title: Functional limitations predict the risk of rehospitalization among patients with chronic heart failure.
abstract: BACKGROUND
  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.
  
  
  RESULTS
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: School of Health Sciences, Nagoya University, Nagoya, Japan. yamadas@met.nagoya-u.ac.jp
authors.forename: Sumio
authors.initials: S
authors.lastname: Yamada
authors.forename: Yuko
authors.initials: Y
authors.lastname: Shimizu
authors.forename: Makoto
authors.initials: M
authors.lastname: Suzuki
authors.forename: Tohru
authors.initials: T
authors.lastname: Izumi
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D002908:Chronic Disease; D004185:Disability Evaluation; D018572:Disease-Free Survival; D005260:Female; D006333:Heart Failure / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy; D006801:Humans; D007564:Japan; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010359:Patient Readmission; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D020127:Recovery of Function; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors