Activities of Daily Living in Heart Failure | Journal Scan

Study Questions:

Does difficulty performing activities of daily living (ADLs) predict outcomes in heart failure (HF)?


This study was conducted in southeastern Minnesota in residents of Olmsted, Dodge, and Fillmore counties. Hospitalized and ambulatory patients with HF and ≥20 years of age were identified from the electronic medical record and recruited between September 2, 2003 and January 31, 2012. ADLs were assessed by a self-administered survey. The outcomes of death from any cause and all-cause hospitalization were assessed through December 31, 2012. Hierarchy of difficulty with ADLs was determined by Rasch analysis. Negative binomial regression was used to identify predictors of the number of ADLs for which patients reported difficulty. Patients were grouped into three categories (mild, moderate, and severe) based on difficulty with ADLs. Kaplan-Meier curves and Cox proportional hazard models were used to evaluate the association between mortality and ADL difficulty.


A total of 1,128 patients were included in the analysis. The mean age was 74.7 years, 50.8% were male, and 51.7% had heart failure (HF) with preserved ejection fraction. Patients who were ineligible for inclusion due to lack of ADL information or consent were more often older and female. 59.4% had difficulty with one or more ADLs, with the most common impairment being climbing stairs. Independent predictors of difficulty with ADLs included age, female sex, unmarried status, diabetes, cerebrovascular disease, dementia, morbid obesity, and anemia. Dementia was most strongly associated with ADL difficulty; compared to patients without dementia, patients with dementia had a more than twofold increase in the number of ADLs in which they reported difficulty. Severity of impairment with ADLs was incrementally associated with mortality, while moderate and severe impairment increased risk of all-cause and noncardiovascular hospitalization similarly. There was no significant association between ADL difficulty and HF or other cardiovascular/renal hospitalization. Persistent severity in ADLs or progression in difficulty was associated with increased risk of mortality and readmission.


The authors concluded that difficulty with ADLs is a powerful marker of adverse outcomes in patients with HF.


ADLs ascertain routine functionality and functional independence. Difficulty with ADLs is a strong predictor of mortality and hospitalization in patients with HF.

Clinical Topics: Geriatric Cardiology, Heart Failure and Cardiomyopathies, Acute Heart Failure, Sleep Apnea

Keywords: Heart Failure, Activities of Daily Living, Anemia, Dementia, Diabetes Mellitus, Obesity, Morbid, Electronic Health Records, Geriatrics, Hospitalization, Mortality, Morbidity, Survival, Patient Readmission, Proportional Hazards Models

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