Abstract 4147686: Activities of Daily Living (ADLs) in Adults with Heart Failure Compared with Cancer: Analysis of Medicare Health Outcomes Survey Data

Introduction: Heart failure (HF) and cancer are highly morbid conditions and contribute to substantial impairments in physical, mental, and social health. Cancer-associated disability has been well described, but little is known about the degree to which HF limits functional status in older individuals. Therefore, we sought to examine self-report of functional status in older people living with HF compared to cancer. Methods: The sample included adults > 65 years of age from the 2016-2020 Medicare Health Outcomes Survey (HOS), who self-reported a history of HF or cancer (lung, colorectal, breast, or prostate) and were undergoing active treatment. We analyzed differences in functional status with two measures: (1) Katz Index of Independence in Activities of Daily Living (KADLs), an assessment of skills required to manage basic physical needs and hygiene, and (2) Instrumental Activities of Daily Living score (IADLs), which is a composite score of the ability to complete a complex set of skills needed to live independently. KADL and IADL were examined in groups of severe impairment (KADL: 0-2, IADL: 0-3), moderate impairment (KADL: 3-5, IADL: 4-6), and full function (KADL: 6, IADL: 7). We compared the distribution of KADL and IADL groups with Chi-Squared. Results: The sample of individuals with HF included 51400 adults (52% female, 14% Black, 49.8% > 75 years). 21.85% of individuals with HF had severe impairment in KADLs and 17.05% in IALDs. These numbers were significantly higher than the proportion of severe impairment in people with lung (KADL: 14.48%; IADL: 11.35%), colorectal (KADL: 15.74%; IADL: 10.39%), breast (KADL: 10.57%; IADL: 7.17%), or prostate (KADL: 10.23%; IADL: 8.32%) cancer (all p <0.001). Individuals with HF also had the lowest proportion of patients with full function in KADLs or IADLs. Conclusion: People living with HF have significantly greater disability compared with people who are undergoing active treatment for lung, colorectal, breast, or prostate cancer. Multidisciplinary care for HF patients that prioritizes physical and occupational therapy and self/home care may improve functional status and overall health-related quality of life.