UCSF

Background: As the final stage of many types of heart disease, heart failure (HF) is a prevalent chronic condition and a costly public health issue. Patients with this highly symptomatic syndrome experience shortness of breath, fatigue, edema, and orthopnea. Mortality in HF is high and functional status is low.

Aims: This study aimed to examine function and symptoms in hospitalized HF patients and determine whether function and/or symptoms predicted cardiac event-free survival within 90 days after discharge. Cardiac events were defined as cardiac rehospitalization, heart transplantation, or death.

Methods: A convenience sample of 32 inpatients with primary or secondary HF diagnoses were enrolled. Symptoms were assessed with yes/no questions at two points in time during hospitalization and function was determined with tools including NYHA Classification and the Katz Index of Activities of Daily Living (ADLs), as well as by the direct performance measure of Short Physical Performance Battery (SPPB). Survival was analyzed via univariate Cox proportional-hazards regression with time to first post-discharge cardiac event as the outcome variable.

Results: Mean age was 58.2 ±13.6 years. Patient ADL function was nearly independent (5.6±1.1) while mean SPPB showed moderate functional limitation (6.4±3.1). All patients reported at least one symptom at the study outset. Within 90 days, 40.6% patients had a cardiac event. Results showed that each increase in NYHA Classification assessed 1.0 days (median) before discharge was associated with a 3.4-fold higher risk of cardiac events (95% CI 1.4-8.5). Patients reporting shortness of breath 1.0 days (median) before discharge had a 4.0-fold greater risk of cardiac events (95% CI 1.2-13.2). Risk of cardiac events was 9.7 times higher among patients reporting fatigue at this time (95% CI 1.2-75.1) and 12.8 times higher among those reporting orthopnea (95% CI 1.7-99.7).

Conclusion: Quick, simple assessments of function and symptoms that can easily be done at the bedside by physicians or nurses may be a meaningful way to predict short-term cardiac outcomes in hospitalized HF patients.