Duke Activity Status Index (DASI)
Self-reported functional capacity before surgery, with estimated VO₂peak
- ESC/ESAIC 2022 non-cardiac surgery
Sources last checked: 2026-10-13
Duke Activity Status Index (DASI)
Self-reported functional capacity before surgery, with estimated VO₂peak
In the METS cohort a DASI below 34 was associated with higher odds of 30-day death or myocardial infarction.
The 34-point threshold is an empirical prognostic cut-off from the METS cohort — it is NOT the same as 4 METs (DASI 34 corresponds to roughly 7 METs on the Hlatky equation). Answers are self-reported and limited by non-cardiac disability.
Interpretation
| < 34 — reduced functional capacity | In the METS cohort a DASI below 34 was associated with higher odds of 30-day death or myocardial infarction. |
|---|---|
| ≥ 34 — adequate functional capacity | Above the prognostic threshold identified in the METS cohort. |
What is the Duke Activity Status Index (DASI)?
The Duke Activity Status Index is a 12-item questionnaire on everyday activities, each weighted by its metabolic cost, giving a score from 0 to 58.2. Hlatky and colleagues developed it in 1989 against measured peak oxygen uptake in patients referred for exercise testing. In the international METS cohort it was the only subjective measure that predicted perioperative cardiac events.
When to use it
- Assessing functional capacity before intermediate- or high-risk non-cardiac surgery
- Replacing the vague "how far can you walk?" question with a structured, reproducible estimate
- Estimating VO₂peak and METs when exercise testing is not available
When not to use it
- Patients whose activity is limited by non-cardiopulmonary problems (orthopaedic, neurological), where a low score does not reflect cardiac reserve
- As a substitute for cardiopulmonary exercise testing when a precise VO₂ is needed
How it is calculated
| Criterion | Points |
|---|---|
| Can take care of yourself (eating, dressing, bathing, toilet) | +2.75 |
| Can walk indoors, such as around your house | +1.75 |
| Can walk a block or two on level ground | +2.75 |
| Can climb a flight of stairs or walk up a hill | +5.5 |
| Can run a short distance | +8 |
| Can do light work around the house (dusting, washing dishes) | +2.7 |
| Can do moderate work around the house (vacuuming, sweeping, carrying groceries) | +3.5 |
| Can do heavy work around the house (scrubbing floors, moving heavy furniture) | +8 |
| Can do yard work (raking leaves, weeding, pushing a mower) | +4.5 |
| Can have sexual relations | +5.25 |
| Can do moderate recreational activities (golf, bowling, dancing, doubles tennis) | +6 |
| Can do strenuous sports (swimming, singles tennis, football, skiing) | +7.5 |
DASI = sum of the weights of the activities the patient can do (0–58.2). Estimated VO₂peak (mL/kg/min) = 0.43 × DASI + 9.6; METs = VO₂peak ÷ 3.5.
Clinical pearls and limitations
- The 34-point threshold is an empirical prognostic cut-off from the METS cohort — it is NOT the same as 4 METs (DASI 34 corresponds to roughly 7 METs on the Hlatky equation). Answers are self-reported and limited by non-cardiac disability.
- The METS sub-study identified 34 points as the threshold below which risk of 30-day death or MI rose; ESC 2022 cites this threshold.
- Do not equate DASI 34 with 4 METs: by the Hlatky equation, 34 points correspond to about 24 mL/kg/min (≈ 7 METs).
- Estimated VO₂peak = 0.43 × DASI + 9.6 mL/kg/min; divide by 3.5 for METs.
- The ESC 2022 algorithm also accepts the ability to climb two flights of stairs as a simple functional capacity check.
Frequently asked questions
What is a good DASI score before surgery?
34 or more was associated with lower perioperative cardiac risk in the METS cohort. Below 34 suggests reduced functional capacity.
How do I convert DASI to METs?
VO₂peak (mL/kg/min) = 0.43 × DASI + 9.6; METs = VO₂peak ÷ 3.5.
What is the maximum DASI score?
58.2, when all twelve activities can be performed.
Evidence and guidelines
- Primary source: Hlatky MA et al. A brief self-administered questionnaire to determine functional capacity (the Duke Activity Status Index). Am J Cardiol 1989;64(10):651-654. Threshold 34: Wijeysundera DN et al. Br J Anaesth 2020;124(3):261-270.
- Wijeysundera DN et al. Assessment of functional capacity before major non-cardiac surgery (METS): an international, prospective cohort study. Lancet 2018;391:2631-2640.
- Wijeysundera DN et al. Duke Activity Status Index thresholds for perioperative risk stratification (METS sub-study). Br J Anaesth 2020;124(3):261-270.
- Halvorsen S et al. 2022 ESC Guidelines on non-cardiac surgery (endorsed by ESAIC). Eur Heart J 2022;43:3826-3924 — cites DASI < 34 and uses DASI or the ability to climb two flights of stairs to assess functional capacity.
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