage, patients showed the highest strength (31.7±8 kgf), whereas acute COPD showed the poorest performance (16.9±7.3 kgf) (p = 0.001) (Figure 1-C). Conclusion Functional capacity is substantially impaired during acute events across HF, COPD, and COPD+HF, with incomplete improvement at the subacute stage. Chronic patients demonstrate the best overall performance, independently of the chronic disease. This abstract is funded by: FAPESP - process n°2015/12763-4; 2015/26501-1 and Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - Brasil (CAPES) - Finance Code 001.