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Montalto M, D’Ignazio F, Camilli S, Di Francesco S, Fedele M, Landi F, Gallo A. Heart Failure in Older Patients: An Update. J Clin Med 2025; 14:1982. [PMID: 40142790 PMCID: PMC11942917 DOI: 10.3390/jcm14061982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2025] [Revised: 03/08/2025] [Accepted: 03/10/2025] [Indexed: 03/28/2025] Open
Abstract
Heart failure (HF) is a clinical syndrome with high incidence and prevalence and high morbidity and death rate, even in the short term, representing a serious public health issue, mainly in older people. It is a growing cause for hospital admission in this age group, being frequently associated with several comorbidities, further aggravating the disease's course. Moreover, older HF patients are usually affected by clinical conditions, like frailty, malnutrition, and cachexia, which significantly impact the overall management of HF and need to be properly identified and treated. Diagnosing and managing HF in older patients may be very complicated and challenging. Although specific data on treatment of both acute and chronic HF in older subjects are limited and mainly extrapolated from large-scale clinical trials, the standard pharmacological management may be considered well-tolerated and generally safe. In any case, a personalized and tailored approach is mandatory and is based on severity of comorbidities, overall status, and prognosis, above all in frailer and more comorbid subjects, due to the higher rate of drug interactions, side effects, and therapy discontinuation in this population. In this scenario, palliative care has become a fundamental part of HF management in the elderly in order to improve their care and the quality of life. Moreover, an increasing number of promising pharmacological options deserve further investigation in order to support clinicians in optimizing management of comorbid and frailer patients. In this work, we provide detailed and updated insight into clinical, therapeutic, and prognostic features of both acute and chronic HF in the older population.
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Affiliation(s)
- Massimo Montalto
- Department of Geriatrics, Orthopedics and Rheumatology, Fondazione Policlinico Universitario “A. Gemelli”, IRCCS, 00168 Rome, Italy; (M.M.); (F.L.)
- Department of Geriatrics, Orthopedics and Rheumatology, Università Cattolica del Sacro Cuore, 00168 Roma, Italy; (F.D.); (S.C.); (S.D.F.); (M.F.)
| | - Federica D’Ignazio
- Department of Geriatrics, Orthopedics and Rheumatology, Università Cattolica del Sacro Cuore, 00168 Roma, Italy; (F.D.); (S.C.); (S.D.F.); (M.F.)
| | - Sara Camilli
- Department of Geriatrics, Orthopedics and Rheumatology, Università Cattolica del Sacro Cuore, 00168 Roma, Italy; (F.D.); (S.C.); (S.D.F.); (M.F.)
| | - Silvino Di Francesco
- Department of Geriatrics, Orthopedics and Rheumatology, Università Cattolica del Sacro Cuore, 00168 Roma, Italy; (F.D.); (S.C.); (S.D.F.); (M.F.)
| | - Marco Fedele
- Department of Geriatrics, Orthopedics and Rheumatology, Università Cattolica del Sacro Cuore, 00168 Roma, Italy; (F.D.); (S.C.); (S.D.F.); (M.F.)
| | - Francesco Landi
- Department of Geriatrics, Orthopedics and Rheumatology, Fondazione Policlinico Universitario “A. Gemelli”, IRCCS, 00168 Rome, Italy; (M.M.); (F.L.)
- Department of Geriatrics, Orthopedics and Rheumatology, Università Cattolica del Sacro Cuore, 00168 Roma, Italy; (F.D.); (S.C.); (S.D.F.); (M.F.)
| | - Antonella Gallo
- Department of Geriatrics, Orthopedics and Rheumatology, Fondazione Policlinico Universitario “A. Gemelli”, IRCCS, 00168 Rome, Italy; (M.M.); (F.L.)
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Wleklik M, Lee CS, Lewandowski Ł, Czapla M, Jędrzejczyk M, Aldossary H, Uchmanowicz I. Frailty determinants in heart failure: Inflammatory markers, cognitive impairment and psychosocial interaction. ESC Heart Fail 2025. [PMID: 39853613 DOI: 10.1002/ehf2.15208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2024] [Revised: 12/10/2024] [Accepted: 12/29/2024] [Indexed: 01/26/2025] Open
Abstract
AIMS This study aimed to identify factors associated with frailty in heart failure (HF) patients, focusing on demographic, biochemical and health-related variables. It also explored the correlation between frailty and comorbidities such as malnutrition, cognitive impairment and depression, assessing how these factors interact to influence frailty risk. METHODS A total of 250 HF patients (mean age 73.5 ± 7.2 years; 45.6% female) hospitalized for acute decompensated HF were included. Frailty was assessed using Fried phenotype criteria. Cognitive function, depression and nutritional status were evaluated using validated instruments [Mini-Mental State Examination (MMSE), Patient Health Questionnaire-9 (PHQ-9) and Mini Nutritional Assessment (MNA)]. Biochemical markers included C-reactive protein (CRP), N-terminal prohormone of brain natriuretic peptide (NT-proBNP), haemoglobin, estimated glomerular filtration rate (eGFR) and systolic blood pressure (SBP). Statistical analyses, including logistic regression, were performed to assess associations and odds ratios (ORs) for frailty, adjusted for inflammation and HF type. RESULTS Frailty was present in 60.4% of patients. Frail individuals exhibited significantly higher CRP (median 4.60 vs. 2.54 mg/L, P < 0.001) and NT-proBNP (median 2558.8 vs. 1102.6 pg/mL, P = 0.001) and lower haemoglobin (13.7 vs. 14.3 g/dL, P = 0.012), eGFR (62 vs. 71 mL/min/1.73 m2, P = 0.025) and SBP (130 vs. 134 mmHg, P = 0.026). Each 10% increase in CRP was associated with a 5.5% increase in frailty odds (P < 0.001). Frailty was linked to cognitive impairment (OR 2.1, P = 0.018), malnutrition (OR 3.0, P < 0.001) and depression (OR 3.1, P < 0.001), while high adherence to treatment reduced frailty risk by 78.9% (P = 0.027). Interactions were observed between cognitive impairment and body mass index (BMI) (P = 0.020), where higher BMI mitigated the frailty odds difference between cognitively impaired and unimpaired patients. Depression's association with frailty odds varied by adherence levels (P = 0.034) and central obesity (P = 0.047), with the absence of depression offering protection against frailty in patients with central obesity. These interactions remained significant after adjustment for HF type and left ventricular ejection fraction (LVEF) and were consistent across stratifications by these factors. CONCLUSIONS Frailty in HF is influenced by inflammatory markers, cognitive impairment and psychosocial factors. Elevated CRP and NT-proBNP were strong predictors of frailty. Cognitive impairment and depression were key modifiable factors, interacting with BMI, adherence and obesity. Targeting these factors with early interventions could mitigate frailty risk, improving outcomes and quality of life in HF patients.
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Affiliation(s)
- Marta Wleklik
- Division of Research Methodology, Department of Nursing, Faculty of Nursing and Midwifery, Wroclaw Medical University, Wrocław, Poland
| | - Christopher S Lee
- Boston College William F. Connell School of Nursing, Chestnut Hill, Massachusetts, USA
| | - Łukasz Lewandowski
- Department of Medical Biochemistry, Wroclaw Medical University, Wrocław, Poland
| | - Michał Czapla
- Division of Scientific Research and Innovation in Emergency Medical Service, Department of Emergency Medical Service, Faculty of Nursing and Midwifery, Wroclaw Medical University, Wrocław, Poland
- Group of Research in Care (GRUPAC), Faculty of Health Science, University of La Rioja, Logroño, Spain
- Institute of Heart Diseases, University Hospital, Wrocław, Poland
| | - Maria Jędrzejczyk
- Division of Research Methodology, Department of Nursing, Faculty of Nursing and Midwifery, Wroclaw Medical University, Wrocław, Poland
| | - Heba Aldossary
- Prince Sultan Military College of Health Sciences, Dhahran, Saudi Arabia
- Payne Bolton School of Nursing at Case Western Reserve University, Cleveland, Ohio, USA
| | - Izabella Uchmanowicz
- Division of Research Methodology, Department of Nursing, Faculty of Nursing and Midwifery, Wroclaw Medical University, Wrocław, Poland
- Centre for Cardiovascular Health, Edinburgh Napier University, Sighthill Campus, Edinburgh, UK
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Nadziakiewicz P, Szczurek-Wasilewicz W, Szyguła-Jurkiewicz B. Heart Failure in Elderly Patients: Medical Management, Therapies and Biomarkers. Pharmaceuticals (Basel) 2024; 18:32. [PMID: 39861095 PMCID: PMC11768694 DOI: 10.3390/ph18010032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2024] [Revised: 12/20/2024] [Accepted: 12/27/2024] [Indexed: 01/27/2025] Open
Abstract
Heart failure (HF) is a common condition and one of the main morbidity and mortality factors in elderly patients. The incidence of HF progressively increases with age, reaching >10% in those aged 70 years or over. In the elderly population, both the diagnosis and the management of HF prove challenging, often requiring specialized care and a multidisciplinary approach. In seniors, atypical presentation of HF is much more common than in younger patients; thus, a holistic assessment with biomarkers related to HF allows for early diagnosis and accurate risk stratification in this group of patients. This article reviews the clinical and diagnostic differences in elderly patients with HF, highlighting the presence of comorbidities, frailty, cognitive impairment, and polypharmacy, as well as discussing potential biomarkers that may have clinical application in this population.
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Affiliation(s)
- Paulina Nadziakiewicz
- Student’s Scientific Society, 3rd Department of Cardiology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 40-055 Katowice, Poland;
| | - Wioletta Szczurek-Wasilewicz
- Department of Pharmacology, Faculty of Medicine, University of Opole, 45-052 Opole, Poland
- 2nd Department of Cardiology and Angiology, Silesian Center for Heart Diseases, 41-800 Zabrze, Poland
| | - Bożena Szyguła-Jurkiewicz
- 3rd Department of Cardiology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 40-055 Katowice, Poland;
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Sentandreu-Mañó T, Deka P, Almenar L, Tomás JM, Ferrer-Sargues FJ, López-Vilella R, Klompstra L, Marques-Sule E. Kinesiophobia and associated variables in patients with heart failure. Eur J Cardiovasc Nurs 2024; 23:221-229. [PMID: 37534763 DOI: 10.1093/eurjcn/zvad072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 07/26/2023] [Accepted: 07/31/2023] [Indexed: 08/04/2023]
Abstract
AIMS Patients with heart failure (HF) can exhibit kinesiophobia, an excessive, debilitating, and irrational fear of movement. This study aimed to enhance the understanding of kinesiophobia in patients with HF by analysing associations with the following variables: musculoskeletal pain, quality of life, quality of sleep, functional capacity, disability, frailty, sex, and age. METHODS AND RESULTS In this cross-sectional study, 107 participants were included, with ages ranging from 28 to 97 years (57% men, mean age 73.18 ± 12.68 years). Multiple regression analyses were performed with all variables, including polynomial regressions for variables with a non-linear relationship. Kinesiophobia was significantly correlated (P < 0.01) with musculoskeletal pain, quality of life, quality of sleep, functional capacity, disability, and being at risk of frailty, while age and sex were not statistically significant. Frailty disability and musculoskeletal pain intensity were variables linearly associated with kinesiophobia, while quality of sleep and disability had a non-linear relationship with kinesiophobia. CONCLUSION Kinesiophobia needs to be evaluated and better understood in patients with HF to improve physical activity and exercise adherence. This study found that musculoskeletal pain intensity, quality of sleep, disability, and frailty risk have a significant association with kinesiophobia in patients with HF. Our results suggest multi-dimensional associations of kinesiophobia in patients with HF, which require further examination and understanding.
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Affiliation(s)
- Trinidad Sentandreu-Mañó
- Department of Physiotherapy, Advanced Research Methods Applied to Quality of Life Promotion (ARMAQoL), University of Valencia, Valencia, Spain
| | - Pallav Deka
- College of Nursing, Michigan State University, 1355 Bogue Street, East Lansing C247, MI, USA
| | - Luis Almenar
- Heart Failure and Transplants Unit, Department of Cardiology, University and Polytechnic Hospital La Fe, Valencia, Spain
- CIBERCV, Valencia, Spain
- University of Valencia, Valencia, Spain
| | - José M Tomás
- Department of Methodology for the Behavioral Sciences, University of Valencia, Valencia, Spain
| | - Francisco-José Ferrer-Sargues
- Department of Physiotherapy, Universidad Cardenal Herrera-CEU, CEU Universities, Alfara del Patriarca, Valencia, Spain
| | - Raquel López-Vilella
- Heart Failure and Transplants Unit, Department of Cardiology, University and Polytechnic Hospital La Fe, Valencia, Spain
| | - Leonie Klompstra
- Department of Health, Medicine and Caring Sciences, Linkoping University, Linkoping, Sweden
| | - Elena Marques-Sule
- Physiotherapy in Motion, Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, Valencia, Spain
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Aguilar-Iglesias L, Merino-Merino A, Sanchez-Corral E, Garcia-Sanchez MJ, Santos-Sanchez I, Dominguez-Calvo J, Saez-Maleta R, Perez-Rivera JA. Prognostic effect of systematic geriatric assessment on patients with acute heart failure. ESC Heart Fail 2024; 11:1194-1204. [PMID: 38287508 DOI: 10.1002/ehf2.14692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 12/28/2023] [Accepted: 01/09/2024] [Indexed: 01/31/2024] Open
Abstract
AIMS Frailty and dependence are frequent in patients admitted for acute heart failure (AHF), but their prognostic significance is unknown, especially in young adults. We aimed to study in adults admitted for AHF, regardless of age, the effect of frailty and dependence on the incidence of mortality and a combined event of mortality, readmissions for AHF, and visits to the emergency room (ER) for AHF at 1 and 6 months. METHODS AND RESULTS We designed a prospective cohort study by including all the patients with AHF admitted in our Cardiology Department from July 2020 through May 2021. A multidimensional geriatric assessment was performed during the admission. We clinically followed up the patients 6 months after discharge. We enrolled 202 patients. The mean age was 73 ± 12.32 years, and 100 (49.5%) of the patients were elderly (>75 years). Just 78 patients (38.6%) were women, and 100 (49.5%) had previous HF. Frailty (FRAIL ≥ 3) was observed in 68 (33.7%) patients (mean FRAIL score: 1.88 ± 1.48). Dependence (Barthel < 100) was observed in 65 (32.2%) patients (mean Barthel index: 94.38 ± 11.21). Frailty and dependence showed a significant association with both prognostic events at 1 and 6 months. In the multivariable analysis, frailty was associated with higher mortality at 1 month [hazard ratio (HR) 12.61, 95% confidence interval (CI) 1.57-101.47, P = 0.017] but not at 6 months (HR 2.25, 95% CI 0.61-8.26, P = 0.224) or with the combined endpoint at neither 1 month (HR 1.64, 95% CI 0.54-5.03, P = 0.384) nor 6 months (HR 1.35, 95% CI 0.75-2.46, P = 0.320). Dependence was related to higher mortality at 1 month (HR 13.04, 95% CI 1.62-104.75, P = 0.016) and 6 months (HR 7.18, 95% CI 1.99-25.86, P = 0.003) and to higher incidence of the combined event at 1 month (HR 5.93, 95% CI 1.63-21.50, P = 0.007) and 6 months (HR 2.62, 95% CI 1.49-4.61, P = 0.001). CONCLUSIONS In AHF patients, frailty and dependence implied a worse prognosis, rising mortality, readmissions, and ER visits for AHF.
