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Decline in activities of daily living predicts HF hospitalization, death

18 Apr 2019

A decline in activities of daily living (ADL) appears to predict being hospitalized for heart failure (HF) and death in HF patients, a recent study suggests.

Drawing from the Kitakawachi Clinical Background and Outcome of Heart Failure Registry, researchers enrolled 923 HF patients (mean age, 75.7±11.2 years; 54.9 percent male). ADLs were categorized into four: independent outdoor walking, independent indoor walking, indoor walking with assistance and abasia. The primary study endpoint was hospitalization for HF.

Most of the patients (89.4 percent; n=825) did not show a decline in ADL while the remaining 10.6 percent (n=98) did. Over a median follow-up period of 369 days, 30.3 percent (n=279) of the participants were hospitalized for HF.

Analysis according to ADL status showed that there were more incidences of HF hospitalization in the group of patients with vs without ADL decline (46.4 percent vs 28.4 percent). This translated to a significantly higher risk of the primary outcome, as measured by multivariable Cox proportional hazard models (hazard ratio [HR], 1.89; 95 percent CI, 1.35–2.58; p<0.001).

Over the same time period, 12.9 percent (n=119) of the overall sample had died. Mortality was likewise more common in the ADL-decline group (28.9 percent vs 11 percent), resulting in a significantly greater risk (HR, 2.67; 1.71–4.02; p<0.001).

Moreover, in a multivariate analysis including all patients, a decline in ADL again emerged as a significant predictor of HF hospitalization (HR, 1.42; 1.01–1.96; p=0.046) and death (HR, 1.95; 1.23–2.99; p<0.01).

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