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. 2012 Jun;14(6):581-7.
doi: 10.1093/eurjhf/hfs034. Epub 2012 Apr 4.

Impairment of activities of daily living and incident heart failure in community-dwelling older adults

C Barrett Bowling  1 , Gregg C Fonarow, Kanan Patel, Yan Zhang, Margaret A Feller, Xuemei Sui, Steven N Blair, Kannayiram Alagiakrishnan, Inmaculada B Aban, Thomas E Love, Richard M Allman, Ali Ahmed
Affiliations

Impairment of activities of daily living and incident heart failure in community-dwelling older adults

C Barrett Bowling et al. Eur J Heart Fail. 2012 Jun.

Abstract

Aims: Instrumental activities of daily living (IADLs) are tasks that are necessary for independent community living. These tasks often require intact physical and cognitive function, the impairment of which may adversely affect health in older adults. In the current study, we examined the association between IADL impairment and incident heart failure (HF) in community-dwelling older adults.

Methods and results: Of the 5795 community-dwelling adults, aged ≥65 years, in the Cardiovascular Health Study, 5511 had data on baseline IADL and were free of prevalent HF. Of these, 1333 (24%) had baseline IADL impairment, defined as self-reported difficulty with one or more of the following tasks: using the telephone, preparing food, performing light and heavy housework, managing finances, and shopping. Propensity scores for IADL impairment, estimated for each of the 5511 participants, were used to assemble a cohort of 1038 pairs of participants with and without IADL impairment who were balanced on 42 baseline characteristics. Centrally adjudicated incident HF occurred in 26% and 21% of matched participants with and without IADL impairment, respectively, during >12 years of follow-up [matched hazard ratio (HR) 1.33; 95% confidence interval (CI) 1.11-1.59; P = 0.002]. Unadjusted and multivariable-adjusted HRs for incident HF before matching were 1.77 (95% CI 1.56-2.01; P < 0.001) and 1.33 (95% CI 1.15-1.54; P < 0.001), respectively. IADL impairment was also associated with all-cause mortality (matched HR 1.19; 95% CI 1.06-1.34; P = 0.004).

Conclusion: Among community-dwelling older adults free of baseline HF, IADL impairment is a strong and independent predictor of incident HF and mortality.

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Figures

Figure 1
Figure 1
Absolute standardized differences of baseline characteristics of older adults in the Cardiovascular Health Study with and without baseline impairment of instrumental activities of daily living, before and after propensity score matching. COPD, chronic obstructive pulmonary disease; EKG, electrocardiography; LV, left ventricular.
Figure 2
Figure 2
Kaplan–Meier plots for (A) incident heart failure and (B) all-cause mortality by baseline impairment of instrumental activities of daily living (IADLs) in a propensity-matched cohort of older adults in the Cardiovascular Health Study. CI, confidence interval; HR, hazard ratio.
Figure 3
Figure 3
Association of baseline impairment of instrumental activities of daily living (IADLs) and incident heart failure in subgroups of a propensity-matched cohort of older adults in the Cardiovascular Health Study. CI, confidence interval; HR, hazard ratio.
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Comment in

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