title: Impact of Oral Treatment on Physical Function in Older Patients Hospitalized for Heart Failure: A Randomized Clinical Trial.
abstract: BACKGROUND
  Frailty is a characteristic of older patients with heart failure, who undergo functional decline during hospitalization. At present, continuous intravenous infusion of diuretics is widely used for the treatment of hospitalized patients with heart failure. In this prospective, randomized, open-label controlled trial, we tested whether an early switch from continuous intravenous infusion therapy to oral treatment with diuretics prevents functional decline in patients hospitalized for heart failure.
  
  
  METHODS
  A total of 59 patients hospitalized for heart failure were randomized to either continuous intravenous infusion (n = 30) or oral medication (n = 29) within 48 h of admission. The primary outcome was the Barthel index, a universally utilized scale to assess the functional status of patients in their activities of daily living, assessed at 10 days. Secondary outcomes included the number of daily steps counted using pedometers and average hospital costs.
  
  
  RESULTS
  Barthel index scores were significantly higher in the oral medication group than in the intravenous group (78.1 ± 20.8 vs. 59.6 ± 34.2, P = 0.029). The number of daily steps was significantly higher in the oral treatment group relative to the intravenous group (P < 0.001), and the average hospital costs were similar between the randomized groups. Multivariate analysis revealed that oral medication was a significant independent predictor of Barthel index score at day 10, and the number of daily steps was significantly associated with the patient's functional outcome.
  
  
  CONCLUSIONS
  This trial showed that, in patients hospitalized for heart failure, oral medication increased functional independence during hospitalization compared with sustained continuous intravenous infusion, most likely because the release from the infusion line enabled the patients to be more mobile. Notably, these beneficial effects were achieved without increasing hospital costs.
authors.affiliation: Department of Cardiology, Tokyo Metropolitan Police Hospital, Tokyo, Japan.|Department of Cardiovascular Medicine, the University of Tokyo Hospital, Tokyo, Japan.
authors.forename: Kazutaka
authors.initials: K
authors.lastname: Ueda
authors.affiliation: Department of Cardiology, Tokyo Metropolitan Police Hospital, Tokyo, Japan.
authors.forename: Masashi
authors.initials: M
authors.lastname: Kasao
authors.affiliation: Department of Cardiology, Tokyo Metropolitan Police Hospital, Tokyo, Japan.
authors.forename: Motoaki
authors.initials: M
authors.lastname: Shimamura
authors.affiliation: Department of Cardiology, Tokyo Metropolitan Police Hospital, Tokyo, Japan.
authors.forename: Hironori
authors.initials: H
authors.lastname: Haruta
authors.affiliation: Department of Cardiology, Tokyo Metropolitan Police Hospital, Tokyo, Japan.
authors.forename: Shuya
authors.initials: S
authors.lastname: Nitta
authors.affiliation: Department of Cardiology, Tokyo Metropolitan Police Hospital, Tokyo, Japan.
authors.forename: Mitsunobu
authors.initials: M
authors.lastname: Kaneko
authors.affiliation: Biostatistics Division, Central Coordinating Unit, Clinical Research Support Center, the University of Tokyo Hospital, Tokyo, Japan.
authors.forename: Yukari
authors.initials: Y
authors.lastname: Uemura
authors.affiliation: Department of Cardiovascular Medicine, the University of Tokyo Hospital, Tokyo, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Morita
authors.affiliation: Department of Cardiovascular Medicine, the University of Tokyo Hospital, Tokyo, Japan.
authors.forename: Issei
authors.initials: I
authors.lastname: Komuro
authors.affiliation: Department of Cardiology, Tokyo Metropolitan Police Hospital, Tokyo, Japan.
authors.forename: Tetsuro
authors.initials: T
authors.lastname: Shirai
mesh_terms: D000284:Administration, Oral; D000368:Aged; D000369:Aged, 80 and over; D004232:Diuretics / Q000008:administration & dosage* / Q000191:economics / Q000627:therapeutic use; D005260:Female; D006333:Heart Failure / Q000188:drug therapy*; D006801:Humans; D008297:Male
chemical_list: D004232:Diuretics