DASC‐21 score and the risk of in‐hospital death in elderly patients with heart failure

Abstract

AimWe investigated whether the Dementia Assessment Sheet for Community‐based Integrated Care System‐21 Items (DASC‐21), a questionnaire that assesses cognitive function, including activities of daily living (ADL), was predictive of in‐hospital death and prolonged hospital stay in elderly patients hospitalized for heart failure.MethodsWe retrospectively assessed the DASC‐21 score at the time of admission, in‐hospital death, length of hospital stay, and change in the Barthel index in 399 patients hospitalized for heart failure between 2016 and 2019.ResultsThe mean patient age was 85.8 ± 7.7 years (61.3% women). The median DASC‐21 score was 38 (64.7% higher than 31). On multivariate logistic regression analysis, a higher DASC‐21 score was associated with an increased risk of in‐hospital death (odds ratio [OR] = 1.045 per 1 point increase, 95% confidence interval [CI]: 1.010–1.081, P = 0.012), even after adjusting for confounding factors, including atrial fibrillation, ejection fraction, and B‐type natriuretic peptide. Difficulties (3 or 4) with the self‐management of medication in instrumental ADL inside the home (OR = 3.28, 95% CI: 1.05–10.28, P = 0.042), toileting (OR = 3.66, 95% CI: 1.19–11.29, P = 0.024), grooming (OR = 6.47, 95% CI: 2.00–20.96, P = 0.002), eating (OR = 7.96, 95% CI: 2.49–25.45, P < 0.001), and mobility in physical ADL (OR = 5.99, 95% CI: 1.85–19.35, P = 0.003) were identified as risk factors for in‐hospital death. Patients in the highest tertile of the DASC‐21 score had a significantly longer hospital stay (P = 0.006) and a greater reduction in the Barthel index (P < 0.001).ConclusionsIn elderly patients hospitalized for heart failure, higher DASC‐21 scores were associated with an increased risk of in‐hospital death, prolonged hospital stay, and impaired ADL. Geriatr Gerontol Int 2024; 24: 546–553.