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Affiliation(s)
- Lara Aguilar-Iglesias
- Department of Cardiology, University Hospital of Burgos, Avda. Islas Baleares, 3, 09005, Burgos, Spain
| | - Ana Merino-Merino
- Department of Cardiology, University Hospital of Burgos, Avda. Islas Baleares, 3, 09005, Burgos, Spain
| | - Ester Sanchez-Corral
- Department of Cardiology, University Hospital of Burgos, Avda. Islas Baleares, 3, 09005, Burgos, Spain
| | | | - Isabel Santos-Sanchez
- Department of Cardiology, University Hospital of Burgos, Avda. Islas Baleares, 3, 09005, Burgos, Spain
| | - Jesus Dominguez-Calvo
- Department of Cardiology, University Hospital of Burgos, Avda. Islas Baleares, 3, 09005, Burgos, Spain
| | - Ruth Saez-Maleta
- Department Clinical Analysis, University Hospital of Burgos, Burgos, Spain
| | - Jose-Angel Perez-Rivera
- Department of Cardiology, University Hospital of Burgos, Avda. Islas Baleares, 3, 09005, Burgos, Spain
- Universidad Isabel I, Burgos, Spain
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Mizuguchi Y, Nakao M, Nagai T, Takahashi Y, Abe T, Kakinoki S, Imagawa S, Matsutani K, Saito T, Takahashi M, Kato Y, Komoriyama H, Hagiwara H, Hirata K, Ogawa T, Shimizu T, Otsu M, Chiyo K, Anzai T. Machine learning-based gait analysis to predict clinical frailty scale in elderly patients with heart failure. EUROPEAN HEART JOURNAL. DIGITAL HEALTH 2024; 5:152-162. [PMID: 38505484 PMCID: PMC10944685 DOI: 10.1093/ehjdh/ztad082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 12/04/2023] [Accepted: 12/13/2023] [Indexed: 03/21/2024]
Abstract
Aims Although frailty assessment is recommended for guiding treatment strategies and outcome prediction in elderly patients with heart failure (HF), most frailty scales are subjective, and the scores vary among raters. We sought to develop a machine learning-based automatic rating method/system/model of the clinical frailty scale (CFS) for patients with HF. Methods and results We prospectively examined 417 elderly (≥75 years) with symptomatic chronic HF patients from 7 centres between January 2019 and October 2023. The patients were divided into derivation (n = 194) and validation (n = 223) cohorts. We obtained body-tracking motion data using a deep learning-based pose estimation library, on a smartphone camera. Predicted CFS was calculated from 128 key features, including gait parameters, using the light gradient boosting machine (LightGBM) model. To evaluate the performance of this model, we calculated Cohen's weighted kappa (CWK) and intraclass correlation coefficient (ICC) between the predicted and actual CFSs. In the derivation and validation datasets, the LightGBM models showed excellent agreements between the actual and predicted CFSs [CWK 0.866, 95% confidence interval (CI) 0.807-0.911; ICC 0.866, 95% CI 0.827-0.898; CWK 0.812, 95% CI 0.752-0.868; ICC 0.813, 95% CI 0.761-0.854, respectively]. During a median follow-up period of 391 (inter-quartile range 273-617) days, the higher predicted CFS was independently associated with a higher risk of all-cause death (hazard ratio 1.60, 95% CI 1.02-2.50) after adjusting for significant prognostic covariates. Conclusion Machine learning-based algorithms of automatically CFS rating are feasible, and the predicted CFS is associated with the risk of all-cause death in elderly patients with HF.
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Affiliation(s)
- Yoshifumi Mizuguchi
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-15 Nishi-7, Kita-ku, Sapporo 0608638, Japan
| | - Motoki Nakao
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-15 Nishi-7, Kita-ku, Sapporo 0608638, Japan
| | - Toshiyuki Nagai
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-15 Nishi-7, Kita-ku, Sapporo 0608638, Japan
| | - Yuki Takahashi
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-15 Nishi-7, Kita-ku, Sapporo 0608638, Japan
| | - Takahiro Abe
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-15 Nishi-7, Kita-ku, Sapporo 0608638, Japan
| | - Shigeo Kakinoki
- Department of Cardiology, Otaru Kyokai Hospital, Hokkaido, Japan
| | - Shogo Imagawa
- Department of Cardiology, National Hospital Organization Hakodate National Hospital, Hokkaido, Japan
| | - Kenichi Matsutani
- Department of Cardiology, Sunagawa City Medical Center, Hokkaido, Japan
| | - Takahiko Saito
- Department of Cardiology, Japan Red Cross Kitami Hospital, Hokkaido, Japan
| | - Masashige Takahashi
- Department of Cardiology, Japan Community Healthcare Organization Hokkaido Hospital, Sapporo, Japan
| | - Yoshiya Kato
- Department of Cardiology, Kushiro City General Hospital, Hokkaido, Japan
| | | | - Hikaru Hagiwara
- Department of Cardiology, Kushiro City General Hospital, Hokkaido, Japan
| | - Kenji Hirata
- Department of Diagnostic Imaging, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Takahiro Ogawa
- Faculty of Information Science and Technology, Hokkaido University, Sapporo, Japan
| | - Takuto Shimizu
- Technical Planning Office, INFOCOM CORPORATION, Tokyo, Japan
| | - Manabu Otsu
- Technical Planning Office, INFOCOM CORPORATION, Tokyo, Japan
| | - Kunihiro Chiyo
- Technical Planning Office, INFOCOM CORPORATION, Tokyo, Japan
| | - Toshihisa Anzai
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-15 Nishi-7, Kita-ku, Sapporo 0608638, Japan
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Pellicciari L, Basagni B, Paperini A, Campagnini S, Sodero A, Hakiki B, Castagnoli C, Politi AM, Avila L, Barilli M, Romano E, Pancani S, Mannini A, Sensoli F, Salvadori E, Poggesi A, Grippo A, Macchi C, Baccini M, Carrozza MC, Cecchi F. Trunk Control Test as a Main Predictor of the Modified Barthel Index Score at Discharge From Intensive Post-acute Stroke Rehabilitation: Results From a Multicenter Italian Study. Arch Phys Med Rehabil 2024; 105:326-334. [PMID: 37625531 DOI: 10.1016/j.apmr.2023.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 07/05/2023] [Accepted: 08/06/2023] [Indexed: 08/27/2023]
Abstract
OBJECTIVES To verify whether trunk control test (TCT) upon admission to intensive inpatient post-stroke rehabilitation, combined with other confounding variables, is independently associated with discharge mBI. DESIGN Multicentric retrospective observational cohort study. SETTING Two Italian inpatient rehabilitation units. PARTICIPANTS A total of 220 post-stroke adult patients, within 30 days from the acute event, were consecutively enrolled. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURE The outcome measure considered was the modified Barthel Index (mBI), one of the most widely recommended tools for assessing stroke rehabilitation functional outcomes. RESULTS All variables collected at admission and significantly associated with mBI at discharge in the univariate analysis (TCT, mBI at admission, pre-stroke modified Rankin Scale [mRS], sex, age, communication ability, time from the event, Cumulative Illness Rating Scale, bladder catheter, and pressure ulcers) entered the multivariate analysis. TCT, mBI at admission, premorbid disability (mRS), communication ability and pressure ulcers (P<.001) independently predicted discharge mBI (adjusted R2=68.5%). Concerning the role of TCT, the model with all covariates and without TCT presented an R2 of 65.1%. On the other side, the model with the TCT only presented an R2 of 53.1%. Finally, with the inclusion of both TCT and all covariates, the model showed an R2 increase up to 68.5%. CONCLUSIONS TCT, with other features suggesting functional/clinical complexity, collected upon admission to post-acute intensive inpatient stroke rehabilitation, independently predicted discharge mBI.
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Affiliation(s)
| | | | - Anita Paperini
- IRCCS Fondazione Don Carlo Gnocchi onlus, Firenze, Italy
| | - Silvia Campagnini
- IRCCS Fondazione Don Carlo Gnocchi onlus, Firenze, Italy; The Biorobotics Institute, Scuola Superiore Sant'Anna, Pontedera (Pisa), Italy.
| | - Alessandro Sodero
- IRCCS Fondazione Don Carlo Gnocchi onlus, Firenze, Italy; Neurofarba Department, Neuroscience Section, University of Florence, Firenze, Italy
| | - Bahia Hakiki
- IRCCS Fondazione Don Carlo Gnocchi onlus, Firenze, Italy
| | | | | | - Lucia Avila
- Fondazione Don Carlo Gnocchi onlus, Marina di Massa, Italy
| | | | | | - Silvia Pancani
- IRCCS Fondazione Don Carlo Gnocchi onlus, Firenze, Italy
| | - Andrea Mannini
- IRCCS Fondazione Don Carlo Gnocchi onlus, Firenze, Italy
| | - Federico Sensoli
- The Biorobotics Institute, Scuola Superiore Sant'Anna, Pontedera (Pisa), Italy
| | | | - Anna Poggesi
- IRCCS Fondazione Don Carlo Gnocchi onlus, Firenze, Italy; Neurofarba Department, Neuroscience Section, University of Florence, Firenze, Italy
| | - Antonello Grippo
- IRCCS Fondazione Don Carlo Gnocchi onlus, Firenze, Italy; SOD Neurofisiopatologia, Dipartimento Neuromuscolo-Scheletrico e degli Organi di Senso, Azienda Ospedaliera Universitaria Careggi, Firenze, Italy
| | - Claudio Macchi
- IRCCS Fondazione Don Carlo Gnocchi onlus, Firenze, Italy; Department of Experimental and Clinical Medicine, University of Florence, Firenze, Italy
| | - Marco Baccini
- IRCCS Fondazione Don Carlo Gnocchi onlus, Firenze, Italy
| | | | - Francesca Cecchi
- IRCCS Fondazione Don Carlo Gnocchi onlus, Firenze, Italy; Department of Experimental and Clinical Medicine, University of Florence, Firenze, Italy
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Lima ACP, Maximiano-Barreto MA, Martins TCR, Luchesi BM. Factors associated with poor health literacy in older adults: A systematic review. Geriatr Nurs 2024; 55:242-254. [PMID: 38070263 DOI: 10.1016/j.gerinurse.2023.11.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 11/24/2023] [Accepted: 11/27/2023] [Indexed: 02/06/2024]
Abstract
OBJECTIVES To identify factors associated with poor health literacy in older adults. METHODS A systematic literature review was conducted, employing the descriptors "Aged" and "Health Literacy". PROSPERO - CRD 42022350140. RESULTS Out of 23,500 articles screened, 176 were selected. Several factors associated with poor health literacy in older adults were identified, such as sociodemographic (e.g., advanced age, low educational level, non-white population, and others), social (e.g., poor family/social support, loneliness, social isolation, few social activities, and others), economic (e.g., lower income and/or lower socioeconomic status) and health aspects (e.g., poor health, chronic conditions, mental health challenges, hospitalizations, frailty, physical inactivity, cognitive impairment, and others). CONCLUSIONS The factors associated with poor health literacy in older adults identified in this review could contribute to future research, support interventions to improve health literacy, and assist professionals in planning educational activities and public policies.
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Affiliation(s)
- Ana Caroline Pinto Lima
- Campus de Três Lagoas, Programa de Pós-Graduação em Enfermagem, Federal University of Mato Grosso do Sul, Três Lagoas, MS, Brazil
| | | | - Tatiana Carvalho Reis Martins
- Campus de Três Lagoas, Programa de Pós-Graduação em Enfermagem, Federal University of Mato Grosso do Sul, Três Lagoas, MS, Brazil; Instituto Integrado de Saúde, Federal University of Mato Grosso do Sul, Campo Grande, MS, Brazil
| | - Bruna Moretti Luchesi
- Campus de Três Lagoas, Programa de Pós-Graduação em Enfermagem, Federal University of Mato Grosso do Sul, Três Lagoas, MS, Brazil; Research Group on Mental Health, Cognition and Aging, Federal University of São Carlos, São Carlos, SP, Brazil.
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9
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Cazalbou S, Naccache L, Sourdet S, Cariou E, Fournier P, Nourhashemi F, Balardy L, Toulza O, Lairez O, Steinmeyer Z. Frailty in Older Patients with Transthyretin Cardiac Amyloidosis. J Clin Med 2023; 12:7507. [PMID: 38137576 PMCID: PMC10743850 DOI: 10.3390/jcm12247507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 11/22/2023] [Accepted: 11/30/2023] [Indexed: 12/24/2023] Open
Abstract
Background-Transthyretin cardiac amyloidosis (ATTR-CA) prevalence increases with age. The interplay between frailty and heart failure has been increasingly recognized. The objective of this study is to compare clinical, biological, and transthoracic echocardiography (TTE) characteristics of older ATTR-CA patients according to the G8 frailty screening tool. Methods-Patients over 75 years old with a confirmed diagnosis of ATTR-CA were included between January 2020 and April 2021. All patients underwent a routine blood test, TTE, and a functional assessment with a six-minute walking distance test (6MWD) or cardiopulmonary exercise testing (CPET), and the G8 score was calculated. Results-Fifty-two patients were included. Thirty-nine (75%) patients were frail and their mean NYHA stage was more severe (2.2 vs. 1.7; p = 0.004); 62% of them had a Gilmore stage of 2 or 3 (p = 0.05). Global left ventricular strain (GLS) was lower (-11.7% vs. -14.9%; p = 0.014) and the interventricular septum was thicker (18 ± 2 mm vs. 17 ± 2 mm; p = 0.033) in frail patients. There were no significant differences according to functional tests. Conclusion-The majority of older patients with ATTR-CA are frail according to the G8 score. They are more symptomatic and have an increased cardiac involvement and a poorer prognosis, requiring more personalized cardiac management.
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Affiliation(s)
- Stéphanie Cazalbou
- Department of Cardiology, University Hospital of Toulouse, 31400 Toulouse, France; (S.C.); (E.C.); (P.F.)
