School of Health Sciences, Nagoya University, Nagoya, Japan.
Circ J. 2012;76(7):1654-61. doi: 10.1253/circj.cj-11-1178. Epub 2012 Apr 7.
Although functional limitations (FLs) can predict clinical deterioration in chronic heart failure (CHF), few studies have focused on the associated clinical significance. The aim of the present study was to examine the association between FL and changes in the related time course with subsequent hospital readmission in CHF patients.
FLs were analyzed using the Performance Measure for Activities of Daily Living-8 (PMADL-8; higher scores indicate worse FLs) for 215 CHF patients at 1 and 3 months after discharge in a multicenter cohort study. The mean follow-up was 20 months. In a multivariate Cox regression analysis including covariates, only the PMADL-8 score remained significantly related to rehospitalization of CHF (hazard ratio, 2.49; 95% confidence interval: 1.27-4.90; P<0.01). Event-free survival differed significantly among the 4 PMADL-8 time-course groups (P<0.01). The persistent low-FL group had lower event rates than the other 3 time-course groups (P<0.01).
FLs as measured by the PMADL-8 and the time course of the PMADL-8 score predict readmission in CHF patients after discharge. Accordingly, FL assessment is recommended as part of the clinical management because it not only identifies decline in physical function but also guides prognosis in CHF patients.
虽然功能障碍（FLs）可以预测慢性心力衰竭（CHF）的临床恶化，但很少有研究关注其相关的临床意义。本研究旨在探讨 FL 与 CHF 患者相关时间过程变化与随后住院再入院之间的关系。
在一项多中心队列研究中，对 215 例出院后 1 个月和 3 个月的 CHF 患者使用日常生活活动能力量表 8 项（PMADL-8；得分越高表示 FL 越差）分析 FL。平均随访时间为 20 个月。在包括协变量的多变量 Cox 回归分析中，只有 PMADL-8 评分与 CHF 再入院显著相关（危险比，2.49；95%置信区间：1.27-4.90；P<0.01）。4 个 PMADL-8 时间过程组之间的无事件生存差异有统计学意义（P<0.01）。持续低 FL 组的事件发生率低于其他 3 个时间过程组（P<0.01）。
PMADL-8 测量的 FL 及其 PMADL-8 评分的时间过程可预测 CHF 患者出院后的再入院。因此，FL 评估应作为临床管理的一部分，因为它不仅可以识别身体功能的下降，还可以指导 CHF 患者的预后。
