DASC-21 score and risk of rehospitalization and all-cause mortality after discharge in older patients with heart failure

IF 2.4 4区医学 Q3 GERIATRICS & GERONTOLOGY Geriatrics & Gerontology International Pub Date : 2024-10-01 DOI:10.1111/ggi.14975

Ruri Shimizu, Joji Ishikawa, Chihiro Jyubishi, Ayumi Toba, Shutaro Futami, Ai Morozumi, Yoshihiro Saito, Shunsuke Komatsu, Hajime Fujimoto, Taizo Ishiyama, Shinichi Usui, Yusuke Tuboko, Shuichi Awata, Masahiro Akishita, Kazumasa Harada

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Abstract

Aim

The impact of cognitive dysfunction-associated activities of daily living (ADL) on mortality and rehospitalization for heart failure has not yet been evaluated.

Methods

We retrospectively evaluated DASC-21, the incidence of all-cause mortality, and rehospitalization for heart failure after discharge in 329 older patients with heart failure.

Results

The mean age was 85.1 ± 7.4 years (62.6% women). There were 110 cases of death from any cause (33.4%) during 25.5 ± 16.1 months of follow-up and 166 cases of rehospitalization from heart failure (50.5%) during 16.1 ± 15.2 months of follow-up. The DASC-21 score was not significantly associated with an increased risk of all-cause mortality or rehospitalization. For each item of the DASC-21 questionnaire, defective route-finding (item 6) (HR = 2.631, P = 0.003), common sense and capacity for judgement (item 9) (HR = 1.717, P = 0.040), instrumental ADL (IADL) for shopping (item 10) (HR = 1.771, P = 0.020), and IADL for meal preparation (item 14) (HR = 1.790, P = 0.019) were significantly associated with an increased risk of all-cause mortality. Disabilities in route finding (HR = 2.257, P = 0.005), IADL for shopping (HR = 1.632, P = 0.016), and IADL for transportation (HR = 1.537, P = 0.033) were significant risk factors for rehospitalization due to heart failure. Even in the multivariate-adjusted model, disability in defective route-finding was significantly associated with an increased risk of all-cause mortality (hazard ratio [HR] = 2.148, 95% confidence interval [CI] 1.090–4.236; P = 0.027) and of rehospitalization for heart failure (HR = 2.138, 95% CI 1.153–3.963, P = 0.016).

Conclusions

In older patients hospitalized for heart failure, route disability was associated with all-cause mortality and rehospitalization for heart failure after discharge. Geriatr Gerontol Int 2024; 24: 1130–1136.

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DASC-21 评分与老年心力衰竭患者出院后再次住院和全因死亡的风险。

目的：认知功能障碍相关的日常生活活动（ADL）对心力衰竭死亡率和再住院率的影响尚未得到评估：我们对329名老年心衰患者的DASC-21、全因死亡率和出院后因心衰再次住院的情况进行了回顾性评估：平均年龄为 85.1 ± 7.4 岁（女性占 62.6%）。在 25.5 ± 16.1 个月的随访期间，有 110 例因任何原因死亡（33.4%），在 16.1 ± 15.2 个月的随访期间，有 166 例因心衰再次住院（50.5%）。DASC-21评分与全因死亡率或再住院风险的增加无明显关联。在 DASC-21 问卷的每个项目中，路线寻找缺陷（第 6 项）（HR = 2.631，P = 0.003）、常识和判断能力（第 9 项）（HR = 1.717，P = 0.040）、购物的工具性日常生活能力（IADL）（第 10 项）（HR = 1.771，P = 0.020）和准备膳食的 IADL（第 14 项）（HR = 1.790，P = 0.019）与全因死亡风险增加显著相关。寻找路线（HR = 2.257，P = 0.005）、购物（HR = 1.632，P = 0.016）和交通（HR = 1.537，P = 0.033）方面的残疾是心衰再住院的重要危险因素。即使在多变量调整模型中，路径选择缺陷也与全因死亡风险增加（危险比 [HR] = 2.148，95% 置信区间 [CI] 1.090-4.236；P = 0.027）和心衰再住院风险增加（HR = 2.138，95% CI 1.153-3.963，P = 0.016）显著相关：结论：在因心力衰竭住院的老年患者中，路线残疾与全因死亡率和出院后因心力衰竭再次住院有关。Geriatr Gerontol Int 2024; --：-----.

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来源期刊

Geriatrics & Gerontology International 医学-老年医学

CiteScore

5.50

自引率

6.10%

发文量

189

审稿时长

4-8 weeks

期刊介绍： Geriatrics & Gerontology International is the official Journal of the Japan Geriatrics Society, reflecting the growing importance of the subject area in developed economies and their particular significance to a country like Japan with a large aging population. Geriatrics & Gerontology International is now an international publication with contributions from around the world and published four times per year.