Evaluates the functional capacity of patients with cardiovascular disease (CVD) for preoperative risk assessment.
Refer to the text below the calculator for more information about the DASI score and associated results (VO2 peak and METs) and its usage.
Instruction: Check whether the patient is able to:
1Take care of selfe.g. eating, dressing, bathing, using the toilet
2Walk indoors
3Walk 1–2 blocks on level ground
4Climb a flight of stairs or walk up a hill
5Run a short distance
6Do light work around the housee.g. dusting, washing dishes
7Do moderate work around the housee.g. vacuuming, sweeping floors, carrying in groceries
8Do heavy work around the housee.g. scrubbing floors, lifting or moving heavy furniture
9Do yardworke.g. raking leaves, weeding, pushing a power mower
10Have sexual relations
11Participate in moderate recreational activitiese.g. golf, bowling, dancing, doubles tennis, throwing a baseball or football
12Participate in strenuous sportse.g. swimming, singles tennis, football, basketball, skiing
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Duke Activity Status Index (DASI) Explained
The DASI is a 12-item scale (in the form of a self-administered questionnaire) developed by Hlatky et al. in 1989, that correlates well with peak oxygen uptake (Spearman correlation coefficient 0.80).
| DASI activity item | DASI points |
| Take care of self e.g. eating, dressing, bathing, using the toilet | 2.75 |
| Walk indoors | 1.75 |
| Walk 1–2 blocks on level ground | 2.75 |
| Climb a flight of stairs or walk up a hill | 5.5 |
| Run a short distance | 8 |
| Do light work around the house e.g. dusting, washing dishes | 2.7 |
| Do moderate work around the house e.g. vacuuming, sweeping floors, carrying in groceries | 3.5 |
| Do heavy work around the house e.g. scrubbing floors, lifting or moving heavy furniture | 8 |
| Do yardwork e.g. raking leaves, weeding, pushing a power mower | 4.5 |
| Have sexual relations | 5.25 |
| Participate in moderate recreational activities e.g. golf, bowling, dancing, doubles tennis, throwing a baseball or football | 6 |
| Participate in strenuous sports e.g. swimming, singles tennis, football, basketball, skiing | 7.5 |
DASI score is calculated by adding the points of all performed activities together. The higher the score (ranges from 0 to 58.2) the higher the functional status.
VO2 peak (mL/kg/min) = 0.43 x DASI + 9.6METs (metabolic equivalents) = VO2 peak / 3.5
Best METS performed can also be used to predict functional capacity. For example, preoperative evaluation requires at least 4 METS performed.
One criticism of the model refers to the fact that prognostically important thresholds in DASI scores remain unclear.
Wijeysundera et al. attempted to establish a threshold DASI, on a cohort of 1546 participants (≥40 yr of age) at an elevated cardiac risk who had inpatient noncardiac surgery. Self-reported functional capacity with DASI scores of 34 of higher was associated with:
- Reduced odds of 30-day death or myocardial injury (odds ratio: 0.97 per 1 point increase above 34; 95% confidence interval [CI]: 0.96–0.99);
- Reduced odds of 1 yr death or new disability (odds ratio: 0.96 per 1 point increase above 34; 95% CI: 0.92–0.99).
Whilst self-reported DASI scores of below 34 were associated with:
- Increased odds of 30-day death or myocardial infarction (odds ratio: 1.05 per 1 point decrease below 34; 95% CI: 1.00–1.09);
- Moderate-to-severe complications (odds ratio: 1.03 per 1 point decrease below 34; 95% CI: 1.01–1.05).
There are several established clinical uses of the DASI aside from measuring functional capacity, that include the assessment of aspects of quality of life, estimation of peak oxygen uptake, evaluation of medical treatment results or cardiac rehabilitation.
References
Original reference
Hlatky MA, Boineau RE, Higginbotham MB, et al. A brief self-administered questionnaire to determine functional capacity (the Duke Activity Status Index). Am J Cardiol. 1989; 64(10):651-654.
Validation
Coutinho-Myrrha MA, Dias RC, Fernandes AA, Araújo CG, Hlatky MA, Pereira DG, Britto RR. Duke Activity Status Index for cardiovascular diseases: validation of the Portuguese translation. Arq Bras Cardiol. 2014; 102(4):383-90.
Carter R, Holiday DB, Grothues C, Nwasuruba C, Stocks J, Tiep B. Criterion validity of the Duke Activity Status Index for assessing functional capacity in patients with chronic obstructive pulmonary disease. J Cardiopulm Rehabil. 2002; 22(4):298-308.
Wijeysundera DN, Beattie WS, Hillis GS, et al. Integration of the Duke Activity Status Index into preoperative risk evaluation: a multicentre prospective cohort study. Br J Anaesth. 2020; 124(3):261-270.
