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DASI

DASI (Duke Activity Status Index): A 12-item questionnaire that accurately estimates functional capacity (peak VO2 and METs), widely used in pre-operative risk assessment.

Guidelines & Evidence

Verified

Last Review: 2026-07-17

When to Use

When to Use

Prior to elevated-risk non-cardiac surgery as part of the standard pre-operative cardiovascular evaluation
To objectively quantify a patient's subjective functional capacity rather than relying on unstructured physician estimation ("Can you climb a flight of stairs?")
In heart failure clinics to monitor trajectory of functional decline without formal CPET (Cardiopulmonary Exercise Testing)

How it Works

Metabolic Equivalents (METs)

One MET equals the resting metabolic rate, roughly equivalent to an oxygen consumption (VO2) of 3.5 mL/kg/min. By asking patients which specific physical tasks they can perform without limiting symptoms (chest pain, severe dyspnea), the index provides a mathematically validated estimation of their peak VO2, which easily converts to maximum METs.

The 4 MET Threshold

A functional capacity of < 4 METs is universally recognized by the ACC/AHA and ESC/ESA guidelines as an independent predictor of perioperative adverse cardiac events. Patients falling below this threshold undergoing intermediate or high-risk surgery may require pre-op non-invasive stress testing, biomarker screening, or perioperative optimization.

Clinical Pearls

The "METs-IR" Trial Context

The METS (Measurement of Exercise Tolerance before Surgery) study showed that physician subjective estimation of functional capacity is notoriously inaccurate and tends to overestimate patients' abilities. DASI was shown to be superior to subjective estimation and was highly correlated with actual CPET data.

Question Bias

Some questions (like "yard work" or "sexual relations") may carry cultural, seasonal, or age-related bias where a patient answers "no" simply because they do not participate in the activity for non-cardiac reasons. Be sure they understand the question means "Are you *physically capable* of doing this without severe shortness of breath or chest pain?"

The Evidence

Original Derivation

A brief self-administered questionnaire to determine functional capacity (the Duke Activity Status Index).

Hlatky MA et al. • Am J Cardiol.. 1989;64(10):651-4. The landmark paper that derived the formula Peak VO2 = (0.43 × DASI) + 9.6.

Pre-operative Validation (METS Trial)

Assessment of functional capacity before major non-cardiac surgery: an international, prospective cohort study.

Wijeysundera DN et al. • Lancet.. 2018;391(10140):2631-2640. Demonstrated that a DASI score < 34 (roughly < 4 METs) strongly predicts 30-day myocardial injury and death.

Last Comprehensive Review: 2026-07-17

In Recent Clinical News

Scanning Medical Journals

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