Determinants of Disability in Older Coronary Patients
Background: Patient-reported physical function is a major component of disability determinations and an important contributor to health-related quality of life. Prior studies of coronary disability have shown a surprisingly poor correlation between real-life activity profile and exercise capacity measured on the treadmill. The goal of the current investigation was to evaluate the relative importance of medical factors, sex, fitness-related measures, and psychologic factors as determinants of patient-reported physical function score in older persons with established coronary heart disease (CHD).
Methods: Determinants of disability were studied in 51 community-dwelling patients >65 years old (71 ± 5 years, range 65-83 years) with established chronic CHD. Patient-reported physical function score (scaled 0-100) was measured by the Medical Outcomes Study Short Form physical function section. Independent variables included clinical and demographic data, treadmill testing, rest and exercise echocardiography, measures of body composition, strength, aerobic fitness, and a depression score.
Results: Patients with a diagnosis of myocardial infarction had a lower physical function score than did patients with other CHD diagnoses (68 ± 19 vs 82 ± 22, P < .05). Univariate predictors of patient-reported physical function score included peak aerobic capacity (R = 0.62), treadmill test duration (R = 0.61), depression score (R = -0.60), handgrip strength (R = 0.42), and comorbidity score (R = -0.39). Peak aerobic capacity (R = 0.38) and depression score (cumulative R = 0.60) were the best independent predictors of physical function. Women had lower physical function scores than men (64 ± 22 vs 78 ± 20, P < .05) despite a similar age, diagnostic distribution, depression score, and comorbidity score. Resting left ventricular ejection fraction was not a predictor of physical function score.
Conclusions: Peak aerobic capacity and depression score were the best independent predictors of patient-reported physical function score in older coronary patients. These data focus on the potential for exercise training and treatment of mental depression to prevent and treat coronary disability in older coronary patients.
Patient-reported physical functioning is a major component of disability determinations and of the need for disability-related services such as visiting nurses, household help, and Meals on Wheels. It is also a major component of health-related quality of life. In a study of middle-aged men with coronary heart disease (CHD) there was only a poor correlation between exercise capacity measured on the treadmill and the performance of practical activities of daily living. For many activities, the patients' perception of their cardiac limitations was a better predictor of physical capacity than was the presence of cardiac symptoms.
Compared with middle-aged patients with CHD, older patients have a diminished exercise capacity and higher rates of disability and mobility limitations. In the Framingham Disability Study, higher rates of disability and mobility limitations were noted with advancing age for patients diagnosed with coronary artery disease or congestive heart failure. Disability rates were particularly high with advancing age for patients with angina pectoris and in women. For example, disability rates in men and women aged 70 to 88 years with CHD were 49% and 79%, respectively, compared with rates of 9% and 25%, respectively, in men and women aged 55 to 69 years without CHD.
The goals of medical care and rehabilitation of older coronary patients are to improve physical functioning and quality of life and to extend disability-free survival. The factors that are associated with disability in older coronary patients, however, have not been well studied. The goal of the current study was to use sophisticated methods such as rest and exercise echocardiography, dual energy x-ray absorptiometry (DEXA), measures of body composition, isokinetic dynamometer measures of muscular strength, and psychologic evaluations to comprehensively study medical, demographic, and psychosocial correlates of patient-reported disability in older coronary patients. We hypothesized that perceptual and psychologic factors would be as important as fitness-related factors in determining patient-reported measures of physical function.
The elucidation of potentially modifiable determinants of physical functioning allows for the design and study of clinical interventions aimed at treating and preventing coronary disability in the elderly. As the size of the elderly population with CHD expands over the next several decades, interventions that successfully improve physical function in this population will have important public health implications.
Background: Patient-reported physical function is a major component of disability determinations and an important contributor to health-related quality of life. Prior studies of coronary disability have shown a surprisingly poor correlation between real-life activity profile and exercise capacity measured on the treadmill. The goal of the current investigation was to evaluate the relative importance of medical factors, sex, fitness-related measures, and psychologic factors as determinants of patient-reported physical function score in older persons with established coronary heart disease (CHD).
Methods: Determinants of disability were studied in 51 community-dwelling patients >65 years old (71 ± 5 years, range 65-83 years) with established chronic CHD. Patient-reported physical function score (scaled 0-100) was measured by the Medical Outcomes Study Short Form physical function section. Independent variables included clinical and demographic data, treadmill testing, rest and exercise echocardiography, measures of body composition, strength, aerobic fitness, and a depression score.
Results: Patients with a diagnosis of myocardial infarction had a lower physical function score than did patients with other CHD diagnoses (68 ± 19 vs 82 ± 22, P < .05). Univariate predictors of patient-reported physical function score included peak aerobic capacity (R = 0.62), treadmill test duration (R = 0.61), depression score (R = -0.60), handgrip strength (R = 0.42), and comorbidity score (R = -0.39). Peak aerobic capacity (R = 0.38) and depression score (cumulative R = 0.60) were the best independent predictors of physical function. Women had lower physical function scores than men (64 ± 22 vs 78 ± 20, P < .05) despite a similar age, diagnostic distribution, depression score, and comorbidity score. Resting left ventricular ejection fraction was not a predictor of physical function score.
Conclusions: Peak aerobic capacity and depression score were the best independent predictors of patient-reported physical function score in older coronary patients. These data focus on the potential for exercise training and treatment of mental depression to prevent and treat coronary disability in older coronary patients.
Patient-reported physical functioning is a major component of disability determinations and of the need for disability-related services such as visiting nurses, household help, and Meals on Wheels. It is also a major component of health-related quality of life. In a study of middle-aged men with coronary heart disease (CHD) there was only a poor correlation between exercise capacity measured on the treadmill and the performance of practical activities of daily living. For many activities, the patients' perception of their cardiac limitations was a better predictor of physical capacity than was the presence of cardiac symptoms.
Compared with middle-aged patients with CHD, older patients have a diminished exercise capacity and higher rates of disability and mobility limitations. In the Framingham Disability Study, higher rates of disability and mobility limitations were noted with advancing age for patients diagnosed with coronary artery disease or congestive heart failure. Disability rates were particularly high with advancing age for patients with angina pectoris and in women. For example, disability rates in men and women aged 70 to 88 years with CHD were 49% and 79%, respectively, compared with rates of 9% and 25%, respectively, in men and women aged 55 to 69 years without CHD.
The goals of medical care and rehabilitation of older coronary patients are to improve physical functioning and quality of life and to extend disability-free survival. The factors that are associated with disability in older coronary patients, however, have not been well studied. The goal of the current study was to use sophisticated methods such as rest and exercise echocardiography, dual energy x-ray absorptiometry (DEXA), measures of body composition, isokinetic dynamometer measures of muscular strength, and psychologic evaluations to comprehensively study medical, demographic, and psychosocial correlates of patient-reported disability in older coronary patients. We hypothesized that perceptual and psychologic factors would be as important as fitness-related factors in determining patient-reported measures of physical function.
The elucidation of potentially modifiable determinants of physical functioning allows for the design and study of clinical interventions aimed at treating and preventing coronary disability in the elderly. As the size of the elderly population with CHD expands over the next several decades, interventions that successfully improve physical function in this population will have important public health implications.