Functional outcomes of elderly patients after the first hospital admission for decompensated heart failure (HF). A prospective study

Abstract

Congestive HF is one of the most common discharge medical diagnoses in elderly hospitalized patients. We evaluate prospectively the usefulness of a global geriatric assessment to identify changes in the functional status of patients who experience their first hospitalization for a new diagnosis of HF. The Barthel Index (BI), the Older Americans Resource Scale (OARS), the Short Portable Mental Status Questionnaire (SPMSQ), and the short form of the Mini Nutritional Assessment (short-MNA) were used to estimate functional, cognitive, and nutritional status. The Charlson score (CS) was used to measure comorbidity. Eighty-eight patients (mean age 79 years; 57% women) were finally included; their median CS score was 2.1. Prior to the index admission, their mean BI score was 91, OARS 9.8, SPMSQ 1.8 errors, and short-MNA 10.7. Twenty-four patients (27%) died during the first year of follow-up. Low preadmission BI scores were predictive of mortality (p=0.02), but not of readmission (p=0.9). After one-year of follow-up BI scores remained lower than preadmission values in 64% of the surviving patients; for OARS scores the figure was 67%. In conclusion, a previous low functional capacity is associated with higher mortality but not with HF-related hospital readmission. Admission because of a new onset HF is often followed by a sustained functional decline both for the performance of basic and instrumental activities of the daily living.