Heart failure
Clinical and Prognostic Value of Duke's Activity Status Index Along With Plasma B-Type Natriuretic Peptide Levels in Chronic Heart Failure Secondary to Ischemic or Idiopathic Dilated Cardiomyopathy

https://doi.org/10.1016/j.amjcard.2008.08.045Get rights and content

The Duke Activity Status Index (DASI) provides an accurate estimate of functional capacity in patients with chronic heart failure (HF). The aim of this study was to evaluate the prognostic value of the DASI against well-established prognostic factors in 130 consecutive patients hospitalized for worsening HF symptoms (mean age 64 ± 12 years, mean left ventricular ejection fraction 26 ± 7%), followed for 9 months for major cardiovascular events, defined as death or hospitalization for HF decompensation. During follow-up, 77 of 130 patients (59%) experienced major cardiovascular events after a median time of 60 days (range 5 to 220). Patients with eventful courses were in higher New York Heart Association functional classes (p = 0.001) and had shorter 6-minute walking distances (p = 0.041), lower ejection fractions (p <0.001), higher plasma B-type natriuretic peptide (BNP) levels at hospital admission and discharge (both p <0.001), and lower DASI scores (16 ± 12 vs 25 ± 17, p = 0.003). In multivariate Cox regression analysis including all these variables, only BNP level at discharge (p = 0.006) and DASI score (p = 0.047) were independently associated with event-free survival. A BNP cutoff of 697 pg/ml predicted future events with 59% sensitivity and 86% specificity, while a DASI score cutoff of 8 had 76% sensitivity and 25% specificity. The combination of the 2 cutoffs predicted events with 33% sensitivity and 95% specificity. Event-free survival was significantly lower in patients with the 2 markers positive (BNP >697 pg/ml and DASI score <8) compared with those with with 2 markers negative (63 ± 27 vs 183 ± 15 days, log-rank p <0.0001). In conclusion, functional status assessment by the DASI bears prognostic value, and its combination with plasma BNP may provide quite specific risk stratification in patients with chronic HF.

Section snippets

Methods

One hundred thirty consecutive patients with HF (of ischemic or idiopathic dilated cardiomyopathy origin) hospitalized for clinical worsening of HF symptoms (mean age 64 ± 12 years), with a mean echocardiographically documented left ventricular ejection fraction of 26 ± 7%, were studied. The study protocol was approved by the institutional ethics committee, and all patients enrolled gave informed written consent.

These patients underwent complete history interviews and physical examinations.

Results

The baseline characteristics of the study population are listed in Table 2. Seventy-seven of 130 patients experienced major cardiovascular events after a median time of 60 days. Patients experiencing events were in higher NYHA classes (p = 0.001) and had shorter 6-minute walking distances (p = 0.041), lower ejection fractions (p <0.001), higher plasma BNP at hospital admission and discharge (both p <0.001), and lower DASI scores (p = 0.003). A significant correlation was observed between plasma

Discussion

The DASI, established by Hlatky et al1 in 1989, seems to be a valuable tool that provides a standardized assessment of functional status and correlates well with peak oxygen uptake. This instrument is based on a patient's ability to perform common activities of daily living. Activities were chosen in a way to represent a wide range of cardiovascular stresses as well as several dimensions of personal health status (see Table 1). The DASI was developed in an attempt to overcome several

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    The DASI is a valid and reliable measure of functional status in patients with coronary artery disease and heart failure [13–17]. In clinical practice, the DASI can be used to assess the effects of interventions, as well as assisting clinical decision making [18–21]. However, to our knowledge, this practical instrument has not been studied in PH patients.

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    Functional status, the ability to perform activities of daily living, has been associated with hospitalisation, mortality and predicted survival in patients with HF (Parissis et al., 2009). Studies have demonstrated that patients with poorer functional status had about twice the risk of experiencing a cardiac event, compared with patients with better functional status before and after controlling for potential confounders (Koch et al., 2007; Parissis et al., 2009); Wu et al. (2016). In addition, some studies have reported that functional status was closely related to HRQOL (Chu et al., 2014; Juenger et al., 2002) and poorer functional status significantly impaired HRQOL of patients with HF (Masoudi et al., 2004).

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