title: Cardiovascular Disease and Patterns of Change in Functional Status Over 15 Years: Findings From the Atherosclerosis Risk in Communities (ARIC) Study.
abstract: BACKGROUND
  Cardiovascular disease (CVD) is the leading cause of premature disability, yet few prospective studies have examined functional status (FS) among persons with CVD. Our aim was to examine patterns of change in FS prior to and after hospitalization for nonfatal myocardial infarction, stroke, and heart failure among members of the Atherosclerosis Risk in Communities (ARIC) study cohort.
  
  
  RESULTS
  FS was assessed using a modified Rosow-Breslau questionnaire administered during routine annual telephone interviews conducted from 1993 through 2007 among 15 277 ARIC study participants. An FS score was constructed as a summary measure of responses to questions about participants' ability to perform selected tasks of daily living (eg, walking half a mile, climbing stairs). Incidence of CVD was assessed through ARIC surveillance of hospitalized events. Rate of change in FS over time prior to and following a CVD event was examined using generalized estimating equations. A decline in FS was observed on average 2 years prior to a myocardial infarction hospitalization and on average 3 years prior to a stroke or heart failure hospitalization. FS post-myocardial infarction declined relative to pre-event levels but improved to close to pre-myocardial infarction levels within 3 years. Decline in FS following incident heart failure and stroke remained over time. Observed patterns of change in FS did not differ appreciably by race or sex.
  
  
  CONCLUSIONS
  This study documents that a decline in FS precedes incidence of CVD-related hospitalization by at least 2 years, providing a strong argument for routine preventative assessment of FS among older adults.
authors.affiliation: University of North Carolina at Chapel Hill, NC anna_newton@unc.edu.
authors.forename: Anna
authors.initials: A
authors.lastname: Kucharska-Newton
authors.affiliation: University of Mississippi, Jackson, MS.
authors.forename: Michael
authors.initials: M
authors.lastname: Griswold
authors.affiliation: University of Mississippi, Jackson, MS.
authors.forename: Zhihao Howard
authors.initials: ZH
authors.lastname: Yao
authors.affiliation: The Ohio State University, Columbus, OH.
authors.forename: Randi
authors.initials: R
authors.lastname: Foraker
authors.affiliation: Social and Scientific Systems, Inc, Durham, NC.
authors.forename: Kathryn
authors.initials: K
authors.lastname: Rose
authors.affiliation: University of North Carolina at Chapel Hill, NC.
authors.forename: Wayne
authors.initials: W
authors.lastname: Rosamond
authors.affiliation: Wake Forest University, Winston Salem, NC.
authors.forename: Lynne
authors.initials: L
authors.lastname: Wagenknecht
authors.affiliation: Tel Aviv University, Tel Aviv, Israel.
authors.forename: Silvia
authors.initials: S
authors.lastname: Koton
authors.affiliation: University of Texas, Houston, TX.
authors.forename: Lisa
authors.initials: L
authors.lastname: Pompeii
authors.affiliation: University of Mississippi, Jackson, MS.
authors.forename: B Gwen
authors.initials: BG
authors.lastname: Windham
mesh_terms: D000203:Activities of Daily Living; D050197:Atherosclerosis / Q000453:epidemiology; D002318:Cardiovascular Diseases / Q000453:epidemiology*; D005260:Female; D005500:Follow-Up Studies; D005544:Forecasting; D006304:Health Status; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D057566:Self Report; D014481:United States / Q000453:epidemiology
keywords: functional status; heart failure; myocardial infarction; stroke