ORIGINAL RESEARCH article
Front. Cardiovasc. Med.
Sec. Heart Failure and Transplantation
Development and validation of a nomogram for predicting hospitalization-associated disability in older patients with acute heart failure
Xiaonan Hao 1
Fei Li 2
Yan Gu 2
Huijing Zhang 1
Xinyu Chen 1
Kun Li 1
1. Jilin University, Changchun, China
2. The First Hospital of Jilin University, Changchun, China
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Abstract
Objectives: To develop and validate a nomogram for predicting hospitalization-associated disability in older patients with acute heart failure. Design: A single-center cohort study. Setting and Participants: This study was carried out in the Cardiovascular Disease Center of a large tertiary-care hospital in China. Between December 2024 and February 2025, 480 older patients with acute heart failure were enrolled. Methods: Hospitalization-associated disability was defined as a decline of 5 points or more in the Barthel Index from admission to discharge. Predictor screening involved univariable logistic regression, Spearman’s correlation, and Least Absolute Shrinkage and Selection Operator regression. Variables retained were entered into a multivariable logistic regression model, and significant predictors were used to construct a nomogram for predicting hospitalization-associated disability. Model performance was assessed in terms of discrimination, calibration, and clinical utility. Results: The incidence of hospitalization-associated disability was 41.88%. A 12-variable nomogram was developed, incorporating age, ejection fraction, emergency admission, comorbidity burden, cognitive function, nutritional risk, pre-admission activities of daily living, pre-admission instrumental activities of daily living, physical mobility, sleep disturbance, depressive symptoms, and perceived social support. The nomogram demonstrated robust discrimination, with the area under the receiver operating characteristic curve of 0.841 and 0.786 in the training and testing sets, respectively. Calibration was accurate in both sets. The training set achieved a mean absolute error of 0.037 and a Brier score of 0.154, while the testing set showed 0.026 and 0.188, accompanied by non-significant Hosmer-Lemeshow test results. Decision curve and clinical impact analyses further supported favorable clinical utility. Conclusions and Implications: A 12-variable nomogram was developed and validated in older individuals with acute heart failure, enabling early identification of hospitalization-associated disability risk and supporting personalized care strategies.
Summary
Keywords
Activities of Daily Living, Disability, Heart Failure, Hospitalization, nomogram, older adults
Received
19 December 2025
Accepted
09 February 2026
Copyright
© 2026 Hao, Li, Gu, Zhang, Chen and Li. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Kun Li
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