Functional Limitations Predict the Risk of Rehospitalization Among Patients With Chronic Heart Failure

Background: Although functional limitations (FLs) can predict clinical deterioration in chronic heart failure (CHF), few studies have focused on the associated clinical significance. The aim of the present study was to examine the association between FL and changes in the related time course with subsequent hospital readmission in CHF patients. Methods and Results: FLs were analyzed using the Performance Measure for Activities of Daily Living-8 (PMADL-8; higher scores indicate worse FLs) for 215 CHF patients at 1 and 3 months after discharge in a multicenter cohort study. The mean follow-up was 20 months. In a multivariate Cox regression analysis including covariates, only the PMADL-8 score remained significantly related to rehospitalization of CHF (hazard ratio, 2.49; 95% confidence interval: 1.27-4.90; P<0.01). Event-free survival differed significantly among the 4 PMADL-8 time-course groups (P<0.01). The persistent low-FL group had lower event rates than the other 3 time-course groups (P<0.01). Conclusions: FLs as measured by the PMADL-8 and the time course of the PMADL-8 score predict readmission in CHF patients after discharge. Accordingly, FL assessment is recommended as part of the clinical management because it not only identifies decline in physical function but also guides prognosis in CHF patients.  (Circ J 2012; 76: 1654–1661)