heart failureA new study finds that heart failure patients who struggle with day-to-day tasks may be at risk for hospitalization and even early death.

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, said researchers of the study published in the American Heart Association journal Circulation: Heart Failure.

Researchers reviewed questionnaires from 1,128 heart failure patients. Half were women, half were married and their average age was around 75.

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 they 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.
  • Patients with dementia had difficulty with twice as many daily activities as others.
  • 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.

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 that 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.”

The struggles with daily activities may not be entirely related to the patients’ heart failure, because most people with heart failure are elderly and often have other chronic conditions, Dunlay said.

“A lot has been written about the problem of readmissions in people with heart failure. This study returns the focus to the patient, and it provides a new tool to assess the impact the disease has on activities of daily living,” said Mariell Jessup, M.D., past president of the American Heart Association and professor of medicine at the University of Pennsylvania Heart and Vascular Center in Philadelphia. “Moreover, the disability which can now be quantitated is shown to relate directly to outcomes. These findings strongly suggest the need to incorporate an assessment of daily living activities into each clinic visit.”

Heart failure affects more than 6 million Americans, many who live fewer than five years after diagnosis.