Abstract 20091: Instrumental Activities of Daily Living Impairment is an Independent Predictor of Incident Heart Failure, Acute Myocardial Infarction and All-Cause Mortality in Community-Dwelling Older Adults
Background: Instrumental Activities of Daily Living (IADL) measures physical and cognitive function in older adults and an impaired IADL correlates with poor clinical outcomes. The relationship between IADLs and cardiovascular disease is less studied. We investigated whether impaired IADLs was associated with cardiovascular outcomes in the Cardiovascular Health Study (CHS).
Methods: Of the 5795 community-dwelling adults ≥65 years in the CHS, 5511 were free of prevalent HF and had data on IADL at baseline. IADL impairment was defined as self-reported difficulty with ≥1 of the 6 items: telephone use, shopping, preparing food, performing light or heavy household work, and managing finances. Overall, 1333 participants reported IADL impairment, of which 1023 (77%) had difficulty with only 1 item (188, 70, 41, 6 and 5 reported 2- to 6-item difficulty resp.). Propensity scores for IADL impairment, calculated for each of the 5511 participants, were used to assemble a cohort of 1038 pairs of participants with and without IADL impairment who were balanced on 42 baseline characteristics. All outcomes were centrally adjudicated.
Results: Participants (n=2076) had a mean (±SD) age of 74 (±6) years, 67% were women, and 15% were African American. Incident HF occurred in 26% and 21% of matched participants with and without impaired IADL respectively during >12 years of follow-up (HR, 1.33; 95% CI, 1.08-1.65; p=0.008; Figure). Baseline IADL impairment was also independently associated with incident acute myocardial infarction (HR, 1.41; 95% CI, 1.05-1.59; p=0.023) and all-cause mortality (HR, 1.24; 95% CI, 1.07-1.43; p=0.003). These associations remained unchanged when we repeated our analysis excluding those with >1 IADL impairment.
Conclusion: Among community-dwelling older adults, baseline impairment of IADL is a strong and independent predictor of incident HF, acute myocardial infarction and all-cause mortality.
- © 2010 by American Heart Association, Inc.