- Cardiac Imaging Center, University Hospital of Toulouse, 31059 Toulouse, France
| | - Louise Naccache
- Geriatrics Department, Internal Medicine and Cardiogeriatry Unit, Toulouse University Hospital, 31059 Toulouse, France; (L.N.); (S.S.); (F.N.); (L.B.); (O.T.); (Z.S.)
| | - Sandrine Sourdet
- Geriatrics Department, Internal Medicine and Cardiogeriatry Unit, Toulouse University Hospital, 31059 Toulouse, France; (L.N.); (S.S.); (F.N.); (L.B.); (O.T.); (Z.S.)
| | - Eve Cariou
- Department of Cardiology, University Hospital of Toulouse, 31400 Toulouse, France; (S.C.); (E.C.); (P.F.)
- Cardiac Imaging Center, University Hospital of Toulouse, 31059 Toulouse, France
| | - Pauline Fournier
- Department of Cardiology, University Hospital of Toulouse, 31400 Toulouse, France; (S.C.); (E.C.); (P.F.)
- Cardiac Imaging Center, University Hospital of Toulouse, 31059 Toulouse, France
| | - Fati Nourhashemi
- Geriatrics Department, Internal Medicine and Cardiogeriatry Unit, Toulouse University Hospital, 31059 Toulouse, France; (L.N.); (S.S.); (F.N.); (L.B.); (O.T.); (Z.S.)
- French National Institute of Health and Medical Research, Toulouse III Paul Sabatier University, 31062 Toulouse, France
- Medical School of Medicine, Toulouse III Paul Sabatier University, 31062 Toulouse, France
| | - Laurent Balardy
- Geriatrics Department, Internal Medicine and Cardiogeriatry Unit, Toulouse University Hospital, 31059 Toulouse, France; (L.N.); (S.S.); (F.N.); (L.B.); (O.T.); (Z.S.)
- French National Institute of Health and Medical Research, Toulouse III Paul Sabatier University, 31062 Toulouse, France
| | - Olivier Toulza
- Geriatrics Department, Internal Medicine and Cardiogeriatry Unit, Toulouse University Hospital, 31059 Toulouse, France; (L.N.); (S.S.); (F.N.); (L.B.); (O.T.); (Z.S.)
| | - Olivier Lairez
- Department of Cardiology, University Hospital of Toulouse, 31400 Toulouse, France; (S.C.); (E.C.); (P.F.)
- Cardiac Imaging Center, University Hospital of Toulouse, 31059 Toulouse, France
- Medical School of Medicine, Toulouse III Paul Sabatier University, 31062 Toulouse, France
- Department of Nuclear Medicine, University Hospital of Toulouse, 31059 Toulouse, France
| | - Zara Steinmeyer
- Geriatrics Department, Internal Medicine and Cardiogeriatry Unit, Toulouse University Hospital, 31059 Toulouse, France; (L.N.); (S.S.); (F.N.); (L.B.); (O.T.); (Z.S.)
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10
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Okoye C, Mazzarone T, Niccolai F, Bencivenga L, Pescatore G, Bianco MG, Guerrini C, Giusti A, Guarino D, Virdis A. Predicting mortality and re-hospitalization for heart failure: a machine-learning and cluster analysis on frailty and comorbidity. Aging Clin Exp Res 2023; 35:2919-2928. [PMID: 37848804 PMCID: PMC10721693 DOI: 10.1007/s40520-023-02566-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 09/13/2023] [Indexed: 10/19/2023]
Abstract
BACKGROUND Machine-learning techniques have been recently utilized to predict the probability of unfavorable outcomes among elderly patients suffering from heart failure (HF); yet none has integrated an assessment for frailty and comorbidity. This research seeks to determine which machine-learning-based phenogroups that incorporate frailty and comorbidity are most strongly correlated with death or readmission at hospital for HF within six months following discharge from hospital. METHODS In this single-center, prospective study of a tertiary care center, we included all patients aged 65 and older discharged for acute decompensated heart failure. Random forest analysis and a Cox multivariable regression were performed to determine the predictors of the composite endpoint. By k-means and hierarchical clustering, those predictors were utilized to phenomapping the cohort in four different clusters. RESULTS A total of 571 patients were included in the study. Cluster analysis identified four different clusters according to frailty, burden of comorbidities and BNP. As compared with Cluster 4, we found an increased 6-month risk of poor outcomes patients in Cluster 1 (very frail and comorbid; HR 3.53 [95% CI 2.30-5.39]), Cluster 2 (pre-frail with low levels of BNP; HR 2.59 [95% CI 1.66-4.07], and in Cluster 3 (pre-frail and comorbid with high levels of BNP; HR 3.75 [95% CI 2.25-6.27])). CONCLUSIONS In older patients discharged for ADHF, the cluster analysis identified four distinct phenotypes according to frailty degree, comorbidity, and BNP levels. Further studies are warranted to validate these phenogroups and to guide an appropriate selection of personalized, model of care.
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Affiliation(s)
- Chukwuma Okoye
- Geriatrics Unit, Department of Clinical and Experimental Medicine, University of Pisa, Via Paradisa, 2, 56124, Pisa, Italy
- Department of Neurobiology, Care Sciences and Society, Department of Geriatrics Aging Research Center, Karolinska Institutet, Stockholm University, Stockholm, Sweden
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Tessa Mazzarone
- Geriatrics Unit, Department of Clinical and Experimental Medicine, University of Pisa, Via Paradisa, 2, 56124, Pisa, Italy.
| | - Filippo Niccolai
- Geriatrics Unit, Department of Clinical and Experimental Medicine, University of Pisa, Via Paradisa, 2, 56124, Pisa, Italy
| | - Leonardo Bencivenga
- Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy
| | - Giulia Pescatore
- Geriatrics Unit, Department of Clinical and Experimental Medicine, University of Pisa, Via Paradisa, 2, 56124, Pisa, Italy
| | - Maria Giovanna Bianco
- Geriatrics Unit, Department of Clinical and Experimental Medicine, University of Pisa, Via Paradisa, 2, 56124, Pisa, Italy
| | - Cinzia Guerrini
- Geriatrics Unit, Department of Clinical and Experimental Medicine, University of Pisa, Via Paradisa, 2, 56124, Pisa, Italy
| | - Andrea Giusti
- Geriatrics Unit, Department of Clinical and Experimental Medicine, University of Pisa, Via Paradisa, 2, 56124, Pisa, Italy
| | - Daniela Guarino
- Geriatrics Unit, Department of Clinical and Experimental Medicine, University of Pisa, Via Paradisa, 2, 56124, Pisa, Italy
| | - Agostino Virdis
- Geriatrics Unit, Department of Clinical and Experimental Medicine, University of Pisa, Via Paradisa, 2, 56124, Pisa, Italy
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11
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Sze S, Pellicori P, Zhang J, Weston J, Clark AL. Which frailty tool best predicts morbidity and mortality in ambulatory patients with heart failure? A prospective study. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2023; 9:731-739. [PMID: 36385564 DOI: 10.1093/ehjqcco/qcac073] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 11/04/2022] [Accepted: 11/15/2022] [Indexed: 11/08/2023]
Abstract
BACKGROUND Frailty is common in patients with heart failure (HF) and is associated with adverse outcome, but it is uncertain how frailty should best be measured. OBJECTIVES To compare the prognostic value of commonly-used frailty tools in ambulatory patients with HF. METHODS AND RESULTS We assessed, simultaneously, three screening tools [clinical frailty scale (CFS); Derby frailty index (DFI); acute frailty network (AFN) frailty criteria), three assessment tools (Fried criteria; Edmonton frailty score (EFS); deficit index (DI)) and three physical tests (handgrip strength, timed get-up-and-go test (TUGT), 5-metre walk test (5MWT)] in consecutive patients with HF attending a routine follow-up visit. 467 patients (67% male, median age = 76 years, median NT-proBNP = 1156 ng/L) were enrolled. During a median follow-up of 554 days, 82 (18%) patients died and 201 (43%) patients were either hospitalised or died. In models corrected for age, Charlson score, haemoglobin, renal function, sodium, NYHA, atrial fibrillation (AF), and body mass index, only log[NT-proBNP] and frailty were independently associated with all-cause death. A base model for predicting mortality at 1 year including NYHA, log[NT-proBNP], sodium and AF, had a C-statistic = 0.75. Amongst screening tools: CFS (C-statistic = 0.84); amongst assessment tools: DI (C-statistic = 0.83) and amongst physical test: 5MWT (C-statistic = 0.80), increased model performance most compared with base model (P <0.05 for all). CONCLUSION Frailty is strongly associated with adverse outcomes in ambulatory patients with HF. When added to a base model for predicting mortality at 1 year including NYHA, NT-proBNP, sodium, and AF, CFS provides comparable prognostic information with assessment tools taking longer to perform.
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Affiliation(s)
- Shirley Sze
- Department of Cardiology, Castle Hill Hospital, Hull York Medical School (at University of Hull), Kingston upon Hull, HU16 5JQ, UK
- Cardiovascular Research Centre, University of Leicester, Glenfield Hospital, Groby Road, Leicester, LE3 9QP, UK
| | - Pierpaolo Pellicori
- Department of Cardiology, Castle Hill Hospital, Hull York Medical School (at University of Hull), Kingston upon Hull, HU16 5JQ, UK
- Robertson Centre for Biostatistics & Clinical Trials, University of Glasgow, Glasgow, G12 8QQ, UK
| | - Jufen Zhang
- Department of Cardiology, Castle Hill Hospital, Hull York Medical School (at University of Hull), Kingston upon Hull, HU16 5JQ, UK
- Faculty of Medical Science, Anglia Ruskin University, Cambridge, CB1 1PT, UK
| | - Joan Weston
- Department of Cardiology, Castle Hill Hospital, Hull York Medical School (at University of Hull), Kingston upon Hull, HU16 5JQ, UK
| | - Andrew L Clark
- Department of Cardiology, Castle Hill Hospital, Hull York Medical School (at University of Hull), Kingston upon Hull, HU16 5JQ, UK
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12
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Ducharme A, Zieroth S, Ahooja V, Anderson K, Andrade J, Boivin-Proulx LA, Ezekowitz J, Howlett J, Lepage S, Leong D, McDonald MA, O'Meara E, Poon S, Swiggum E, Virani S. Canadian Cardiovascular Society-Canadian Heart Failure Society Focused Clinical Practice Update of Patients With Differing Heart Failure Phenotypes. Can J Cardiol 2023; 39:1030-1040. [PMID: 37169222 DOI: 10.1016/j.cjca.2023.04.022] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 04/20/2023] [Accepted: 04/21/2023] [Indexed: 05/13/2023] Open
Abstract
A number of societies produce heart failure (HF) management guidelines, comprising official recommendations on the basis of recent research discoveries, but their applicability to specific situations encountered in daily practice might be difficult. In this clinical practice update we aim to provide responses to fundamental questions that face health care providers, like appropriate timing for the introduction and optimization of different classes of medication according to specific patient phenotypes, when second-line therapies and valvular interventions should be considered, and management of difficult clinical scenarios such as cardiorenal syndrome and frailty. A consensus-based methodology was used. Approaches to 5 different phenotypes are presented: (1) The wet HF phenotype is the easiest to manage, decongestion being performed alongside introduction of guideline-directed medical therapy (GDMT); (2) The de novo HF phenotype requires the introduction of the 4 pillars of GDMT, personalizing the order on the basis of the individuals' biological and physiological characteristics; (3) The worsening HF phenotype is a marker of poor prognosis, and therefore should motivate optimization of GDMT, start second-line therapies, and/or reevaluate goals of care/advanced HF therapies; (4) The cardiorenal phenotypes require correct volume assessment, because renal function usually improves with decongestion; and (5) The frail HF phenotype require special attention, careful drug titration, and consideration of cardiac rehabilitation programs. In conclusion, specific common HF phenotypes call for a personalized approach to improve adoption of the HF guidelines into clinical practice.
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Affiliation(s)
- Anique Ducharme
- Department of Medicine, Institut de Cardiologie de Montréal, Université de Montréal, Montréal, Québec, Canada.
| | - Shelley Zieroth
- Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Vineeta Ahooja
- Department of Medicine, The Heart Health Institute, Scarborough, Ontario, Canada
| | - Kim Anderson
- Department of Medicine, Dalhousie University QEII Health Sciences Centre, Halifax, Nova Scotia, Canada
| | - Jason Andrade
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Justin Ezekowitz
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Jonathan Howlett
- Department of Medicine, Cumming School of Medicine, University of Calgary, Libin Cardiovascular Institute, Calgary, Alberta, Canada
| | - Serge Lepage
- Department of Medicine, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Derek Leong
- Department of Medicine, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Michael A McDonald
- Department of Medicine, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
| | - Eileen O'Meara
- Department of Medicine, Institut de Cardiologie de Montréal, Université de Montréal, Montréal, Québec, Canada
| | - Stephanie Poon
- Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Elizabeth Swiggum
- Department of Medicine, Royal Jubilee Hospital, University of British Columbia, Victoria, British Columbia, Canada
| | - Sean Virani
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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13
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van Leunen MMCJ, de Lathauwer ILJ, Verstappen CCAG, Visser-Stevelink DMG, Brouwers RWM, Herkert C, Tio RA, Spee RF, Lu Y, Kemps HMC. Telerehabilitation in patients with recent hospitalisation due to acute decompensated heart failure: protocol for the Tele-ADHF randomised controlled trial. BMC Cardiovasc Disord 2023; 23:379. [PMID: 37516829 PMCID: PMC10386674 DOI: 10.1186/s12872-023-03407-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 07/19/2023] [Indexed: 07/31/2023] Open
Abstract
BACKGROUND Cardiac rehabilitation in patients with chronic heart failure (CHF) has favourable effects on exercise capacity, the risk at hospital (re-)admission and quality of life. Although cardiac rehabilitation is generally recommended it is still under-utilised in daily clinical practice, particularly in frail elderly patients after hospital admission, mainly due to low referral and patient-related barriers. Cardiac telerehabilitation (CTR) has the potential to partially solve these barriers. The purpose of this study is to evaluate the effects of CTR as compared to standard remote care after hospital admission on physical functional capacity in CHF patients. METHODS In this randomised controlled trial, 64 CHF patients will be recruited during hospitalisation for acute decompensated heart failure, and randomised to CTR combined with remote patient management (RPM) or RPM alone (1:1). All participants will start with RPM after hospital discharge for early detection of deterioration, and will be up titrated to optimal medical therapy before being randomised. CTR will start after randomisation and consists of an 18-week multidisciplinary programme with exercise training by physical and occupational therapists, supported by a (remote) technology-assisted dietary intervention and mental health guiding by a physiologist. The training programme consists of three centre-based and two home-based video exercise training sessions followed by weekly video coaching. The mental health and dietary programme are executed using individual and group video sessions. A wrist-worn device enables remote coaching by the physical therapist. The web application is used for promoting self-management by the following modules: 1) goal setting, 2) progress tracking, 3) education, and 4) video and chat communication. The primary outcome measure is physical functional capacity evaluated by the Short Physical Performance Battery (SPPB) score. Secondary outcome measures include frailty scoring, recovery after submaximal exercise, subjective health status, compliance and acceptance to the rehabilitation programme, and readmission rate. DISCUSSION The Tele-ADHF trial is the first prospective randomised controlled trial designed for evaluating the effects of a comprehensive combined RPM and CTR programme in recently hospitalised CHF patients. We hypothesize that this intervention has superior effects on physical functional capacity than RPM alone. TRIAL REGISTRATION Netherlands Trial Registry (NTR) NL9619, registered 21 July 2021.
