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Aims Functional decline due to skeletal muscle abnormalities leads to poor outcomes in patients with acute heart failure (AHF). The 6-minute walking test (6MWT) reliably evaluates functional capacity, but its technical difficulty for the elderly often limits its benefits. Although the Short Physical Performance Battery (SPPB) is a comprehensive measure of physical performance, its role in AHF remains unclear. This study aimed to examine the prognostic significance of SPPB compared to the 6MWT in elderly patients hospitalized for AHF. Methods and results We retrospectively analysed 1192 elderly patients with AHF whose SPPB and 6MWT were measured during the hospitalization. The primary outcome measure was defined as a composite of all-cause death and heart failure readmission until 1 year after discharge. Patients with lower SPPB scores (0–6, n = 373) had significantly poorer outcomes than those with higher SPPB scores (7–12, n = 819) even after multivariable adjustment [adjusted hazard ratio (HR) 1.28, 95% confidence interval (CI) 1.01–1.61; P = 0.049], similar to those with shorter 6MWT (&amp;lt;median) than those with longer 6MWT (adjusted HR 1.61, 95% CI 1.27–2.04; P &amp;lt; 0.001). Although both SPPB and 6MWT [net reclassification index (NRI) 0.139, P = 0.036 and NRI 0.350, P &amp;lt; 0.001, respectively] exhibited incremental prognostic value over conventional risk factors of HF, the additive prognostic effect of 6MWT was superior to that of SPPB (NRI 0.300, P &amp;lt; 0.001). Conclusions Reduced functional capacity assessed by either the SPPB or 6MWT was associated with worse outcomes in hospitalized elderly patients with AHF. The incremental prognostic value over the conventional risk factors was higher in 6MWT than in SPPB. Trial Registration UMIN000023929

Short physical performance battery vs. 6-minute walking test in hospitalized elderly patients with heart failure