Disability in heart failure: Contributions of clinical, functional, and contextual factors

Area of Science:

• Cardiology
• Rehabilitation Medicine
• Public Health

Background:

• Heart failure (HF) presents challenges beyond cardiac dysfunction, affecting quality of life and daily functioning.
• The extent of cardiac impairment does not fully explain the level of disability experienced by patients.
• Understanding factors contributing to disability is crucial for comprehensive HF management.

Purpose of the Study:

• To identify clinical and functional factors associated with disability in individuals with heart failure.
• To explore the relationship between functional capacity, sleep quality, and disability.
• To investigate the impact of specific comorbidities on disability in HF patients.

Main Methods:

• A cross-sectional, quantitative study involving 74 heart failure patients undergoing cardiopulmonary exercise testing (CPET).
• Disability assessed using the World Health Disability Assessment Schedule 2.0 (WHODAS 2.0).
• Sleep quality measured by the Pittsburgh Sleep Quality Index (PSQI), and functional capacity by the Duke Activity Status Index (DASI).

Main Results:

• Higher disability levels were observed in patients with NYHA functional class II or higher.
• Each unit increase in metabolic equivalent (MET) estimated by DASI correlated with reduced disability.
• Dyslipidemia was associated with a 168% increase in cognitive impairment, and poor sleep quality with a 236% increase in cognitive impairment.

Conclusions:

• Disability in heart failure is significantly associated with poorer functional class (NYHA ≥ II).
• Dyslipidemia and poor sleep quality are key factors contributing to disability, particularly cognitive impairment.
• Interventions targeting functional status, sleep, and lipid management may improve disability outcomes in HF.