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Affiliation(s)
- Mayke M C J van Leunen
- Department of Cardiology, Máxima Medical Centre, De Run 4600, 5504 DB, Veldhoven, The Netherlands.
- Department of Industrial Design, Eindhoven University of Technology, Eindhoven, the Netherlands.
| | - Ignace L J de Lathauwer
- Department of Cardiology, Máxima Medical Centre, De Run 4600, 5504 DB, Veldhoven, The Netherlands
- Department of Industrial Design, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - Cindy C A G Verstappen
- Department of Cardiology, Catharina Hospital Eindhoven, Eindhoven, the Netherlands
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
| | | | - Rutger W M Brouwers
- Department of Cardiology, Máxima Medical Centre, De Run 4600, 5504 DB, Veldhoven, The Netherlands
- Department of Industrial Design, Eindhoven University of Technology, Eindhoven, the Netherlands
- Department of Cardiology, Catharina Hospital Eindhoven, Eindhoven, the Netherlands
| | - Cyrille Herkert
- Department of Cardiology, Máxima Medical Centre, De Run 4600, 5504 DB, Veldhoven, The Netherlands
- Department of Cardiology, Catharina Hospital Eindhoven, Eindhoven, the Netherlands
| | - René A Tio
- Department of Cardiology, Catharina Hospital Eindhoven, Eindhoven, the Netherlands
| | - Ruud F Spee
- Department of Cardiology, Máxima Medical Centre, De Run 4600, 5504 DB, Veldhoven, The Netherlands
| | - Yuan Lu
- Department of Industrial Design, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - Hareld M C Kemps
- Department of Cardiology, Máxima Medical Centre, De Run 4600, 5504 DB, Veldhoven, The Netherlands
- Department of Industrial Design, Eindhoven University of Technology, Eindhoven, the Netherlands
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14
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Granata N, Torlaschi V, Zanatta F, Giardini A, Maestri R, Pavesi C, Sommaruga M, Gazzi L, Bertolotti G, Sarzi Braga S, Monelli M, Zanelli E, Pierobon A. Positive affect as a predictor of non-pharmacological adherence in older Chronic Heart Failure (CHF) patients undergoing cardiac rehabilitation. PSYCHOL HEALTH MED 2023; 28:606-620. [PMID: 35603663 DOI: 10.1080/13548506.2022.2077394] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
In Chronic Heart Failure (CHF) patients, psychological and cognitive variables and their association with treatment adherence have been extensively reported in the literature, but few are the investigations in older people. The present study aimed to evaluate the psychological, cognitive, and adherence to treatment profile of older (>65 years) CHF patients, the interrelation between these variables, and identify possible independent predictors of self-reported treatment adherence. CHF inpatients undergoing cardiac rehabilitation were assessed for: anxiety, depression, cognitive impairment, positive and negative affect, and self-reported adherence (adherence antecedents, pharmacological adherence, and non-pharmacological adherence). 100 CHF inpatients (mean age: 74.9 ± 7.1 years) were recruited. 16% of patients showed anxiety and 24.5% depressive symptoms; 4% presented cognitive decline. Cognitive functioning negatively correlated to depression, anxiety, and negative affect (p < 0.01). The adherence antecedents (disease acceptance, adaptation, knowledge, and socio-familiar support) negatively correlated to anxiety (p < 0.05), depression (p < 0.001), and negative affect (p < 0.05), while they positively correlated to positive affect (p < 0.01). Pharmacological adherence negatively correlated to anxiety and negative affect (p < 0.05). Conversely, non-pharmacological adherence and positive affect positively correlated (p < 0.05). Furthermore, depression and anxiety negatively predicted adherence antecedents (β = -0.162, p = 0.037) and pharmacological adherence (β = -0.171, p = 0.036), respectively. Finally, positive affect was found as an independent predictor of non-pharmacological adherence (β = 0.133, p = 0.004). In cardiac rehabilitation, a specific psychological assessment focused on anxiety, depression, and affect can provide useful information to manage CHF older patients' care related to treatment adherence. In particular, positive affect should be targeted in future interventions to foster patients' non-pharmacological adherence.
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Affiliation(s)
- Nicolò Granata
- Psychology Unit, Istituti Clinici Scientifici Maugeri IRCSS, Istituto Di Montescano, Pavia, Italy
| | - Valeria Torlaschi
- Psychology Unit, Istituti Clinici Scientifici Maugeri IRCSS, Istituto Di Montescano, Pavia, Italy
| | - Francesco Zanatta
- Department of Psychology, University of Milano-Bicocca, Milano, Italy
| | - Anna Giardini
- Information Technology Department, Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy
| | - Roberto Maestri
- Department of Biomedical Engineering, Istituti Clinici Scientifici Maugeri IRCSS, Istituto Di Montescano, Pavia, Italy
| | - Claudia Pavesi
- Department of Cardiac Rehabilitation, Istituti Clinici Scientifici Maugeri IRCSS, Istituto Di Montescano, Pavia, Italy
| | - Marinella Sommaruga
- Psychology Unit, Istituti Clinici Scientifici Maugeri IRCSS, Istituto Di Camaldoli, Milano, Italy
| | - Lidia Gazzi
- Psychology Unit, Istituti Clinici Scientifici Maugeri IRCSS, Istituto di Lumezzane, Brescia, Italy
| | - Giorgio Bertolotti
- Psychology Unit, Istituti Clinici Scientifici Maugeri IRCSS, Istituto di Tradate, Varese, Italy
| | - Simona Sarzi Braga
- Department of Cardiac Rehabilitation, Istituti Clinici Scientifici Maugeri IRCSS, Istituto di Tradate, Varese, Italy
| | - Mauro Monelli
- Subacute Care, Istituti Clinici Scientifici Maugeri IRCSS, Istituto Di Camaldoli, Milano, Italy
| | - Emanuela Zanelli
- Department of Cardiac Rehabilitation, Istituti Clinici Scientifici Maugeri IRCSS, Istituto di Lumezzane, Brescia, Italy
| | - Antonia Pierobon
- Psychology Unit, Istituti Clinici Scientifici Maugeri IRCSS, Istituto Di Montescano, Pavia, Italy
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15
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Mori E, Aoyagi Y, Kono Y, Asai H, Tomita H, Izawa H. Exploring the factors associated with decreased dynamic balance ability in older patients with heart failure. Heart Lung 2023; 58:139-143. [PMID: 36512879 DOI: 10.1016/j.hrtlng.2022.11.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Revised: 11/23/2022] [Accepted: 11/29/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Older patients with heart failure (HF) have a higher prevalence of frailty and poorer dynamic balance ability than other community-dwelling older adults. However, the association of frailty and other clinical characteristics with dynamic balance ability in these patients remains unclear. OBJECTIVES We aimed to determine the clinical characteristics associated with decreased dynamic balance ability in older patients with HF. METHODS This observational study included patients aged ≥65 years who could walk independently and were admitted to our university hospitals to undergo a cardiac rehabilitation. The timed up and go test (TUG) was used to evaluate dynamic balance ability. Pearson's and Spearman's correlation analyses were performed to determine the relationships between TUG scores and clinical characteristics. A multiple regression model based on the forced entry method was used to determine independent predictors of TUG scores. RESULTS Of the 183 participants in this study (94 women; mean age, 82.5 ± 8.1 years), 116 (61.7%) had frailty. Pearson's and Spearman's correlation analyses revealed that age, frailty, sex, knee extensor muscle strength, maximum calf circumference, and Mini-Mental State Examination-Japanese version (MMSE-J) score were significantly correlated with TUG score (p < 0.001). Further, multiple regression analysis showed that age (p < 0.001), frailty (p = 0.041), knee extensor muscle strength (p = 0.002), and MMSE-J score (p = 0.048) were independent predictors of TUG scores. CONCLUSION Multiple factors, including age, frailty, knee extensor muscle weakness, and cognitive function impairment are independently associated with decreased dynamic balance ability in older patients with HF.
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Affiliation(s)
- Etsuko Mori
- Department of Rehabilitation, Fujita Health University Bantane Hospital, Nagoya, Japan; School of Health Sciences, Graduate of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Japan
| | - Yoichiro Aoyagi
- Department of Rehabilitation Medicine, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan; Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Toyoake, Japan.
| | - Yuji Kono
- Department of Rehabilitation, Fujita Health University Hospital, Toyoake, Japan
| | - Hitoshi Asai
- Department of Physical Therapy, Graduate Course of Rehabilitation Sciences, Kanazawa University, Kanazawa, Japan
| | - Hidehito Tomita
- Graduate School of Health Sciences, Toyohashi SOZO University, Toyohashi, Japan
| | - Hideo Izawa
- Department of Cardiology, School of Medicine, Fujita Health University, Toyoake, Japan
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16
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Mollar A, Bonanad C, Diez-Villanueva P, Segarra D, Civera J, Sastre C, Conesa A, Villaescusa A, Fernández J, Miñana G, Navarro J, Sanchis J, Núñez J. Frailty and Hospitalization Burden in Patients With Chronic Heart Failure. Am J Cardiol 2022; 183:48-54. [PMID: 36153181 DOI: 10.1016/j.amjcard.2022.08.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 08/02/2022] [Accepted: 08/08/2022] [Indexed: 11/27/2022]
Abstract
Frailty is associated with increased mortality and hospitalizations in patients with heart failure (HF). However, there is little evidence regarding the burden of morbidity. In this study, we aimed to assess the association between frailty and recurrent all-cause HF hospitalizations in patients with stable chronic HF. This was an observational and prospective study that enrolled HF outpatients followed in a specialized HF unit of a single tertiary care center from 2017 to 2019. Frailty was assessed by Fried criteria. Robustness, prefrailty, and frailty were defined as 0, 1 to 2, and ≥3, respectively. The independent association between frailty status and recurrent hospitalizations was assessed through Famoye's bivariate Poisson regression model, and risk estimates were expressed as incidence rate ratios (IRR). A total of 277 patients were included. The mean age was 74 ± 10 years, 118 were women (42.6%), and 131 patients (47.3%) had left ventricular ejection fraction ≥50. According to Fried's score 61 patients (22%) were robust, 95 patients (34%) were prefrail, and 121 patients (44%) were frail. After a median follow-up of 2.21 (1.6 to 2.8) years, 52 patients (19%) died. We registered 348 all-cause hospitalizations in 144 patients (52%) and 178 HF hospitalizations in 108 patients (39%). Compared with robust patients, frailty was associated with a higher risk of all-cause and HF recurrent hospitalizations in multivariable analysis (IRR 2.01, 95% confidence interval 1.14 to 3.57, p = 0.017 and IRR 2.25, 95% confidence interval 1.16-4.36, p = 0.016, respectively). In conclusion, in patients with chronic HF, frailty identifies patients with an increased risk of total and recurrent all-cause and HF hospitalizations.
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Affiliation(s)
- Anna Mollar
- Cardiology Department, Universitary Clinic Hospital, INCLIVA. Universitat de València. Valencia, Spain; CIBER Cardiovascular, Madrid, Spain
| | - Clara Bonanad
- Cardiology Department, Universitary Clinic Hospital, INCLIVA. Universitat de València. Valencia, Spain
| | | | - Daniel Segarra
- Cardiology Department, Universitary Clinic Hospital, INCLIVA. Universitat de València. Valencia, Spain
| | - Jose Civera
- Cardiology Department, Universitary Clinic Hospital, INCLIVA. Universitat de València. Valencia, Spain
| | - Clara Sastre
- Cardiology Department, Universitary Clinic Hospital, INCLIVA. Universitat de València. Valencia, Spain
| | - Adriana Conesa
- Cardiology Department, Universitary Clinic Hospital, INCLIVA. Universitat de València. Valencia, Spain
| | - Amparo Villaescusa
- Cardiology Department, Universitary Clinic Hospital, INCLIVA. Universitat de València. Valencia, Spain
| | - Julio Fernández
- Cardiology Department, Universitary Clinic Hospital, INCLIVA. Universitat de València. Valencia, Spain
| | - Gema Miñana
- Cardiology Department, Universitary Clinic Hospital, INCLIVA. Universitat de València. Valencia, Spain; CIBER Cardiovascular, Madrid, Spain
| | - Jorge Navarro
- Cardiology Department, Universitary Clinic Hospital, INCLIVA. Universitat de València. Valencia, Spain
| | - Juan Sanchis
- Cardiology Department, Universitary Clinic Hospital, INCLIVA. Universitat de València. Valencia, Spain; CIBER Cardiovascular, Madrid, Spain
| | - Julio Núñez
- Cardiology Department, Universitary Clinic Hospital, INCLIVA. Universitat de València. Valencia, Spain; CIBER Cardiovascular, Madrid, Spain.
