Diabetes, valvular heart disease, and poor symptom management were key predictors of long-term ADL impairment in patients with heart failure over a 12-month follow-up period.
Key Findings
Results
Patients with low ADL at 12 months had significantly higher rates of valvular heart disease and diabetes mellitus compared to high-ADL patients.
Valvular heart disease prevalence was 12% in the low-ADL group vs 3% in the high-ADL group (P = .025)
Diabetes mellitus prevalence was 29% in the low-ADL group vs 16% in the high-ADL group (P = .043)
Study enrolled 162 hospitalized HF patients stratified into low-ADL (ADL < 100, n = 66) and high-ADL (ADL = 100, n = 96) groups
Follow-up duration was 12 months post-hospital discharge
Results
Patients with low ADL had significantly elevated BNP levels compared to those with high ADL.
Median BNP was 474.9 pg/mL in the low-ADL group versus 398.0 pg/mL in the high-ADL group (P = .039)
BNP (B-type natriuretic peptide) was measured as a biomarker reflecting cardiac stress and dysfunction
The difference was statistically significant at conventional thresholds
Results
Patients with low ADL had poorer self-management scores across all measured domains compared to high-ADL patients.
Self-management domains assessed included psychological, drug, dietary, and symptom management
All self-management domain comparisons were statistically significant (P < .05)
Poorer self-management was observed across all four domains in the low-ADL group
Results
Diabetes mellitus was an independent negative predictor of ADL at 12 months in multivariable logistic regression.
Adjusted odds ratio (aOR) for diabetes was 0.33 (95% CI, 0.14–0.80; P = .014)
An aOR below 1.0 indicates diabetes was associated with significantly lower odds of achieving high ADL
This finding was confirmed in multivariable analysis controlling for other factors
Results
Valvular heart disease was an independent negative predictor of ADL at 12 months in multivariable logistic regression.
Adjusted odds ratio (aOR) for VHD was 0.19 (95% CI, 0.04–0.80; P = .024)
VHD had a stronger negative association with high ADL than diabetes based on the aOR magnitude
This was confirmed as an independent predictor after multivariable adjustment
Results
Symptom management was the strongest positive predictor of high ADL at 12 months.
Crude OR for symptom management was 12.71 (95% CI, 3.38–47.74; P < .001)
After multivariable adjustment, aOR was 6.26 (95% CI, 1.44–27.19; P = .014)
Symptom management was one of four self-management domains assessed, and it showed the largest effect size among positive predictors
Results
Diabetes mellitus disproportionately impaired ADL in patients with heart failure with reduced ejection fraction (HFrEF) compared to other HF subtypes.
HFrEF was defined as LVEF < 50%
OR for diabetes in the HFrEF subgroup was 0.21 (95% CI, 0.06–0.82)
Subgroup analyses stratified by left ventricular ejection fraction (LVEF) were performed to examine differential effects
This suggests diabetes has a particularly pronounced negative impact on functional outcomes in patients with reduced cardiac function
Results
The factors influencing ADL scores changed over the 12-month follow-up period.
The study was designed as a prospective cohort with longitudinal follow-up at 12 months
This temporal variability in predictors was noted as a distinct finding from the primary endpoint analysis
The study used logistic regression to identify predictors at the 12-month time point specifically
What This Means
This research followed 162 hospitalized heart failure patients for 12 months after discharge to understand what factors predict whether patients will be able to perform everyday activities independently, measured using a standard activities of daily living (ADL) scale. Patients were divided into two groups: those with full independence (high ADL) and those with some degree of impairment (low ADL). The study found that having diabetes, having valvular heart disease (a structural problem with the heart's valves), and having higher levels of a heart stress biomarker (BNP) were all associated with worse functional outcomes at 12 months. Importantly, patients with lower ADL also scored worse on all aspects of self-management, including managing symptoms, taking medications, following dietary guidelines, and psychological well-being.
Among all the factors studied, poor symptom management had the strongest association with worse ADL outcomes — patients with good symptom management had more than six times higher odds of maintaining full independence after adjustment for other factors. Diabetes was particularly harmful for patients whose hearts pump with reduced force (a condition called heart failure with reduced ejection fraction, or HFrEF), where having diabetes was associated with roughly one-fifth the odds of maintaining full ADL independence compared to those without diabetes in that subgroup.
This research suggests that in people living with heart failure, paying close attention to symptom recognition and response — knowing when symptoms like breathlessness or swelling are worsening and acting on them — may be especially important for maintaining the ability to carry out daily tasks over time. It also highlights that patients with both heart failure and diabetes, or those with valve problems, may need more intensive support and monitoring. Healthcare teams targeting these specific risk factors and improving patients' ability to manage their own symptoms could potentially improve long-term functional independence in this population.
Ning M, Li Z, Zhang C, Liu Y, Zheng C. (2026). Risk factors and self-management predictors of activities of daily living in patients with heart failure: A 12-month prospective cohort study.. Medicine. https://doi.org/10.1097/MD.0000000000049195