Key result
In HF patients with cognitive impairment, proxies reported greater functional dependence than patients self-reported (median ALSAR 7 vs 4, p<0.01), with larger discrepancies at lower MoCA scores.
Why the study?
Heart failure patients often experience cognitive impairment that harms self-management ability, and patient proxies may provide better insight into functional capacity.
Does proxy-reported functional ability differ from self-reported functional ability and correlate with cognitive impairment in hospitalized heart failure patients?
Cross-Sectional (n=30)
No
Does proxy-reported functional ability differ from self-reported functional ability and correlate with cognitive impairment in hospitalized heart failure patients?
In hospitalized heart failure patients with cognitive impairment, proxy-reported functional ability scores indicate greater dependence than self-reported scores, with the discrepancy correlating with the severity of cognitive impairment.
Caution against sole reliance on self-reports for functional status in cognitively impaired HF; hypothesis-generating for proxy integration in assessments.
Background: Heart failure (HF) patients often experience cognitive impairment that negatively impacts self-management ability, predisposing these individuals to worse post-hospitalization outcomes. Patient proxies may have more insight into a patient's self-management capability especially in the context of patient cognitive impairment. Here, we incorporate proxy input to evaluate associations between patient- and proxy-reported capacity for instrumental activities of daily living (IADL) stratified along a patient's cognitive function in an older hospitalized heart failure population. Methods: We conducted a quality improvement study in older HF inpatients with cognitive impairment determined by Mini-Cog. Functional activity performance has been previously assessed using the Assessment of Living Skills and Resources Revision 2 (ALSAR), a validated index where higher numerical scores associate with increasing dependence in completing IADL and risk for needing a more structured living environment, nursing home placement, hospitalization, and death. We assessed ALSAR with patient self-report and proxy-report (range 0-44 lower scores equate to better performance) and calculated the absolute difference (ALSAR difference, lower scores show stronger agreement between patients and proxies). Patients' Montreal Cognitive Assessment (MoCA) scores, among which scores less than 26 suggest clinically significant cognitive impairment, were correlated with ALSAR difference. Results: Median patient age was 74 years. Forty-two percent were female among our sample of 30 hospitalized HF patients with cognitive impairment. Median patient ALSAR score of 4 (range 2-7) differed from median proxy ALSAR score of 7 (range 4-12) (p<0.01). Lower MoCA correlated with higher ALSAR difference (r=-0.58, p<0.01). Conclusions: Assessing ALSAR difference in clinical practice is feasible and it correlates to MoCA score in hospitalized HF patients with cognitive impairment, consistent with prior work. These results support the notion that proxy-input of patient IADL assessment could improve patient needs detection among HF patients with cognitive impairment. This information may enhance risk assessment, disease management and discharge planning when targeting and proactively involving proxies. Prospective studies should evaluate this novel metric and its association with patient-centered outcomes.
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Gravenstein et al. (2024) conducted a cross-sectional in Heart failure with cognitive impairment (n=30). Proxy-reported functional ability assessment vs. Patient self-reported functional ability assessment was evaluated on Assessment of Living Skills and Resources (ALSAR) score (r=-0.58, p=<0.01). In HF patients with cognitive impairment, proxies reported greater functional dependence than patients self-reported (median ALSAR 7 vs 4, p<0.01), with larger discrepancies at lower MoCA scores.
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