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17
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Doody P, Asamane EA, Aunger JA, Swales B, Lord JM, Greig CA, Whittaker AC. The prevalence of frailty and pre-frailty among geriatric hospital inpatients and its association with economic prosperity and healthcare expenditure: A systematic review and meta-analysis of 467,779 geriatric hospital inpatients. Ageing Res Rev 2022; 80:101666. [PMID: 35697143 DOI: 10.1016/j.arr.2022.101666] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 04/27/2022] [Accepted: 06/06/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND Frailty is a common and clinically significant condition among geriatric populations. Although well-evidenced pooled estimates of the prevalence of frailty exist within various settings and populations, presently there are none assessing the overall prevalence of frailty among geriatric hospital inpatients. The purpose of this review was to systematically search and analyse the prevalence of frailty among geriatric hospital inpatients within the literature and examine its associations with national economic indicators. METHODS Systematic searches were conducted on Ovid, Web of Science, Scopus, CINAHL Plus, and the Cochrane Library, encompassing all literature published prior to 22 November 2018, supplemented with manual reference searches. Included studies utilised a validated operational definition of frailty, reported the prevalence of frailty, had a minimum age ≥ 65 years, attempted to assess the whole ward/clinical population, and occurred among hospital inpatients. Two reviewers independently extracted data and assessed study quality. RESULTS Ninety-six studies with a pooled sample of 467,779 geriatric hospital inpatients were included. The median critical appraisal score was 8/9 (range 7-9). The pooled prevalence of frailty, and pre-frailty, among geriatric hospital inpatients was 47.4% (95% CI 43.7-51.1%), and 25.8% (95% CI 22.0-29.6%), respectively. Significant differences were observed in the prevalence of frailty stratified by age, prevalent morbidity, ward type, clinical population, and operational definition. No significant differences were observed in stratified analyses by sex or continent, or significant associations between the prevalence of frailty and economic indicators. CONCLUSIONS Frailty is highly prevalent among geriatric hospital inpatients. High heterogeneity exists within this setting based on various clinical and demographic characteristics. Pooled estimates reported in this review place the prevalence of frailty among geriatric hospital inpatients between that reported for community-dwelling older adults and older adults in nursing homes, outlining an increase in the relative prevalence of frailty with progression through the healthcare system.
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Affiliation(s)
- Paul Doody
- School of Sport, Exercise, and Rehabilitation Sciences, University of Birmingham, United Kingdom; The Irish Longitudinal Study on Ageing, School of Medicine, Trinity College Dublin, Dublin 2, Ireland; Mercer's Institute for Successful Ageing, St. James Hospital, Dublin 8, Ireland.
| | - Evans A Asamane
- School of Sport, Exercise, and Rehabilitation Sciences, University of Birmingham, United Kingdom; Institute of Applied Health Research, University of Birmingham, United Kingdom
| | - Justin A Aunger
- School of Sport, Exercise, and Rehabilitation Sciences, University of Birmingham, United Kingdom; School of Health Sciences, University of Surrey, United Kingdom
| | - Bridgitte Swales
- School of Sport, Exercise, and Rehabilitation Sciences, University of Birmingham, United Kingdom; Faculty of Health Sciences and Sport, University of Stirling, United Kingdom
| | - Janet M Lord
- MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research, Institute of Inflammation and Ageing, University of Birmingham, United Kingdom; NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and the University of Birmingham, United Kingdom
| | - Carolyn A Greig
- School of Sport, Exercise, and Rehabilitation Sciences, University of Birmingham, United Kingdom; MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research, Institute of Inflammation and Ageing, University of Birmingham, United Kingdom; NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and the University of Birmingham, United Kingdom
| | - Anna C Whittaker
- School of Sport, Exercise, and Rehabilitation Sciences, University of Birmingham, United Kingdom; Faculty of Health Sciences and Sport, University of Stirling, United Kingdom
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18
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Antonio-Oriola R, Vellone E, Durante A, De Maria M, Di Nitto M, Gea-Caballero V, Santolalla-Arnedo I, Czapla M, Benavent-Cervera JV, Sánchez-González JL, Juárez-Vela R. Spanish Version of the Caregiver Contribution to Self-Care of Heart Failure Index (CC-SCHFI): A Psychometric Evaluation. J Pers Med 2022; 12:625. [PMID: 35455741 PMCID: PMC9028340 DOI: 10.3390/jpm12040625] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 04/07/2022] [Accepted: 04/11/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The Caregiver Contribution to Self-Care of Heart Failure (CC-SCHFI) is a theoretically driven instrument to measure the extent to which caregivers support heart failure (HF) patients to perform self-care. The CC-SCHFI measures caregivers' contribution to self-care maintenance and self-care management and caregiver confidence in contributing to heart failure patients' self-care. To date, the CC-SCHFI has never been tested in Spanish-speaking populations. PURPOSE To translate the CC-SCHFI from English into Spanish and to test its psychometric characteristics. METHOD CC-SCHFI translation and back-translation were performed according to the Beaton et al. methodology. Data from a cross-sectional study conducted in an outpatient clinic in Spain were used for the analysis. Psychometric analysis was performed with exploratory factor analysis (EFA) with oblique rotation. RESULTS Caregivers had a mean age of 60.5 years (SD 14,9) and the majority were female (85%). Data from 220 caregivers were analyzed. From EFA, using the principal axis factoring method, we extracted two factors in the self-care maintenance subscale ("treatment adherence behaviors" and "symptom control and maintenance behaviors"), two in the self-care monitoring subscale ("illness behaviors" and "prevention behaviors") and one factor for the self-efficacy subscale. The Pearson's rank correlation coefficients between SCHFI and CCSCHFI showed significant correlation in each subdimension.
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Affiliation(s)
- Rosa Antonio-Oriola
- Doctorate Program in Clinical and Community Nursing, University of Valencia, 46001 Valencia, Spain;
| | - Ercole Vellone
- Department of Biomedicine and Prevention, University of Roma Tor Vergata, 00133 Rome, Italy; (E.V.); (M.D.M.)
| | - Angela Durante
- Group of Research in Care GRUPAC, Department of Nursing, University of La Rioja, 26004 Logroño, Spain; (I.S.-A.); (M.C.); (R.J.-V.)
| | - Maddalena De Maria
- Department of Biomedicine and Prevention, University of Roma Tor Vergata, 00133 Rome, Italy; (E.V.); (M.D.M.)
| | - Marco Di Nitto
- Centro per l’Eccellenza Clinica, la Qualità e la Sicurezza Delle Cure (CNEC), Istituto Superiore di Sanità, 00162 Rome, Italy;
| | - Vicente Gea-Caballero
- Faculty of Health Sciences, Valencia International University, 46002 Valencia, Spain; (V.G.-C.); (J.V.B.-C.)
| | - Iván Santolalla-Arnedo
- Group of Research in Care GRUPAC, Department of Nursing, University of La Rioja, 26004 Logroño, Spain; (I.S.-A.); (M.C.); (R.J.-V.)
| | - Michał Czapla
- Group of Research in Care GRUPAC, Department of Nursing, University of La Rioja, 26004 Logroño, Spain; (I.S.-A.); (M.C.); (R.J.-V.)
- Laboratory for Experimental Medicine and Innovative Technologies, Department of Emergency Medical Service, Wroclaw Medical University, 51-616 Wroclaw, Poland
| | | | | | - Raúl Juárez-Vela
- Group of Research in Care GRUPAC, Department of Nursing, University of La Rioja, 26004 Logroño, Spain; (I.S.-A.); (M.C.); (R.J.-V.)
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19
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Chi J, Chen F, Zhang J, Niu X, Tao H, Ruan H, Jin L, Wang Y. Frailty is associated with 90-day unplanned readmissions and death in patients with heart failure: A longitudinal study in China. Heart Lung 2022; 53:25-31. [PMID: 35121488 DOI: 10.1016/j.hrtlng.2022.01.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 01/13/2022] [Accepted: 01/16/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Frailty has been reported to be significantly associated with adverse health outcomes in people with heart failure (HF). OBJECTIVES To explore the potential effects of frailty on unplanned readmissions and death in people with HF patients aged 18 years or older. METHODS 342 HF patients aged 18 years or older from the heart centers of two different tertiary care hospitals located in northwest of China were enrolled between July and December 2020. Frailty was assessed by the Tilburg Frailty Indicator. The patients were followed for unplanned readmissions, and all-cause mortality at 30, 60, as well as 90 days after discharge. Multivariate cox regression models were used to analyze the effects of frailty on 90-day unplanned readmission and death in the patients with HF. RESULTS Frailty prevalence was 54.7% among 342 HF patients, with a mean age of 64.65 ± 11.90 years. It was found that compared to non-frailty HF patients, the frailty HF patients were older and displayed higher systolic blood pressure, longer duration of HF, more severe cognitive function, and more comorbidities (P < 0.05). On the contrary, the patients in the frail group had a higher incidence of unplanned readmission (73.1% vs. 26.9%, χ2 = 18.87, P < 0.01) and death (100% vs. 0%, χ2 = 6.94, P < 0.01) than those in the non-frail group. Multivariate cox regression analysis showed that frailty could serve as an independent risk factor for 90-day unplanned readmission (HR = 1.469, 95% CI 1.318-1.637, P < 0.01) and 90-day death (HR=2.270, 95% CI 1.091-4.726, P < 0.01) in the patients with HF. CONCLUSION Frailty can act as an independent predictor of unplanned readmission and death 90-day after discharge in HF patients aged 18 years or older.
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Affiliation(s)
- Junting Chi
- Department of Nursing, First People's Hospital of Yunnan, 157 Jinbi Road, Xishan District, Kunming, Yunnan 650032, PR China; The Affiliated Hospital of Kunming University of Science and Technology, Kunming, Yunnan 650032, PR China; School of Nursing, Lanzhou University, NO.28 Yanxi Road, Lanzhou, Gansu 730000, PR China
| | - Fei Chen
- School of Nursing, Lanzhou University, NO.28 Yanxi Road, Lanzhou, Gansu 730000, PR China; Evidence-Based Nursing Center, School of Nursing, Lanzhou University, NO. 28 Yanxi Road, Lanzhou, Gansu 730000, PR China
| | - Jing Zhang
- School of Nursing, Lanzhou University, NO.28 Yanxi Road, Lanzhou, Gansu 730000, PR China
| | - Xiaodan Niu
- School of Nursing, Lanzhou University, NO.28 Yanxi Road, Lanzhou, Gansu 730000, PR China
| | - Hongxia Tao
- School of Nursing, Lanzhou University, NO.28 Yanxi Road, Lanzhou, Gansu 730000, PR China
| | - Haihui Ruan
- School of Nursing, Lanzhou University, NO.28 Yanxi Road, Lanzhou, Gansu 730000, PR China
| | - Lifen Jin
- Department of Nursing, First People's Hospital of Yunnan, 157 Jinbi Road, Xishan District, Kunming, Yunnan 650032, PR China; The Affiliated Hospital of Kunming University of Science and Technology, Kunming, Yunnan 650032, PR China.
| | - Yanhong Wang
- School of Nursing, Lanzhou University, NO.28 Yanxi Road, Lanzhou, Gansu 730000, PR China.
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20
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Uchmanowicz I, Pasieczna AH, Wójta-Kempa M, Gobbens RJJ, Młynarska A, Faulkner KM, Czapla M, Szczepanowski R. Physical, Psychological and Social Frailty Are Predictive of Heart Failure: A Cross-Sectional Study. J Clin Med 2022; 11:jcm11030565. [PMID: 35160017 PMCID: PMC8836458 DOI: 10.3390/jcm11030565] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 01/18/2022] [Accepted: 01/21/2022] [Indexed: 02/07/2023] Open
Abstract
Background: Little is known about frailty among patients hospitalized with heart failure (HF). To date, the limited information on frailty in HF is based on a unidimensional view of frailty, in which only physical aspects are considered when determining frailty. The aims of this study were to study different dimensions of frailty (physical, psychological and social) in patients with HF and the effect of different dimensions of frailty on the incidence of heart failure. Methods: The study used a cross-sectional design and included 965 patients hospitalized for heart failure and 164 healthy controls. HF was defined according to the ESC guidelines. The Tilburg Frailty Indicator (TFI) was used to assess frailty. Probit regression analyses and chi-square statistics were used to examine associations between the occurrence of heart failure and TFI domains of frailty. Results: Patients diagnosed with frailty were 15.3% more likely to develop HF compared to those not diagnosed with frailty (p < 0.001). An increase in physical, psychological and social frailty corresponded to an increased risk of HF of 2.9% (p < 0.001), 4.4% (p < 0.001) and 6.6% (p < 0.001), respectively. Conclusions: We found evidence of the association between different dimensions of frailty and incidence of HF.
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Affiliation(s)
- Izabella Uchmanowicz
- Department of Nursing and Obstetrics, Faculty of Health Sciences, Wroclaw Medical University, 51-618 Wrocław, Poland;
- Institute of Heart Diseases, University Hospital, 50-566 Wroclaw, Poland
| | | | - Monika Wójta-Kempa
- Department of Health Humanities and Social Science, Wroclaw Medical University, 51-618 Wrocław, Poland;
| | - Robbert J. J. Gobbens
- Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, 1081 HV Amsterdam, The Netherlands;
- Zonnehuisgroep Amstelland, 1186 AA Amstelveen, The Netherlands
- Department Family Medicine and Population Health, Faculty of Medicine and Health Sciences, University of Antwerp, 2610 Wilrijk, Belgium
| | - Agnieszka Młynarska
- Department of Gerontology and Geriatric Nursing, School of Health Sciences, Medical University of Silesia, 40-055 Katowice, Poland;
| | | | - Michał Czapla
- Institute of Heart Diseases, University Hospital, 50-566 Wroclaw, Poland
- Laboratory for Experimental Medicine and Innovative Technologies, Department of Emergency Medical Service, Wroclaw Medical University, 51-616 Wroclaw, Poland
- Correspondence:
| | - Remigiusz Szczepanowski
- Department of Computer Science and Systems Engineering, Wrocław University of Science and Technology, 50-370 Wrocław, Poland;
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21
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Nakhjiri LZ, Darvishpour A, Pourghane P, Chaboki BG. The relationship between frailty syndrome and self-care ability in the elderly with heart failure. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2021; 10:475. [PMID: 35233422 PMCID: PMC8826780 DOI: 10.4103/jehp.jehp_199_21] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Accepted: 05/22/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Identification of frailty syndrome in patients with heart failure can affect the process of the disease and their ability to self-care. Considering the lack of a study on the relationship between frailty syndrome and self-care ability in the elderly with heart failure in the Guilan province, the North of Iran, this study was conducted to determine the relationship between fertility syndrome and self-care ability in these patients. MATERIALS AND METHODS The present cross-sectional correlational study was conducted in 2020. Research settings were the CCU and post CCU wards in the East Guilan public hospitals. The sample size was 125 people who were selected by the convenience sampling method. The research tools include; Self-Care Heart Failure Index and Tilburg Frailty Index Questionnaires. Data were analyzed using SPSS software version 20 using descriptive and inferential statistics with a significance level of 0.05. RESULTS The results showed that the mean score of frailty syndrome in the elderly with heart failure was 5.44 ± 2.47. In addition, the mean score of self-care in the elderly with heart failure was 67.16 ± 10.96. There was a significant and negative correlation between frailty syndrome and the ability to care in the elderly with heart failure (P < 0.001, r = -0.358). CONCLUSIONS According to the results, the elderly with fragility syndrome cannot take good care of themselves. This indicates that in the management of heart failure, the assessment of frailty syndrome as a care/treatment goal in the care programs of these patients should be considered.
