Prognostic Value of Estimating Functional Capacity With the Use of the Duke Activity Status Index in Stable Patients With Chronic Heart Failure

• The Duke Activity Status Index is a simple self-assessment tool estimating functional capacity.
• 1,700 subjects with chronic heart failure completed the questionnaire.
• All subjects were undergoing elective coronary angiography upon entry to this prospective cohort.
• Lower scores were associated with higher mortality on long-term follow-up.
• These results highlight the importance of functional status assessment in chronic heart failure.

BackgroundOver the years, several methods have been developed to reliably quantify functional capacity in patients with heart failure. Few studies have investigated the prognostic value of these assessment tools beyond cardiorenal prognostic biomarkers in stable patients with chronic heart failure.Methods and ResultsWe administered the Duke Activity Status Index (DASI) questionnaire, a self-assessment tool comprising 12 questions for estimating functional capacity, to 1,700 stable nonacute coronary syndrome patients with history of heart failure who underwent elective diagnostic coronary angiography with 5-year follow-up of all-cause mortality. In a subset of patients (n = 800), B-type natriuretic peptide (BNP) was measured. In our study cohort, the median DASI score was 26.2 (interquartile range [IQR] 15.5–42.7). Low DASI score provided independent prediction of a 3.3-fold increase in 5-year mortality risk (quartile 1 vs quartile 4: hazard ratio [HR] 3.33, 95% confidence interval [CI] 2.57–4.36; P < .0001). After adjusting for traditional risk factors, BNP, and estimated glomerular filtration rate, low DASI score still conferred a 2.6-fold increase in mortality risk (HR 2.57, 95% CI 1.64–4.15; P < .0001).ConclusionsA simple self-assessment tool of functional capacity provides independent and incremental prognostic value for mortality prediction in stable patients with chronic heart failure beyond cardiorenal biomarkers.