A Duke Activity Status Index score ≤24 effectively discriminated symptomatic status in chronic heart failure patients with a sensitivity of 92%, specificity of 66%, and AUC of 0.80 (p<0.001).
Cross-Sectional (n=128)
Does the Duke Activity Status Index (DASI) questionnaire cut-off accurately distinguish symptomatic from asymptomatic patients in chronic heart failure?
A DASI score of ≤24 effectively identifies symptomatic chronic heart failure patients and correlates with worse functional capacity and quality of life.
Effect estimate: OR 0.925 (95% CI 0.896-0.956)
p-value: p=<0.001
Abstract Background The Duke Activity Status Index (DASI) questionnaire is widely used to assess functional capacity in patients with chronic heart failure (CHF). Symptom burden strongly affects functional performance and quality of life in this population. However, evidence defining clinically meaningful DASI threshold values remains limited. Establishing an optimal cut-off score may enhance the tool’s clinical and rehabilitative utility. Aims: To determine the optimal DASI cut-off value for distinguishing symptomatic from asymptomatic CHF patients according to the New York Heart Association (NYHA) functional classification. Methods In this prospective cross-sectional study, 128 medically stable CHF patients were classified as asymptomatic class (NYHA I) or symptomatic (NYHA II-IV). All participants underwent evaluation with the six-minute walk test (6MWT), handgrip strength assessment, echocardiography, and the Minnesota Living with Heart Failure Questionnaire (MLHFQ). Associations between DASI scores and NYHA class were analyzed using Binary logistic regression. Receiver operating characteristic (ROC) curve analysis was performed to identify the optimal DASI cut-off point. Results According to NYHA classification, 41 patients (32%) were asymptomatic and 87 (68%) symptomatic. Compared with asymptomatic patients, symptomatic patients exhibited lower left ventricular ejection fraction (LVEF) (36±11% vs. 43±10%; p 0.001), higher prevalence of dyslipidemia (58% vs. 42%; p = 0.02), sedentary behavior (80% vs. %; p = 0.01) and lower DASI questionnaire scores (19 IQR 16 vs. 40 IQR 18; p 0.001). DASI scores were independently associated with NYHA class (β= -0.077; p 0.001; odds ratio = 0.925; 95% CI: 0.896-0.956), indicating that lower DASI scores increased the likelihood of being symptomatic. The optimal DASI cutoff was 24 points, with a sensitivity of 92%, specificity of 66%, Youden index of 0.57, and area under the ROC curve of 0.80 (p 0.001). Participants with DASI ≤ 24 demonstrated poorer performance on the 6MWT (p = 0.007; Cohen’s d = 0,63), lower handgrip strength (p 0.001; d = 0.72), reduced LVEF (p 0.001; d = 0.67), and worse MLHFQ scores (p 0.001; d = 0.59). Conclusions DASI score ≤24 effectively discriminates symptomatic status in CHF, identifying patients at higher risk of functional limitation and poorer quality of life. Lower LVEF and a sedentary behavior further contribute to symptom burden. This threshold may support individualized management and targeted rehabilitation strategies in CHF care. This abstract is funded by: Funding The São Paulo Research Foundation (Process: 2015/26501-1). Coordination for the Improvement of Higher Education Personnel (CAPES), National Council for Scientific and Technological Development (CNPq);
Pereira et al. (Fri,) conducted a cross-sectional in chronic heart failure (CHF) (n=128). Duke Activity Status Index (DASI) was evaluated on Distinguishing symptomatic from asymptomatic CHF patients according to NYHA functional classification (OR 0.925, 95% CI 0.896-0.956, p=<0.001). A Duke Activity Status Index score ≤24 effectively discriminated symptomatic status in chronic heart failure patients with a sensitivity of 92%, specificity of 66%, and AUC of 0.80 (p<0.001).