Heart failure patients struggling with daily tasks more often hospitalized, die early

Heart failure patients who struggle doing daily tasks are more likely to be hospitalized and die early, according to new research in the American Heart Association journal Circulation: Heart Failure.

The risk is higher for older women, unmarried people and those with chronic conditions that affect mobility and ability, including obesity, dementia, anemia and diabetes, researchers said.

Heart failure affects more than 5 million Americans, many who live fewer than five years after diagnosis.

Assessing patients' abilities to perform daily living activities -- like bathing or dressing -- can help determine if they need more hands-on care.

"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," said Shannon Dunlay, M.D., M.S., lead author of the study and an advanced heart failure cardiologist at the Mayo Clinic in Rochester, Minnesota. "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 percent were obese and most had other medical conditions including high blood pressure (87.4 percent), anemia (57 percent), diabetes (36.5 percent), peripheral vascular disease (26.5 percent) and cerebrovascular disease (almost 30 percent).

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 percent of patients reported difficulty with one or more daily activities at the start of the study, including 24.1 percent who reported moderate difficulty and 12.9 percent 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 anemia, 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 percent, 36.3 percent and 54.6 percent, 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 hospitalized. Heart failure was the most common reasons for hospitalization (18.4 percent) followed by arrhythmia (4.7 percent) and pneumonia (4.3 percent).

• In a second questionnaire among 823 patients at follow-up: 73 percent reported stability in performing daily activities, 8.8 percent 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 said. "Most patients with heart failure are elderly and have many other chronic conditions, and we need to consider providing comprehensive care."

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Co-authors are: Sheila M. Manemann, M.P.H.; Alanna M. Chamberlain, Ph,D,; Andrea L. Cheville, M.D.; Ruoxiang Jiang, B.S.; Susan A. Weston, M.S.; and Véronique L. Roger, M.D., M.P.H. Author disclosures are on the manuscript.

The National Institutes of Health provided funding for the study.

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