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 More than five million people in the U.S. have heart failure,
meaning their hearts cannot supply enough blood and oxygen to other
organs, and about half die within five years of diagnosis, according
to the Centers for Disease Control and Prevention. Treatments
include medications, a low-salt diet and daily physical activity.
“I certainly suspected that patients who had increasing difficulty
with daily living would be at increased risk for death,” but just
how accurately a brief questionnaire could predict hospitalization
and death was surprising, said Dr. Shannon Dunlay, lead author of
the study and an advanced heart failure cardiologist at the Mayo
Clinic in Rochester, Minnesota.
For the study, more than 1,000 people with heart failure, and an
average age of 75, filled out questionnaires assessing their ability
to perform nine activities of daily living, including feeding
themselves, dressing, using the toilet, housekeeping, climbing
stairs, walking and bathing.
Many of the participants had other health problems like high blood
pressure, diabetes or past strokes.
Those who had difficulty with things like bathing or housekeeping
were classified as having “moderate difficulty” and those who
struggled to feed themselves, use the toilet or dress themselves
were classified as having “severe difficulty.”
Almost 60 percent of people reported difficulty with at least one of
the nine activities. Around one quarter had moderate difficulty and
13 percent had severe difficulty.
After about three years, more than half of the patients had died and
more than 900 had been hospitalized at least once.
The study team adjusted for other illnesses, and found that compared
to people with no difficulty with daily activities, those with
moderate difficulty were 50 percent more likely to die, and those
with severe difficulty were more than twice as likely to die during
the study.
Those with moderate or severe difficulty were also more likely to be
hospitalized for heart problems or for any reason than those with no
difficulty, according to the results published in Circulation: Heart
Failure.
People with heart failure tend to be elderly and to have other
chronic health conditions, so it can be difficult to separate out
what is actually causing the decline in function, Dunlay told
Reuters Health.
Doctors do ask their patients about their ability to get around the
house and complete daily tasks, but sometimes it can be hard to fit
this conversation in with a regular clinic visit, Dunlay said.
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Adding a quick questionnaire to the appointment could be a good tool
for doctors to assess their patients’ risk of death and
hospitalization, which can vary widely for people with heart
failure, she said. Some patients do maintain most functional
ability, while others will have severe disability.
Many patients become asymptomatic with therapy, according to Dr.
Eldrin F. Lewis of the cardiovascular division at Brigham and
Women’s Hospital in Boston, who wrote an editorial accompanying the
new research. “Providers should always aim to get patients to the
point where they can do all of the things that they enjoy,” he told
Reuters Health by email.
“When I first meet a patient, I often ask them about their hobbies
so that I can be realistic with them regarding their ability to
eventually do those activities,” he said.
People who were older, female, unmarried and had other health
conditions like diabetes, dementia or morbid obesity tended to have
more difficulty with daily activities and were therefore at higher
risk of hospitalization and death, the authors note.
People who are married have a partner to help with daily tasks and
may not notice their functional decline as much as those who are
widowed, Dunlay said. Women may have worse outcomes because they
tend to be slightly older than men when they develop heart failure.
“Certainly the next step is to better understand whether there are
interventions we can do to improve or halt the progression of
decline,” both to extend life expectancy and to improve quality of
life immediately, Dunlay said.
“Is there an optimal time to catch patients, and intervene with
physical therapy?” she said. “For some patients quality of life is
as, or more, important than living longer.”
Even before a doctor asks, family are probably already aware that a
person with heart failure is having trouble with daily activities,
and shouldn’t hesitate to bring it up in the doctor’s office, she
said.
SOURCE: http://bit.ly/1weXaVR
Circulation: Heart Failure, online February 25, 2015.
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