Heart failure patients who struggle doing daily tasks are more likely to be hospitalised and die early, according to new research in the American Heart Association journal Circulation: Heart Failure. The National Institutes of Health provided funding for the study.
The risk is higher for older women, unmarried people and those with chronic conditions that affect mobility and ability, including obesity, dementia, anaemia and diabetes, researchers said.
“Difficulty with daily living is easy to assess in a routine doctor’s visit, and can provide important information to help guide conversations about goals of care,” says Shannon Dunlay, lead author of the study and an advanced heart failure cardiologist at the Mayo Clinic in Rochester, USA. “Patients who report difficulties may be candidates for a more thorough assessment and physical therapy evaluation to improve or halt the decline in mobility. Our findings support the assessment of mobility as a part of the routine clinical care of patients with heart failure.”
Researchers reviewed questionnaires from 1,128 heart failure patients. Half were female, the average age was about 75, and half were married. Eighteen per cent were obese and most had other medical conditions including high blood pressure (87.4%), anaemia (57%), diabetes (36.5%), peripheral vascular disease (26.5%) and cerebrovascular disease (almost 30%).
Patients were grouped as having minimal, moderate or severe difficulty with daily activities that included getting dressed, using the bathroom, cleaning the house, climbing stairs and taking medications. Most patients had a hard time with at least one daily activity, but there was a corresponding relationship between how easily one could go about their day and overall mortality.
Among the findings:
- More than 59% of patients reported difficulty with one or more daily activities at the start of the study, including 24.1% who reported moderate difficulty and 12.9% who experienced severe difficulty.
- Patients with dementia had difficulty with twice as many daily activities as others.
- Other factors that increased the likelihood of problems with daily tasks included being female, unmarried, and having anaemia, obesity or diabetes.
- At the start of the study, the estimated two-year mortality for those with minimal, moderate and severe difficulty with everyday tasks was 21.4%, 36.3% and 54.6%, respectively.
- The average survival for these three groups was 5.6 years, 3 years and 1.5 years, respectively.
- During about three years of follow-up, 614 patients died and 910 were hospitalised. Heart failure was the most common reasons for hospitalisation (18.4%) followed by arrhythmia (4.7%) and pneumonia (4.3%).
- In a second questionnaire among 823 patients at follow-up: 73% reported stability in performing daily activities, 8.8% improved and 17.7% worsened.
“We suspect that the difficulty with daily activities that we observed is not entirely attributable to the patients’ heart failure,” Dunlay says. “Most patients with heart failure are elderly and have many other chronic conditions, and we need to consider providing comprehensive care.”