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Affiliation(s)
- Leila Zahed Nakhjiri
- Department of Nursing, Zeynab (P.B.U.H) School of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, Iran
| | - Azar Darvishpour
- Department of Nursing, Zeynab (P.B.U.H) School of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, Iran
- Social Determinants of Health Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Parand Pourghane
- Department of Nursing, Zeynab (P.B.U.H) School of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, Iran
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22
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Clark KAA, Nanna MG. Moving the field forward: untangling the impact of frailty in advanced heart failure patients and prognosticating outcomes. J Card Fail 2021; 28:775-777. [PMID: 34936895 PMCID: PMC9106896 DOI: 10.1016/j.cardfail.2021.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 12/06/2021] [Indexed: 10/19/2022]
Affiliation(s)
- Katherine A A Clark
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT.
| | - Michael G Nanna
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT
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23
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Barros MPD, Bachi ALL, Santos JDMBD, Lambertucci RH, Ishihara R, Polotow TG, Caldo-Silva A, Valente PA, Hogervorst E, Furtado GE. The poorly conducted orchestra of steroid hormones, oxidative stress and inflammation in frailty needs a maestro: Regular physical exercise. Exp Gerontol 2021; 155:111562. [PMID: 34560197 DOI: 10.1016/j.exger.2021.111562] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 09/14/2021] [Accepted: 09/17/2021] [Indexed: 12/25/2022]
Abstract
This review outlines the various factors associated with unhealthy aging which includes becoming frail and dependent. With many people not engaging in recommended exercise, facilitators and barriers to engage with exercise must be investigated to promote exercise uptake and adherence over the lifespan for different demographics, including the old, less affluent, women, and those with different cultural-ethnic backgrounds. Governmental and locally funded public health messages and environmental facilitation (gyms, parks etc.) can play an important role. Studies have shown that exercise can act as a conductor to balance oxidative stress, immune and endocrine functions together to promote healthy aging and reduce the risk for age-related morbidities, such as cardiovascular disease and atherosclerosis, and promote cognition and mood over the lifespan. Like a classic symphony orchestra, consisting of four groups of related musical instruments - the woodwinds, brass, percussion, and strings - the aging process should also perform in harmony, with compassion, avoiding the aggrandizement of any of its individual parts during the presentation. This review discusses the wide variety of molecular, cellular and endocrine mechanisms (focusing on the steroid balance) underlying this process and their interrelationships.
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Affiliation(s)
- Marcelo Paes de Barros
- Institute of Physical Activity Sciences and Sports (ICAFE), MSc/PhD Interdisciplinary Program in Health Sciences, Cruzeiro do Sul University, 01506-000 São Paulo, Brazil.
| | - André Luís Lacerda Bachi
- Department of Otorhinolaryngology, ENT Lab, Federal University of São Paulo (UNIFESP), São Paulo 04025-002, Brazil; Post-Graduation Program in Health Sciences, Santo Amaro University (UNISA), São Paulo 04829-300, Brazil
| | | | | | - Rafael Ishihara
- Department of Biosciences, Federal University of São Paulo (UNIFESP), Santos 11015-020, SP, Brazil
| | - Tatiana Geraldo Polotow
- Institute of Physical Activity Sciences and Sports (ICAFE), MSc/PhD Interdisciplinary Program in Health Sciences, Cruzeiro do Sul University, 01506-000 São Paulo, Brazil
| | - Adriana Caldo-Silva
- University of Coimbra, Research Unit for Sport and Physical Activity (CIDAF, UID/PTD/04213/2019) at Faculty of Sport Science and Physical Education, (FCDEF-UC), Portugal
| | - Pedro Afonso Valente
- University of Coimbra, Research Unit for Sport and Physical Activity (CIDAF, UID/PTD/04213/2019) at Faculty of Sport Science and Physical Education, (FCDEF-UC), Portugal
| | - Eef Hogervorst
- Applied Cognitive Research National Centre for Sports and Exercise Medicine, Loughborough University, Loughborough, UK
| | - Guilherme Eustáquio Furtado
- Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), Coimbra, Portugal; Institute Polytechnic of Maia, Porto, Portugal; University of Coimbra, Research Unit for Sport and Physical Activity (CIDAF, UID/PTD/04213/2019) at Faculty of Sport Science and Physical Education, (FCDEF-UC), Portugal.
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24
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Douros A, Schneider A, Ebert N, Huscher D, Kuhlmann MK, Martus P, Mielke N, Van Der Giet M, Wenning V, Schaeffner E. Control of blood pressure in older patients with heart failure and the risk of mortality: a population-based prospective cohort study. Age Ageing 2021; 50:1173-1181. [PMID: 33320927 DOI: 10.1093/ageing/afaa261] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND treatment goals for blood pressure (BP) lowering in older patients with heart failure (HF) are unclear. OBJECTIVE to assess whether BP control < 140/90 mmHg is associated with a decreased risk of mortality in older HF patients. DESIGN population-based prospective cohort study. SETTING/SUBJECTS participants of the Berlin Initiative Study, a prospective cohort of community-dwelling older adults launched in 2009. Clinical information was obtained in face-to-face interviews and linked to administrative healthcare data. METHODS Cox proportional hazards models estimated adjusted hazard ratios (HRs) with 95% confidence intervals (CIs) of cardiovascular death and all-cause mortality associated with normalised BP (systolic BP < 140 mmHg and diastolic BP < 90 mmHg) compared with non-normalised BP (systolic BP ≥ 140 mmHg or diastolic BP ≥ 90 mmHg) in HF patients. The primary analysis considered only baseline BP ('time-fixed'); an additional analysis updated BP during follow-up ('time-dependent'). RESULTS at baseline, 544 patients were diagnosed with HF and treated with antihypertensive drugs (mean age 82.8 years; 45.4% female). During a median follow-up of 7.5 years and compared with non-normalised BP, normalised BP was associated with similar risks of cardiovascular death (HR, 1.24; 95% CI, 0.84-1.85) and all-cause mortality (HR, 1.16; 95% CI, 0.89-1.51) in the time-fixed analysis but with increased risks of cardiovascular death (HR, 1.79; 95% CI, 1.23-2.61) and all-cause mortality (HR, 1.48; 95% CI, 1.15-1.90) in the time-dependent analysis. CONCLUSIONS BP control < 140/90 mmHg was not associated with a decreased risk of mortality in older HF patients. The increased risk in the time-dependent analysis requires further corroboration.
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Affiliation(s)
- Antonios Douros
- Departments of Medicine and Epidemiology, McGill University, Montreal, QC, Canada
- Centre for Clinical Epidemiology, Lady Davis Institute, Montreal, QC, Canada
- Institute of Clinical Pharmacology and Toxicology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Alice Schneider
- Institute of Public Health, Charité-Universitätsmedizin Berlin, Berlin, Germany
- Institute of Biometry and Clinical Epidemiology, and Berlin Institute of Health, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Natalie Ebert
- Institute of Public Health, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Dörte Huscher
- Institute of Public Health, Charité-Universitätsmedizin Berlin, Berlin, Germany
- Institute of Biometry and Clinical Epidemiology, and Berlin Institute of Health, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Martin K Kuhlmann
- Department of Nephrology, Vivantes Klinikum im Friedrichshain, Berlin, Germany
| | - Peter Martus
- Institut für Klinische Epidemiologie und angewandte Biometrie, Eberhard Karls Universität Tübingen, Tübingen, Germany
| | - Nina Mielke
- Institute of Public Health, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Markus Van Der Giet
- Department of Nephrology and Intensive Care Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | | | - Elke Schaeffner
- Institute of Public Health, Charité-Universitätsmedizin Berlin, Berlin, Germany
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Liperoti R, Vetrano DL, Palmer K, Targowski T, Cipriani MC, Lo Monaco MR, Giovannini S, Acampora N, Villani ER, Bernabei R, Onder G. Association between frailty and ischemic heart disease: a systematic review and meta-analysis. BMC Geriatr 2021; 21:357. [PMID: 34112104 PMCID: PMC8193864 DOI: 10.1186/s12877-021-02304-9] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 05/26/2021] [Indexed: 02/07/2023] Open
Abstract
Background Frailty is increasingly reported among older adults with cardiovascular diseases and it has been demonstrated to increase negative health outcomes and mortality. To date, no systematic review of the evidence is available regarding the association between frailty and ischemic heart disease (IHD). We performed a systematic review of literature and a meta-analysis to assess the association between frailty and IHD. Methods We selected all the studies that provided information on the association between frailty and IHD, regardless of the study setting, study design, or definition of IHD and frailty. PubMed, Web of Science and Embase were searched for relevant papers. Studies that adopted the Fried definition for frailty were included in the meta-analyses. For each measure of interest (proportions and estimates of associations), a meta-analysis was performed if at least three studies used the same definition of frailty. Pooled estimates were obtained through random effect models and Mantel-Haenszel weighting. Results Thirty-seven studies were included. Of these, 22 adopted the Fried criteria to define frailty and provided estimates of prevalence and therefore they were included in meta-analyses. The pooled prevalence of IHD in frail individuals was 17% (95% Confidence Interval [95%CI] 11–23%) and the pooled prevalence of frailty in individuals with IHD was 19% (95% CI 15–24%). The prevalence of frailty among IHD patients ranged from 4 to 61%. Insufficient data were found to assess longitudinal association between frailty and IHD. Conclusions Frailty is quite common in older persons with IHD. The identification of frailty among older adults with IHD should be considered relevant to provide individualized strategies of cardiovascular prevention and care. Further research should specifically explore the association between frailty and IHD and investigate the potential common biological ground. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-021-02304-9.
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Affiliation(s)
- Rosa Liperoti
- Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo F. Vito 1, 00168, Rome, Italy.,Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Davide L Vetrano
- Aging Research Center, Department of Neurobiology, Health Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Katie Palmer
- Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo F. Vito 1, 00168, Rome, Italy
| | - Tomasz Targowski
- Department of Geriatrics, National Institute of Geriatrics, Rheumatology, and Rehabilitation, Warsaw, Poland
| | - Maria C Cipriani
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | | | | | - Nicola Acampora
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Emanuele Rocco Villani
- Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo F. Vito 1, 00168, Rome, Italy.
| | - Roberto Bernabei
- Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo F. Vito 1, 00168, Rome, Italy.,Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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Tkacheva ON, Kotovskaya YV, Runihina NK, Frolova EV, Milto AS, Aleksanyan LA, Tyukhmenev EA, Shedrina AY, Rozanov AV, Ostapenko VS, Sharashkina NV, Eruslanova KA, Esenbekova EE, Fedin MA. Comprehensive geriatric assessment in elderly and senile patients with cardiovascular diseases. Expert opinion of the Russian Association of Gerontologists and Geriatricians. KARDIOLOGIIA 2021; 61:71-78. [PMID: 34112078 DOI: 10.18087/cardio.2021.5.n1349] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 09/01/2020] [Indexed: 11/18/2022]
Abstract
Senile asthenia syndrome (SAS) is a geriatric syndrome characterized by age-associated decline of the physiological reserve and function in multiple systems, which results in higher vulnerability to effects of endo- and exogenous factors and a high risk of unfavorable outcomes, loss of self-sufficiency, and death. Generally, SAS is observed in elderly patients with comorbidities. In cardiovascular diseases, SAS is associated with a poor prognosis, including a higher incidence of exacerbation and death both during acute events and in chronic disease. However, SAS is often not taken into account in developing diagnostic and therapeutic programs for managing elderly patients with cardiovascular diseases (CVD). This article analyzes available scientific information about SAS, algorithms for SAS diagnosis, and the scales that may be useful in developing individual plans for management of elderly patients with CVD.
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Affiliation(s)
- O N Tkacheva
- Pirogov Russian National Research Medical University, Russian Gerintology Research and Clinical Centre, Moscow, Russia
| | - Yu V Kotovskaya
- Pirogov Russian National Research Medical University, Russian Gerintology Research and Clinical Centre, Moscow, Russia
| | - N K Runihina
- Pirogov Russian National Research Medical University, Russian Gerintology Research and Clinical Centre, Moscow, Russia
| | - E V Frolova
- North-Western State Medical University named after I.I. Mechnikov
| | - A S Milto
- Moscow Regional Research and Clinical Institute (MONIKI) named after M.F. Vladimirskogo
| | - L A Aleksanyan
- Pirogov Russian National Research Medical University, Russian Gerintology Research and Clinical Centre, Moscow, Russia
| | - E A Tyukhmenev
- Moscow Regional Research and Clinical Institute (MONIKI) named after M.F. Vladimirskogo
| | - A Yu Shedrina
- Pirogov Russian National Research Medical University, Russian Gerintology Research and Clinical Centre, Moscow, Russia
| | - A V Rozanov
- Pirogov Russian National Research Medical University, Russian Gerintology Research and Clinical Centre, Moscow, Russia
| | - V S Ostapenko
- Pirogov Russian National Research Medical University, Russian Gerintology Research and Clinical Centre, Moscow, Russia
| | - N V Sharashkina
- Pirogov Russian National Research Medical University, Russian Gerintology Research and Clinical Centre, Moscow, Russia
| | - K A Eruslanova
- Pirogov Russian National Research Medical University, Russian Gerintology Research and Clinical Centre, Moscow, Russia
| | - E E Esenbekova
- Pirogov Russian National Research Medical University, Russian Gerintology Research and Clinical Centre, Moscow, Russia
| | - M A Fedin
- Pirogov Russian National Research Medical University, Russian Gerintology Research and Clinical Centre, Moscow, Russia
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27
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Mudge AM, Pelecanos A, Adsett JA. Frailty implications for exercise participation and outcomes in patients with heart failure. J Am Geriatr Soc 2021; 69:2476-2485. [PMID: 33826158 DOI: 10.1111/jgs.17145] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 03/09/2021] [Accepted: 03/09/2021] [Indexed: 01/01/2023]
Abstract
BACKGROUND/OBJECTIVES Frailty is common in people with heart failure (HF) and associated with poorer outcomes. The aim of this study was to describe the characteristics, exercise participation, and outcomes of frail and not-frail participants enrolled in a randomized trial of exercise training (ET) within a cardiac rehabilitation (CR) program. DESIGN Secondary analysis of EJECTION-HF randomized trial (ACTRN12608000263392). SETTING Five HF-specific CR programs in Queensland, Australia. PARTICIPANTS Adults recently hospitalized with HF. INTERVENTION All participated in CR including home exercise prescription and monitoring; half were randomized to center-based ET. MEASUREMENTS A frailty index (FI) was constructed at randomization and 6-month follow-up. Outcomes included ET attendance, change in 6-min walk distance (6MWD), improved FI (>0.09 units) at 6 months, achieving physical activity (PA) guidelines at 6 months, and 12 month all-cause death or readmission. RESULTS The FI was measured in 256 participants at randomization: 110 (43%) were not-frail (FI 0.2 or less), 119 (46%) were frail (FI >0.2 to 0.39), and 27 (11%) were very frail (FI ≥0.4). Frailty was more common with older age, female gender, decompensated HF, worse HF symptoms, and preserved ejection fraction. ET attendance did not differ by frailty group. Participants who were more frail had lower 6WMD at enrollment, but similar improvement over 6 months. Mean FI improved by 0.03 units at 6 months (95% CI 0.02-0.04, p < 0.001). Participants who were more frail had significantly greater improvements in FI compared with not-frail participants and were often able to achieve PA guidelines, both in intervention and control groups. Neither baseline frailty nor intervention was significantly associated with 12-month death or readmission. CONCLUSION Frail people with HF participating in CR that includes home and/or center-based ET often achieve PA guidelines, and some may have meaningful reductions in frailty.
