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Cardiovascular Disease and Patterns of Change in Functional Status Over 15 Years: Findings From the Atherosclerosis
Anna Kucharska-Newton1, Michael Griswold2, Zhihao Howard Yao2
1University of North Carolina at Chapel Hill, NC anna_newton@unc.edu.
Insights
Functional status (FS) declines at least two years before cardiovascular disease (CVD) hospitalization. While FS recovers after myocardial infarction, it remains declined after stroke and heart failure.
Area of Science:
- Gerontology
- Epidemiology
- Cardiology
Background:
- Cardiovascular disease (CVD) is a primary cause of early disability.
- Few studies have prospectively investigated functional status (FS) in individuals with CVD.
- This study examines FS changes before and after hospitalization for myocardial infarction, stroke, and heart failure.
Purpose of the Study:
- To investigate patterns of change in functional status (FS) preceding and following hospitalization for major cardiovascular events.
- To analyze FS trajectories in relation to myocardial infarction, stroke, and heart failure.
- To identify potential early indicators of CVD risk through functional status assessment.
Main Methods:
- Utilized data from 15,277 Atherosclerosis Risk in Communities (ARIC) study participants (1993-2007).
- Assessed FS using a modified Rosow-Breslau questionnaire during annual telephone interviews.
- Analyzed changes in FS over time relative to CVD events using generalized estimating equations.
Main Results:
- A decline in FS was observed an average of 2 years before myocardial infarction and 3 years before stroke or heart failure hospitalizations.
- FS decreased post-myocardial infarction but largely recovered within 3 years.
- Persistent FS decline was noted following incident heart failure and stroke.
- No significant differences in FS change patterns were observed based on race or sex.
Conclusions:
- A decline in functional status precedes cardiovascular disease hospitalization by at least two years.
- Routine assessment of functional status in older adults is recommended for preventative evaluation.
- Understanding FS trajectories can aid in early detection and management of cardiovascular disease.
Background:
Cardiovascular disease (CVD) is the leading cause of premature disability, yet few prospective studies have examined functional status (FS) among persons with CVD. Our aim was to examine patterns of change in FS prior to and after hospitalization for nonfatal myocardial infarction, stroke, and heart failure among members of the Atherosclerosis Risk in Communities (ARIC) study cohort.
Methods And Results:
FS was assessed using a modified Rosow-Breslau questionnaire administered during routine annual telephone interviews conducted from 1993 through 2007 among 15 277 ARIC study participants. An FS score was constructed as a summary measure of responses to questions about participants' ability to perform selected tasks of daily living (eg, walking half a mile, climbing stairs). Incidence of CVD was assessed through ARIC surveillance of hospitalized events. Rate of change in FS over time prior to and following a CVD event was examined using generalized estimating equations. A decline in FS was observed on average 2 years prior to a myocardial infarction hospitalization and on average 3 years prior to a stroke or heart failure hospitalization. FS post-myocardial infarction declined relative to pre-event levels but improved to close to pre-myocardial infarction levels within 3 years. Decline in FS following incident heart failure and stroke remained over time. Observed patterns of change in FS did not differ appreciably by race or sex.
Conclusions:
This study documents that a decline in FS precedes incidence of CVD-related hospitalization by at least 2 years, providing a strong argument for routine preventative assessment of FS among older adults.