Clinical Impact of Functional Independent Measure (FIM) on the Prognosis of Patients with Acute Decompensated Heart Failure

Background Activities of Daily Living (ADL) has been identified as an important prognostic factor in patient with heart failure (HF). Although the assessment of ADL is recommended to be performed based on both physical and cognitive functions, previous studies for HF mainly focused on either of these functions. Functional independent measure (FIM) has emerged as a comprehensive valid measure evaluating the ADL from both physical and cognitive viewpoints. This study aimed to investigate the prognostic impact of the FIM score on the clinical outcomes in hospitalized patients with acute decompensated heart failure (ADHF). Methods A total of 529 consecutive patients(age: 77±12 years, male: 58.2%)who admitted to our institution due to ADHF between May 2018 and May 2020 were retrospectively reviewed. Among them, we analyzed 473 patients whose FIM scores before discharge were available. Patients were divided into tertile of the FIM score. Primary outcome measures, defined as a composited of 180-day all-cause death and readmission after discharge, were compared among the 3 groups. Results The median FIM scores was 102 [interquartile range: 85-115]. The tertile 1 corresponds to a FIM score 111 (n=154). During the follow-up, there were 128 primary outcome measures(28 deaths from any cause and 114 readmission). Patients with the lower FIM scores were associated with graded increase of risks of the primary outcome measure (Figure, p=0.001). Even after multivariable adjustment using conventional risk factors for heart failure, including age, gender, left ventricular ejection fraction, anemia, sodium levels, creatinine, brain natriuretic peptide, medications at discharge, the results remained significant(tertile 1 vs 3; adjusted hazard ratio: 3.28 [95% confidence interval: 1.72-6.56], p Conclusions The FIM scores were significantly associated with readmission or death within 180 days of discharge in hospitalized patients with ADHF.