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Affiliation(s)
- Alison M Mudge
- Department of Internal Medicine and Aged Care, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.,University of Queensland Faculty of Medicine, Brisbane, Queensland, Australia
| | - Anita Pelecanos
- Statistics Unit, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Julie A Adsett
- Physiotherapy Department, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
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28
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Beltrami M, Fumagalli C, Milli M. Frailty, sarcopenia and cachexia in heart failure patients: Different clinical entities of the same painting. World J Cardiol 2021; 13:1-10. [PMID: 33552398 PMCID: PMC7821009 DOI: 10.4330/wjc.v13.i1.1] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 11/25/2020] [Accepted: 12/28/2020] [Indexed: 02/06/2023] Open
Abstract
Heart Failure (HF) in elderly patients is a systemic syndrome where advanced age, comorbidities with organ system deterioration, frailty and impaired cognition significantly impact outcome. Cardiac cachexia, sarcopenia and frailty despite overlap in definitions are different clinical entities that frequently coexist in HF patients. However, these co-factors often remain unaddressed, resulting in poor quality-of-life, prolonged physical disability and exercise intolerance and finally with higher rehospitalization rates and mortality. Strategy aim to increase muscle mass and muscle strength and delay the occurrence of frailty state appear essential in this regard. Common HF drugs therapy (b-blockers, angiotensin-converting enzyme inhibitors) and prescription of physical exercise program remain the cornerstone of therapeutic approach in HF patients with new promising data regarding nutritional supplementation. However, the treatment of all these conditions still remain debated and only a profound knowledge of the specific mechanisms and patterns of disease progression will allow to use the appropriate therapy in a given clinical setting. For all these reasons we briefly review current knowledge on frailty, sarcopenia and cachexia in HF patients with the attempt to define clinically significant degrees of multiorgan dysfunction, specific "red alert" thresholds in clinical practice and therapeutic approach.
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Affiliation(s)
- Matteo Beltrami
- Cardiology Unit, San Giovanni di Dio Hospital, Florence 50142, Italy
| | - Carlo Fumagalli
- Cardiomyopathy Unit, Careggi University Hospital, Florence 50139, Italy
| | - Massimo Milli
- Cardiology Unit, San Giovanni di Dio Hospital, Florence 50142, Italy
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Lima MA, Duque AP, Rodrigues Junior LF, Lima VCS, Trotte LAC, Guimaraes TCF. Health literacy and quality of life in hospitalized heart failure patients: a cross-sectional study. AMERICAN JOURNAL OF CARDIOVASCULAR DISEASE 2020; 10:490-498. [PMID: 33224600 PMCID: PMC7675168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 10/10/2020] [Indexed: 06/11/2023]
Abstract
INTRODUCTION Heart Failure (HF) treatment may be improved by good knowledge of the disease (Health Literacy) that, despite the well-established role on improving self-care, preventing complications and avoiding worse outcomes, has little evidence on affecting QoL of HF patients. Therefore, the objective of the present study was to evaluate the impact of Health Literacy on QoL in hospitalized HF patients. METHODOLOGY A cross-sectional exploratory study was conducted with HF patients hospitalized at a public cardiological hospital. Health Literacy was assessed using the "Questionnaire about Heart Failure Patients' Knowledge of Disease" and QoL using the "Minnesota Living with Heart Failure Questionnaire" (MLHFQ). The association between Health Literacy and QoL was assessed by linear regression (P<0.05). RESULTS 50 patients were included in the study; the mean Health Literacy score was 34.2 ± 15.1 (the majority presenting acceptable or better knowledge). The mean MLHFQ score was 73.5 ± 19.8. The one-year hospital readmission rate (β=+3.8; P=0.009) and the patients' Health Literacy score (β=-0.4; P=0.024) or good knowledge category (β=-20.2; P=0.016) were independently associated with QoL. CONCLUSION While the readmission rate was inversely associated with QoL, the better the HF knowledge the better QoL in hospitalized HF patients.
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Affiliation(s)
- Marcone A Lima
- Education and Research Department, National Institute of CardiologyRio de Janeiro-RJ, Brazil
| | - Alice P Duque
- Education and Research Department, National Institute of CardiologyRio de Janeiro-RJ, Brazil
| | - Luiz F Rodrigues Junior
- Education and Research Department, National Institute of CardiologyRio de Janeiro-RJ, Brazil
- Department of Physiological Sciences, Federal University of The State of Rio de JaneiroRio de Janeiro-RJ, Brazil
| | - Viviani CS Lima
- Education and Research Department, National Institute of CardiologyRio de Janeiro-RJ, Brazil
| | - Liana AC Trotte
- Department of Nursing Methodology, Federal University of Rio de JaneiroRio de Janeiro-RJ, Brazil
| | - Tereza CF Guimaraes
- Education and Research Department, National Institute of CardiologyRio de Janeiro-RJ, Brazil
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30
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Segev A, Itelman E, Avaky C, Negru L, Shenhav-Saltzman G, Grupper A, Wasserstrum Y, Segal G. Low ALT Levels Associated with Poor Outcomes in 8700 Hospitalized Heart Failure Patients. J Clin Med 2020; 9:E3185. [PMID: 33008125 PMCID: PMC7600048 DOI: 10.3390/jcm9103185] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 09/23/2020] [Accepted: 09/28/2020] [Indexed: 12/12/2022] Open
Abstract
Sarcopenia and frailty are causes for morbidity and mortality amongst heart failure (HF) patients. Low alanine transaminase (ALT) is a marker for these syndromes and, therefore, could serve as a biomarker for the prognostication of HF patients. We performed a retrospective analysis of all consecutive hospitalized HF patients in our institute in order to find out whether low ALT values would be a biomarker for poor outcomes. Our cohort included 11,102 patients, 35.6% categorized as heart failure with reduced ejection fraction. We excluded patients with ALT > 40 IU/L and cirrhosis. 8700 patients were followed for a median duration of 22 months and included in a univariate analysis. Patients with ALT < 10 IU/L were older (mean age 78.6 vs. 81.8, p < 0.001), had past stroke (24.6% vs. 19.6%, p < 0.001), dementia (7.7% vs. 4.6%, p < 0.001), and malignancy (13.4% vs. 10.2%, p = 0.003). Hospitalization length was longer in the low-ALT group (4 vs. 3 days, p < 0.001), and the rate of acute kidney injury during hospitalization was higher (19.1% vs. 15.6%; p = 0.006). The in-hospital mortality rate was higher in the low-ALT group (6.5% vs. 3.9%; p < 0.001). Long-term mortality was also higher (73.3% vs. 61.5%; p < 0.001). In a multivariate regression analysis, ALT < 10 IU/L had a 1.22 hazard ratio for mortality throughout the follow-up period (CI = 1.09-1.36; p < 0.001). Low ALT plasma level, a biomarker for sarcopenia and frailty, can assist clinicians in prognostic stratification of heart failure patients.
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Affiliation(s)
- Amitai Segev
- Internal Medicine “T”, Chaim Sheba Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Ramat-Gan 5266202, Israel; (A.S.); (E.I.); (C.A.); (L.N.); (G.S.-S.); (Y.W.)
| | - Edward Itelman
- Internal Medicine “T”, Chaim Sheba Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Ramat-Gan 5266202, Israel; (A.S.); (E.I.); (C.A.); (L.N.); (G.S.-S.); (Y.W.)
| | - Chen Avaky
- Internal Medicine “T”, Chaim Sheba Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Ramat-Gan 5266202, Israel; (A.S.); (E.I.); (C.A.); (L.N.); (G.S.-S.); (Y.W.)
| | - Liat Negru
- Internal Medicine “T”, Chaim Sheba Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Ramat-Gan 5266202, Israel; (A.S.); (E.I.); (C.A.); (L.N.); (G.S.-S.); (Y.W.)
| | - Gilat Shenhav-Saltzman
- Internal Medicine “T”, Chaim Sheba Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Ramat-Gan 5266202, Israel; (A.S.); (E.I.); (C.A.); (L.N.); (G.S.-S.); (Y.W.)
| | - Avishay Grupper
- Cardiovascular Division, Chaim Sheba Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Ramat-Gan 5266202, Israel;
| | - Yishay Wasserstrum
- Internal Medicine “T”, Chaim Sheba Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Ramat-Gan 5266202, Israel; (A.S.); (E.I.); (C.A.); (L.N.); (G.S.-S.); (Y.W.)
| | - Gad Segal
- Internal Medicine “T”, Chaim Sheba Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Ramat-Gan 5266202, Israel; (A.S.); (E.I.); (C.A.); (L.N.); (G.S.-S.); (Y.W.)
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Giuliano C, Levinger I, Vogrin S, Neil CJ, Allen JD. PRIME-HF: Novel Exercise for Older Patients with Heart Failure. A Pilot Randomized Controlled Study. J Am Geriatr Soc 2020; 68:1954-1961. [PMID: 32293033 PMCID: PMC7540058 DOI: 10.1111/jgs.16428] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 02/25/2020] [Accepted: 03/04/2020] [Indexed: 12/28/2022]
Abstract
OBJECTIVES To test the hypothesis that (1) older patients with heart failure (HF) can tolerate COMBined moderate-intensity aerobic and resistance training (COMBO), and (2) 4 weeks of Peripheral Remodeling through Intermittent Muscular Exercise (PRIME) before 4 weeks of COMBO will improve aerobic capacity and muscle strength to a greater extent than 8 weeks of COMBO. DESIGN Prospective randomized parallel open-label blinded end point. SETTING Single-site Australian metropolitan hospital. PARTICIPANTS Nineteen adults (72.8 ± 8.4 years of age) with heart failure with reduced ejection fraction (HFrEF). INTERVENTION Participants were randomized to 4 weeks of PRIME or COMBO (phase 1). All participants subsequently completed 4 weeks of COMBO (phase 2). Sessions were twice a week for 60 minutes. PRIME is a low-mass, high-repetition regime (40% one-repetition maximum [1RM], eight strength exercises, 5 minutes each). COMBO training involved combined aerobic (40%-60% of peak aerobic capacity [VO2peak ], up to 20 minutes) and resistance training (50-70% 1RM, eight exercises, two sets of 10 repetitions). MEASUREMENTS We measured VO2peak , VO2 at anaerobic threshold (AT), and muscle voluntary contraction (MVC). RESULTS The PRIME group significantly increased VO2peak after 8 weeks (2.4 mL/kg/min; 95% confidence interval [CI] = .7-4.1; P = .004), whereas the COMBO group showed minimal change (.2; 95% CI -1.5 to 1.8). This produced a large between-group effect size of 1.0. VO2 at AT increased in the PRIME group (1.6 mL/kg/min; 95% CI .0-3.2) but not in the COMBO group (-1.2; 95% CI -2.9 to .4), producing a large between-group effect size. Total MVC increased significantly in both groups in comparison with baseline; however, the change was larger in the COMBO group (effect size = .6). CONCLUSION Traditional exercise approaches (COMBO) and PRIME improved strength. Only PRIME training produced statistically and clinically significant improvements to aerobic capacity. Taken together, these findings support the hypothesis that PRIME may have potential advantages for older patients with HFrEF and could be a possible alternative exercise modality.
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Affiliation(s)
- Catherine Giuliano
- Institute for Health and Sport (IHES)Victoria UniversityMelbourneAustralia
- Department of CardiologyWestern Health, Sunshine HospitalMelbourneAustralia
| | - Itamar Levinger
- Institute for Health and Sport (IHES)Victoria UniversityMelbourneAustralia
- Department of CardiologyWestern Health, Sunshine HospitalMelbourneAustralia
- Australian Institute for Musculoskeletal Science (AIMSS)MelbourneAustralia
| | - Sara Vogrin
- Australian Institute for Musculoskeletal Science (AIMSS)MelbourneAustralia
- Department of Medicine – Western HealthThe University of MelbourneAustralia
| | - Christopher James Neil
- Institute for Health and Sport (IHES)Victoria UniversityMelbourneAustralia
- Department of CardiologyWestern Health, Sunshine HospitalMelbourneAustralia
- Department of Medicine – Western HealthThe University of MelbourneAustralia
| | - Jason David Allen
- Department of Kinesiology, Curry School of Education & Division of Cardiovascular MedicineUniversity of VirginiaCharlottesvilleVirginiaUSA
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Abstract
PURPOSE OF REVIEW Malnutrition, sarcopenia, and cachexia are areas of increasing interest in the management of patients with heart failure (HF). This review aims to examine the serological markers useful in guiding the physician in identification of these patients. RECENT FINDINGS Traditional nutritional biomarkers including albumin/prealbumin, iron, and vitamin D deficiencies predict poor prognosis in malnutrition and HF. Novel biomarkers including ghrelin, myostatin, C-terminal agrin fragment, and adiponectin have been identified as possible substrates and/or therapeutic targets in cardiac patients with sarcopenia and cachexia, though clinical trial data is limited to date. Increased focus on nutritional deficiency syndromes in heart failure has led to the use of established markers of malnutrition as well as the identification of novel biomarkers in the management of these patients, though to date, their usage has been confined to the academic domain and further research is required to establish their role in the clinical setting.
