Relationship of physical function with quality of life in older patients with acute heart failure.

Abstract

Background

Older patients with acute decompensated heart failure (ADHF) have severely impaired physical function (PF) and quality of life (QOL). However, relationships between impairments in PF and QOL are unknown but are relevant to clinical practice and trial design.

Methods

We assessed 202 consecutive patients hospitalized with ADHF in the multicenter Rehabilitation Therapy in Older Acute HF Patients (REHAB-HF) Trial. PF measures included Short Physical Performance Battery (SPPB) and 6-min walk distance (6MWD). Disease-specific QOL was assessed by the Kansas City Cardiomyopathy Questionnaire (KCCQ). General QOL was assessed by the Short Form-12 (SF-12) and EuroQol-5D-5L. PF was evaluated as a predictor of QOL using stepwise regression adjusted for age, sex, race, and New York Heart Association class.

Results

Participants were 72 ± 8 years, 54% women, 55% minority race, 52% with reduced ejection fraction, and body mass index 33 ± 9 kg/m2 . Participants had severe impairments in PF (6MWD 185 ± 99 m, SPPB 6.0 ± 2.5 units) and disease-specific QOL (KCCQ Overall Score 41 ± 21 and Physical Score 47 ± 24) and general QOL (SF-12 Physical Score 28 ± 9 and EuroQol Visual Analog Scale 57 ± 23). There were modest, statistically significant correlations between 6MWD and KCCQ Overall, KCCQ Physical Limitation, and SF-12 Physical Scores (r = 0.23, p < 0.001; r = 0.30, p < 0.001; and r = 0.24, p = 0.001, respectively); and between SPPB and KCCQ Physical and SF-12 Physical Scores (r = 0.20, p = 0.004, and r = 0.19, p = 0.007, respectively). Both 6MWD and SPPB were correlated with multiple components of the EuroQol-5D-5L. 6MWD was a significant, weak predictor of KCCQ Overall Score and SF-12 Physical Score (estimate = 0.05 ± 0.01, p < 0.001 and estimate = 0.05 ± 0.02, p = 0.012, respectively). SPPB was a significant, weak predictor of KCCQ Physical Score and SF-12 Physical Score (estimate = 1.37 ± 0.66, p = 0.040 and estimate = 0.54 ± 0.25, p = 0.030, respectively).

Conclusion

In older, hospitalized ADHF patients, PF and QOL are both severely impaired but are only modestly related, suggesting that PF and QOL provide complementary information and assessment of both should be considered to fully assess clinically meaningful patient-oriented outcomes.

Department

Description

Provenance

Citation

Published Version (Please cite this version)

10.1111/jgs.17156

Publication Info

Aladin, Amer I, David Whellan, Robert J Mentz, Amy M Pastva, M Benjamin Nelson, Peter Brubaker, Pamela Duncan, Gordon Reeves, et al. (2021). Relationship of physical function with quality of life in older patients with acute heart failure. Journal of the American Geriatrics Society, 69(7). pp. 1836–1845. 10.1111/jgs.17156 Retrieved from https://hdl.handle.net/10161/30119.

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Scholars@Duke

Pastva

Amy Martha Pastva

Professor in Orthopaedic Surgery

The major themes that embody Dr. Pastva's scholarly pursuits include:  a) mechanisms of physical reserve and resilience; b) rehabilitation strategies for improving the health and function of individuals living with chronic cardiovascular and pulmonary diseases and/or surviving critical illness; and c) pedagogical strategies that will optimize health professions curricula to address clinical practice expectations in aging and acute or critical illness. In addition to her faculty appointments, she is Director of Research in the Physical Therapy Division, a Senior Fellow in the Duke Center for the Study of Aging and Human Development, a Duke Pepper Older American Independence Center (OAIC) Scholar, and co-lead of the Center’s Health and Mobility Measures Core. She serves as an advisor in Duke Health's Cardiovascular and Pulmonary Physical Therapy Residency Program. She also serves on the American Physical Therapy Association’s ICU Rehabilitation Clinical Guideline Development Group, on the Research Committee of its Cardiovascular and Pulmonary Academy, and on the Editorial Board of the Physical Therapy & Rehabilitation Journal.


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