Most heart failure patients are elderly and have many other chronic conditions.
More than 5 million people in the US have heart failure and many of these patients do not survive for more than 5 years following diagnosis.
To investigate what further assessments could assist health care professionals in determining adequate care for people with heart failure, researchers from the Mayo Clinic in Rochester, MN, analyzed data from questionnaires completed by 1,128 patients.
The participants were roughly evenly split in terms of gender and marital status, with an average age of 75. The following proportions of patients also had these medical conditions:
- High blood pressure (87.4%)
- Anemia (57%)
- Diabetes (36.5%)
- Peripheral vascular disease (26.5%)
- Cerebrovascular disease (almost 30%)
- Obesity (18%).
Examples of daily activities in the questionnaire included getting dressed, using the bathroom, cleaning the house, climbing stairs and taking medications.
More than half of the participants had problems with daily activities
The questionnaire data show that more than 59% of participants reported having problems carrying out one or more daily activities - 24.1% of whom reported having "moderate" difficulty, while 12.9% had "severe" difficulty conducting these tasks.
Over the 3-year follow-up period, 614 patients died and 910 were hospitalized. The most common reasons for hospitalization were:
The average survival for participants was 5.6 years for those with minimal difficulty conducting daily tasks, 3 years for those with moderate difficulty and 1.5 years for people who reported severe difficulty.
The researchers suspect that the difficulty with daily activities "is not entirely attributable" to the participants' heart failure. Most heart failure patients are elderly, the authors point out, and have many other chronic conditions.
Participants with dementia were found to have difficulty with twice as many daily activities as participants without this condition. Interestingly, the study found that being female, unmarried and having anemia, obesity or diabetes also increased the likelihood of having difficulties with day-to-day tasks.
We asked Dr. Shannon Dunlay, lead author of the study and an advanced heart failure cardiologist at the Mayo Clinic, why women and unmarried people were found to have more difficulties with everyday tasks.
"Most available data have shown that women tend to report more difficulty with activities in daily living than men," she replied. "While the reasons for these gender differences in disability are not entirely clear, women were, on average, older than men in this study, which could have an impact on differences observed."
"As far as marital status," she added, "it may be that having a spouse masks difficulty with activities in daily living if the spouse is able to compensate by, for example, doing all of the housework and cleaning. When a person with mobility difficulty doesn't have that safety net in place, difficulty with activities in daily living may become more apparent."
Assessing patients' abilities can help determine care package
Dr. Dunlay believes that assessing patients' abilities to perform daily activities can help professionals determine whether they require more hands-on care. She told us:
"Asking patients about difficulty with activities of daily living is a quick and simple way for clinicians to gauge mobility and identify patients who are at higher risk for poor outcomes. This can be helpful to guide discussions about goals of care and prognosis with patients.
Patients who are having difficulty with activities of daily living may benefit from interventions to help them better manage their daily tasks or even improve or preserve their mobility."
Last month, Medical News Today reported on a study published in the European Heart Journal that found elevated blood sugar in heart failure patients is linked with early death.