Longitudinal association between a combination of four persistent patient-reported cardiopulmonary and circulatory symptoms and incident ADL/IADL difficulties

This study aimed to examine the longitudinal association between the burden of 4 persistent patient-reported cardiopulmonary and circulatory symptoms and a composite outcome of incident difficulties in activities of daily living (ADL) or instrumental activities of daily living (IADL). We analyzed Health and Retirement Study and Research and Development Corporation Health and Retirement Study data, using 2012 (wave 11) as baseline and follow-up assessments in 2014, 2016, and 2018. Participants were aged ≥50 years, had complete symptom data, and reported no previous myocardial infarction or heart failure. Symptoms included persistent ankle/foot swelling, shortness of breath while awake, persistent dizziness, and severe fatigue. The primary outcome was new-onset difficulty in either ADL or IADL within 2 years. Secondary or exploratory outcomes included ADL difficulties, IADL difficulties, mobility difficulties, any functional difficulty, and cumulative ADL/IADL difficulties over 4 and 6 years. Modified Poisson regression estimated adjusted risk ratios (RRs). Standardized absolute risk differences and 95% confidence intervals (CIs) were reported. Sensitivity analyses assessed robustness to sample weighting, household clustering, missing data, follow-up ascertainment, proxy interviews, and exposure and outcome definitions. The main sample included 16,728 participants; the primary risk set comprised 12,140, with 11,272 included in M3. At baseline, 37.4% reported any symptom and 16.4% reported ≥2 symptoms. The association between any symptom and 2-year ADL/IADL difficulties attenuated from RR 1.90 (95% CI = 1.70–2.12) in the M2 clinical model to 1.52 (1.35–1.70) in the M3 expanded health burden model (both P < .001). M3-standardized risks without and with symptoms were 9.0% and 13.6%, respectively, yielding an absolute risk difference of 4.6 percentage points (95% CI = 3.3–6.0). RRs were 1.71 (1.49–1.95) for ADL difficulties and 1.40 (1.22–1.61) for IADL difficulties (both P < .001). Compared with no symptoms, RRs were 1.42 (1.25–1.61) for 1 symptom and 1.72 (1.48–1.99) for ≥2 symptoms. Associations remained directionally consistent over 4 and 6 years. Among adults initially free of ADL/IADL difficulties, symptom burden remained associated with incident difficulties after sequential adjustment. This patient-reported symptom combination may signal a need for further functional assessment but should not be interpreted as a basis for cardiovascular disease diagnosis or as a causal factor.