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HF patients with functional disability at higher risk for hospitalization, early death
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Patients with HF who have difficulty performing daily tasks such as taking medication and climbing stairs appear to have an increased risk for hospitalization and early death, especially older women, unmarried individuals and those with chronic conditions such as obesity, dementia and diabetes.
“Our findings support the assessment of mobility as part of the routine clinical care in patients with [HF],” Shannon M. Dunlay, MD, MS, from the division of cardiovascular diseases in the department of medicine at Mayo Clinic, said in a press release. “Patients who report difficulties may be candidates for a more thorough assessment and physical therapy evaluation to improve or halt the decline in mobility.”
Researchers performed a cohort study of 1,128 patients with HF (mean age, 74.7 years). They assessed by questionnaire difficulty with nine activities of daily living and stratified patients into three categories of difficulty: none/minimal, moderate and severe.
Higher risk for death
At enrollment, 59.4% of patients reported difficulty with at least one activity of daily living; 24.1% experienced moderate difficulty and 12.9% experienced severe difficulty. Mean follow-up was 3.2 years.
During follow-up, 54.4% of patients died. Mortality rate rose with increasing difficulty. Compared with no or minimal difficulty, patients with moderate difficulty (HR = 1.49; 95% CI, 1.22-1.82) and severe difficulty (HR = 2.26; 95% CI, 1.79-2.86) had a greater risk for death (P for trend < .001).
Higher risk for hospitalization
During the study period, 910 patients were hospitalized 4,024 times. The most common reasons for hospitalization were HF (18.4%), arrhythmias (4.7%) and pneumonia (4.3%).
After adjustment for age, sex and Charlson comorbidity index, the researchers found that patients with moderate difficulty (HR = 1.37; 95% CI, 1.17-1.59) and severe difficulty (HR = 1.22; 95% CI, 1-1.49) had an elevated risk for hospitalization vs. those with no or minimal difficulty.
The researchers noted that a likely reason for a higher risk for hospitalization among patients with moderate difficulty is that patients with severe difficulty had an increased risk for death and were more likely to die without being hospitalized. When the researchers performed a sensitivity analysis assuming that all patients who died were hospitalized on their day of death, the HRs for hospitalization were 1.57 for both groups.
Hospitalization for HF followed a similar trend as all-cause hospitalization, but hospitalization for other CV causes was not associated with difficulty in performing activities of daily living, according to the researchers.
“We suspect that the difficulty with daily activities that we observed is not entirely attributable to the patients’ [HF],” Dunlay said in the press release. “Most patients with [HF] are elderly and have many other chronic conditions, and we need to consider providing comprehensive care.” – by Erik Swain
Disclosure: The researchers report no relevant financial disclosures.
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