Clinical characteristics of heart failure associated with functional dependence at admission in hospitalized elderly

The Prevalence of Activities of Daily Living Impairment in Patients With Heart Failure: A Systematic Review and Meta-Analysis

Objectives

The prevalence of activities of daily living (ADL) in patients with heart failure (HF) reported in current studies were inconsistent, ranging from 11.1 to 70.5%. The purpose of this study is to quantify the prevalence of ADL impairment in HF patients.

Methods

PubMed, Embase, Cochrane, CINAHL, CNKI, SinoMed, VIP, and Wanfang databases were systematically searched for relevant studies (up to March 2, 2022). Cross-sectional, case-control, or cohort studies with detailed descriptions of overall ADL impairment in HF were included. Stata 16.0 was used for statistical analysis. Fixed-effect or random-effect model was adopted according to heterogeneity which was evaluated by Cochran’s Q and I2 values. Sensitivity analysis, subgroup analysis, and meta-regression were performed to investigate the sources of heterogeneity.

Results

A total of 12 studies with 15,795 HF patients were included in the meta-analysis, and the pooled prevalence of ADL impairment in patients with HF was 38.8% (95%CI: 28.2–49.3%; I2 = 99.5%, P < 0.001). No possible sources of heterogeneity were found in subgroup analysis and meta-regression. Funnel plots and Egger’s test showed no publication bias (P = 0.595).

Conclusion

The prevalence of ADL impairment is relatively high in HF patients. Differences in the prevalence of ADL impairment in patients with HF may be influenced by country, region, and assessment time. We suggest that more researchers could focus on the changes of ADL impairment in HF patients during different disease periods in different regions and countries.

Identification of factors associated with social dysfunction in patients with heart failure

AIMS

Social dysfunction is adversely associated with individuals' physical and mental quality of life. However, little is known about the status of social dysfunction and its associated factors in patients with heart failure. Our study aimed to reveal the prevalence of social dysfunction, and the associations between fatigue, dyspnoea, anxiety, depression, social connectedness, and social dysfunction in patients with heart failure.

METHODS AND RESULTS

We assessed the social dysfunction, fatigue, dyspnoea, anxiety, depression, and social connectedness using self-report questionnaires among 291 patients (64.13 ± 11.84 years, 53.3% male) with heart failure. Two stepwise forward logistic regression models were employed to identify the factors associated with social dysfunction, and the area under receiver operating characteristic curve was used to calculate the variance of the associated factors accounting for social dysfunction. Of the 291 patients, 76.6% reported social dysfunction. The logistic regression model after adjusting co-variables showed that fatigue [odds ratio (OR) 4.233, 95% confidence interval (CI) 1.778-10.081], dyspnoea (OR 0.866, 95% CI 0.756-0.991), depression (OR 1.173, 95% CI 1.037-1.328) were positively associated with social dysfunction, whereas social connectedness (OR 0.394, 95% CI 0.203-0.764) was negatively associated with social dysfunction. Four factors explained 84.5% of the variance of social dysfunction in patients with heart failure.

CONCLUSIONS

Social dysfunction is prevalent in patients with heart failure, and fatigue, dyspnoea, depression, and social connectedness are the associated factors. The findings indicate that the key to helping heart failure patients return to social life may be to attenuate fatigue, dyspnoea, and depression and to improve social connectedness.