Functional Status Decline Occurs at Least 2 Years Before Cardiovascular Events

No significant differences in functional status trajectories were observed in terms of race or sex.
No significant differences in functional status trajectories were observed in terms of race or sex.

In a new prospective study published in the Journal of the American Heart Association, patients hospitalized for cardiovascular (CV) events showed a reduction in functional status at least 2 years before an event occurred.1

High functional status has been linked to greater patient adherence to medication and rehabilitation programs.2,3 The Institute of Medicine recommends functional status assessment as a core measure for patients with complex chronic conditions (who make up a group that represents 26% of US adults), and the American Heart Association encourages the use of patient-reported functional status in clinical care.4-6

"However, routine assessment of functional status in clinical settings is subject to availability of validated, nonproprietary instruments, which can be easily incorporated into electronic health record platforms," Anna Kucharska-Newton, PhD, MPH, from the University of North Carolina at Chapel Hill, and colleagues wrote. Noting a lack of prospective studies regarding functional status in CV disease (CVD), they analyzed data from the longitudinal Atherosclerosis Risk in Communities (ARIC) study to examine self-report measures of functional status in 15,277 patients before and after they were hospitalized for myocardial infarction (MI), heart failure, or stroke.

Their aim was to highlight the "importance of regular assessment of functional status among individuals at risk for and following a diagnosis of CVD."

A modified Rosow-Breslau scale of functional health was used for functional status assessment and included questions pertaining to patients' ability to perform daily tasks such as walking half a mile, climbing stairs, housework, and recreation. In patients who experienced a CV event, functional status was assessed annually up to 8 years before and after the event. Generalized estimating equations were used to determine incremental functional status changes over time.

For MI, the results demonstrate a reduction in functional status an average of 2 years before hospitalization. For heart failure and stroke, a decline in functional status was evident an average of 3 years before hospitalization. During the window of time 3 years before and 1 year after the event:

  • Patients with heart failure had a functional status reduction of −0.30 (95% CI, −0.33 to −0.27) units of the summary functional status score per year;
  • Patients with stroke had a functional status reduction of –0.33 (95% CI, –0.37 to –0.29) units per year;
  • Patients with MI had a functional status reduction of −0.23 (95% CI, −0.27 to −0.19) units per year; and
  • Patients with multiple CV events had a functional status reduction of −0.31 (95% CI, −0.44 to −0.35) units per year.

Functional status further declined after MI, but approached pre-MI levels within 3 years of the event, whereas the decrease in functional status after heart failure and stroke remained over time. There were no significant differences in functional status trajectories in terms of race or sex.

These findings "suggest that changes in functional status are evident at least 2 years prior to the incident CVD hospitalization, strongly supporting regular functional status assessments among older adults," the authors stated. "Such assessments may prevent or delay hospitalizations due to CVDs."


  1. Kucharska‐Newton A, Griswold M, Yao ZH, et al. Cardiovascular disease and patterns of change in functional status over 15 years: findings from the Atherosclerosis Risk in Communities (ARIC) study [published online March 1, 2017]. J Am Heart Assoc. doi:10.1161/JAHA.116.004144
  2. Whaley C, Reed M, Hsu J, Fung V. PS2-18: functional limitations, home support, and responses to drug costs among Medicare beneficiaries. Clin Med Res. 2013;11(3):159-160. doi: 10.3121/cmr.2013.1176.ps2-18
  3. Harlan WR III, Sandler SA, Lee KL, Lam LC, Mark DB. Importance of baseline functional and socioeconomic factors for participation in cardiac rehabilitation. Am J Cardiol. 1995; 76(1):36-39. doi: 10.1016/S0002-9149(99)80797-8
  4. Richardson W. Institute of Medicine (US) Committee on Quality of Health Care in America. Crossing the Quality Chasm: A New Healthcare for the 21st century. Washington, DC: National Academy Press; 2001.
  5. Ward BW, Schiller JS, Goodman RA. Multiple chronic conditions among US adults: a 2012 update. Prev Chronic Dis. 2014;11:130389. doi: 10.5888/pcd11.130389
  6. Rumsfeld JS, Alexander KP, Goff DC, et al. Cardiovascular health: the importance of measuring patient-reported health status: a scientific statement from the American Heart Association. Circulation. 2013;127(22):2233-2249. doi: 10.1161/CIR.0b013e3182949a2e

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