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Homar V, Mirosevic S, Svab I, Lainscak M. Natriuretic peptides for heart failure screening in nursing homes: a systematic review. Heart Fail Rev 2020; 26:1131-1140. [PMID: 32200491 DOI: 10.1007/s10741-020-09944-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The high burden of heart failure in nursing-home populations is due to advanced age and comorbidities. Heart failure is often undiagnosed or misdiagnosed in this population and therefore remains untreated. We review the use of natriuretic peptide biomarkers for screening heart failure in nursing-home residents. The study was performed in accordance with recommendations from the Cochrane Collaboration using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement (PRISMA) and is registered in PROSPERO Register of Systematic Reviews. Databases PubMed, Embase, and Trip were searched from 2000 to March 2019, supplemented by hand-searching of references. Studies investigating the nursing-home population were included. The prevalence of heart failure among nursing-home residents was higher than in the general population of comparable age (23% vs 10%, respectively). The rate of misdiagnosis in nursing homes ranged from 25 to 76%. NT-proBNP was the most commonly used natriuretic peptide biomarker for heart failure screening. The mean value of NT-proBNP was significantly higher in residents with heart failure than in residents overall (pooled means of 2409 pg/mL vs 1074 pg/mL, respectively). In comparison with current guidelines, the proposed cut-off values for ruling out heart failure were higher in the analyzed studies, with ranges of 230-760 pg/mL for NT-proBNP and 50-115 pg/mL for BNP. NT-proBNP and BNP are used for screening heart failure in the nursing-home population. The current screening cut-off values are probably too low for use in nursing homes. Our most conservative estimation for ruling out heart failure is an NT-proBNP cut-off value of 230 pg/mL.
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Affiliation(s)
- Vesna Homar
- Department of Family Medicine, Faculty of Medicine, University of Ljubljana, 56 Poljanski nasip, 1000, Ljubljana, Slovenia. .,Community Health Centre Vrhnika, Vrhnika, Slovenia.
| | - Spela Mirosevic
- Department of Family Medicine, Faculty of Medicine, University of Ljubljana, 56 Poljanski nasip, 1000, Ljubljana, Slovenia
| | - Igor Svab
- Department of Family Medicine, Faculty of Medicine, University of Ljubljana, 56 Poljanski nasip, 1000, Ljubljana, Slovenia
| | - Mitja Lainscak
- Department of Family Medicine, Faculty of Medicine, University of Ljubljana, 56 Poljanski nasip, 1000, Ljubljana, Slovenia.,Division of Cardiology, General Hospital Murska Sobota, Murska Sobota, Slovenia
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Buttery AK. Cardiac Rehabilitation for Frail Older People. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2020; 1216:131-147. [DOI: 10.1007/978-3-030-33330-0_13] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Kańtoch A, Gryglewska B, Wójkowska-Mach J, Heczko P, Grodzicki T. Treatment of Cardiovascular Diseases Among Elderly Residents of Long-term Care Facilities. J Am Med Dir Assoc 2019; 19:428-432. [PMID: 29402648 DOI: 10.1016/j.jamda.2017.12.102] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Accepted: 12/29/2017] [Indexed: 01/02/2023]
Abstract
BACKGROUND The prevalence of cardiovascular diseases among nursing home residents is high but little is known whether pharmacologic therapy recommended by actual medication guidelines is followed by facility's staff. AIM To evaluate the adherence to actual guidelines for treatment of cardiovascular diseases among older adult residents of long-term care (LTC) facilities. MATERIAL AND METHODS The cross-sectional study was performed from December 2009 to November 2010 among 189 elderly residents aged ≥60 years in 3 LTC facilities in Poland: 1 long-term care hospital (LTCH) and 2 nursing homes (NHs). The initial evaluation included analysis of medical documentation (all diagnosed diseases and used drugs), blood pressure (BP) measurements and performance of Mini Nutritional Assessment Short-Form (MNA-SF), Abbreviated Mental Test Score (AMTS), Activities of Daily Living (ADL) score, and Barthel Index. Prescribed medication for hypertension (HT), heart failure (HF), and coronary heart disease (CHD) were compared to current European Cardiology Society (ESC), and European Society of Hypertension (ESH) medication guidelines. Residents were divided into 3 subgroups: with HT, HF, and CHD. Results were presented as means and standard deviation. Groups were compared using Mann-Whitney U test for nonparametric data and chi-square test to assess differences in distribution of categorical variables. P values <.05 were considered statistically significant. RESULTS CHD was diagnosed among 114 residents (60.3%) but only 60.5% of them were treated with aspirin (ASA), 45.6% with beta-blockers (BBs), 60.5% with angiotensin-converting enzyme inhibitor (ACEI), and 24.6% with statins. HF observed in 75% of cases was treated by using ACEI (54.7%), BBs (45.3%), loop diuretics (LDs, 36%), mineralocorticoid-receptor antagonists (MRAs, 21.3%). HT was diagnosed among 98 study participants (51.9%) and in the majority of cases (76.6%) was well controlled (mean BP: 133.7 ± 17.6/73.8 ± 10.2 mmHg). The most popular antihypertensive drugs were ACEIs (77.6%), BBs (40.8%) and calcium channel blockers (CCBs, 26.5%) whereas thiazides, alpha-blockers (ABs), and angiotensin receptor blockers (ARBs) were used less frequently. CONCLUSION In summary, the study showed that insufficient treatment of cardiovascular diseases among elderly residents of LTC facilities could be a potential risk factor of poor prognosis.
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Affiliation(s)
- Anna Kańtoch
- Department of Internal Medicine and Gerontology, Faculty of Medicine, Jagiellonian University Medical College, University Hospital in Kraków, Kraków, Poland.
| | - Barbara Gryglewska
- Department of Internal Medicine and Gerontology, Faculty of Medicine, Jagiellonian University Medical College, University Hospital in Kraków, Kraków, Poland
| | - Jadwiga Wójkowska-Mach
- Department of Microbiology, Faculty of Medicine, Jagiellonian University Medical College, Kraków, Poland
| | - Piotr Heczko
- Department of Microbiology, Faculty of Medicine, Jagiellonian University Medical College, Kraków, Poland
| | - Tomasz Grodzicki
- Department of Internal Medicine and Gerontology, Faculty of Medicine, Jagiellonian University Medical College, University Hospital in Kraków, Kraków, Poland
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36
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Yang X, Lupón J, Vidán MT, Ferguson C, Gastelurrutia P, Newton PJ, Macdonald PS, Bueno H, Bayés-Genís A, Woo J, Fung E. Impact of Frailty on Mortality and Hospitalization in Chronic Heart Failure: A Systematic Review and Meta-Analysis. J Am Heart Assoc 2019; 7:e008251. [PMID: 30571603 PMCID: PMC6405567 DOI: 10.1161/jaha.117.008251] [Citation(s) in RCA: 139] [Impact Index Per Article: 23.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background Although frailty has been associated with increased risks for hospitalization and mortality in chronic heart failure, the precise average effect remains uncertain. We performed a systematic review and meta‐analysis to summarize the hazards for mortality and incident hospitalization in patients with heart failure and frailty compared with those without frailty and explored the heterogeneity underlying the effect size estimates. Methods and Results MEDLINE, EMBASE, and Cochrane databases were queried for articles published between January 1966 and March 2018. Predefined selection criteria were used. Hazard ratios (HRs) were pooled for meta‐analyses, and where odds ratios were used previously, original data were recalculated for HR. Overlapping data were consolidated, and only unique data points were used. Study quality and bias were assessed. Eight studies were included for mortality (2645 patients), and 6 studies were included for incident hospitalization (2541 patients) during a median follow‐up of 1.82 and 1.12 years, respectively. Frailty was significantly associated with an increased hazard for mortality (HR, 1.54; 95% confidence interval, 1.34–1.75; P<0.001) and incident hospitalization (HR, 1.56; 95% confidence interval, 1.36–1.78; P<0.001) in chronic heart failure. The Fried phenotype estimated a 16.9% larger effect size than the combined Fried/non‐Fried frailty assessment for the end point of mortality (HR, 1.80; 95% confidence interval, 1.41–2.28; P<0.001), but not for hospitalization (HR, 1.57; 95% confidence interval, 1.30–1.89; P<0.001). Study heterogeneity was found to be low (I2=0%), and high quality of studies was verified by the Newcastle‐Ottawa scale. Conclusions Overall, the presence of frailty in chronic heart failure is associated with an increased hazard for death and hospitalization by ≈1.5‐fold.
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Affiliation(s)
- Xiaobo Yang
- 1 Department of Medicine and Therapeutics Faculty of Medicine The Chinese University of Hong Kong Hong Kong, SAR.,2 Laboratory for Heart Failure and Circulation Research Li Ka Shing Institute of Health Sciences Prince of Wales Hospital Hong Kong, SAR
| | - Josep Lupón
- 3 Cardiology Department Hospital Universitari Germans Trias i Pujol Badalona Spain.,4 Department of Medicine Universitat Autonòma de Barcelona Spain.,5 CIBERCV Instituto de Salud Carlos III Madrid Spain
| | - Maria T Vidán
- 6 Department of Geriatrics Instituto de Investigación IiSGM and CIBERFES Hospital General Universitario Gregorio Marañón Madrid Spain.,7 Universidad Complutense de Madrid Spain
| | - Caleb Ferguson
- 8 Western Sydney Nursing and Midwifery Research Centre Western Sydney University and Western Sydney Local Health District Sydney Australia
| | - Paloma Gastelurrutia
- 5 CIBERCV Instituto de Salud Carlos III Madrid Spain.,9 Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol Badalona Spain
| | - Phillip J Newton
- 8 Western Sydney Nursing and Midwifery Research Centre Western Sydney University and Western Sydney Local Health District Sydney Australia
| | - Peter S Macdonald
- 10 Heart and Lung Transplant Unit St Vincent's Hospital University of New South Wales Sydney Australia.,11 Transplantation Research Laboratory Victor Chang Cardiac Research Institute Sydney Australia
| | - Héctor Bueno
- 7 Universidad Complutense de Madrid Spain.,12 Centro Nacional de Investigaciones Cardiovasculares Madrid Spain.,13 Instituto de Investigación i+12 and Cardiology Department Hospital Universitario 12 de Octubre Madrid Spain
| | - Antoni Bayés-Genís
- 3 Cardiology Department Hospital Universitari Germans Trias i Pujol Badalona Spain.,4 Department of Medicine Universitat Autonòma de Barcelona Spain.,5 CIBERCV Instituto de Salud Carlos III Madrid Spain
| | - Jean Woo
- 1 Department of Medicine and Therapeutics Faculty of Medicine The Chinese University of Hong Kong Hong Kong, SAR.,14 CUHK Jockey Club Institute of Ageing The Chinese University of Hong Kong Hong Kong, SAR
| | - Erik Fung
- 1 Department of Medicine and Therapeutics Faculty of Medicine The Chinese University of Hong Kong Hong Kong, SAR.,2 Laboratory for Heart Failure and Circulation Research Li Ka Shing Institute of Health Sciences Prince of Wales Hospital Hong Kong, SAR.,15 School of Public Health Imperial College London London United Kingdom.,16 CARE Programme Lui Che Woo Institute of Innovative Medicine Faculty of Medicine The Chinese University of Hong Kong Hong Kong, SAR.,17 Gerald Choa Cardiac Research Centre Faculty of Medicine The Chinese University of Hong Kong Hong Kong, SAR
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37
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Hollenberg SM, Warner Stevenson L, Ahmad T, Amin VJ, Bozkurt B, Butler J, Davis LL, Drazner MH, Kirkpatrick JN, Peterson PN, Reed BN, Roy CL, Storrow AB. 2019 ACC Expert Consensus Decision Pathway on Risk Assessment, Management, and Clinical Trajectory of Patients Hospitalized With Heart Failure: A Report of the American College of Cardiology Solution Set Oversight Committee. J Am Coll Cardiol 2019; 74:1966-2011. [PMID: 31526538 DOI: 10.1016/j.jacc.2019.08.001] [Citation(s) in RCA: 228] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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38
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Vidán MT, Martín Sánchez F, Sánchez E, Ortiz F, Serra‐Rexach JA, Martínez‐Sellés M, Bueno H. Most elderly patients hospitalized for heart failure lack the abilities needed to perform the tasks required for self‐care: impact on outcomes. Eur J Heart Fail 2019; 21:1434-1442. [DOI: 10.1002/ejhf.1559] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 06/23/2019] [Accepted: 06/24/2019] [Indexed: 12/12/2022] Open
Affiliation(s)
- María T. Vidán
- Department of Geriatric MedicineHospital General Universitario Gregorio Marañón Madrid Spain
- Facultad de Medicina, Universidad Complutense de Madrid Madrid Spain
- Instituto de Investigación IiSGM Madrid Spain
- CIBER Fragilidad y Envejecimiento Saludable Madrid Spain
| | - Francisco‐Javier Martín Sánchez
- Facultad de Medicina, Universidad Complutense de Madrid Madrid Spain
- Emergency DepartmentHospital Clinico San Carlos Madrid Spain
- Instituto de Investigación Sanitaria, Hospital Clínico San Carlos (IdISSC) Madrid Spain
| | - Elísabet Sánchez
- Department of Geriatric MedicineHospital Universitario Ramón y Cajal Madrid Spain
| | - Francisco‐Javier Ortiz
- Department of Geriatric MedicineHospital General Universitario Gregorio Marañón Madrid Spain
- Instituto de Investigación IiSGM Madrid Spain
- CIBER Fragilidad y Envejecimiento Saludable Madrid Spain
| | - José A. Serra‐Rexach
- Department of Geriatric MedicineHospital General Universitario Gregorio Marañón Madrid Spain
- Facultad de Medicina, Universidad Complutense de Madrid Madrid Spain
- Instituto de Investigación IiSGM Madrid Spain
- CIBER Fragilidad y Envejecimiento Saludable Madrid Spain
| | - Manuel Martínez‐Sellés
- Facultad de Medicina, Universidad Complutense de Madrid Madrid Spain
- Department of CardiologyHospital General Universitario Gregorio Marañón Madrid Spain
- CIBER Cardiovascular (CIBERCV) Madrid Spain
- Facultad de Medicina, Universidad Europea Madrid Spain
| | - Héctor Bueno
- Facultad de Medicina, Universidad Complutense de Madrid Madrid Spain
- CIBER Cardiovascular (CIBERCV) Madrid Spain
- MTCR Group, Centro Nacional de Investigaciones Cardiovasculares (CNIC) Madrid Spain
- Cardiovascular Research Area, Instituto de Investigación i+12 Madrid Spain
- Cardiology DepartmentHospital Universitario 12 de Octubre Madrid Spain
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Hickman L, Ferguson C, Davidson PM, Allida S, Inglis S, Parker D, Agar M. Key elements of interventions for heart failure patients with mild cognitive impairment or dementia: A systematic review. Eur J Cardiovasc Nurs 2019; 19:8-19. [PMID: 31347402 DOI: 10.1177/1474515119865755] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND The purpose of this systematic review was to (a) examine the effects of interventions delivered by a heart failure professional for mild cognitive impairment and dementia on cognitive function, memory, working memory, instrumental activities of daily living, heart failure knowledge, self-care, quality of life and depression; and (b) identify the successful elements of these strategies for heart failure patients with mild cognitive impairment or dementia. METHODS AND RESULTS During March 2018, an electronic search of databases including CINAHL, MEDLINE, EMBASE and PsycINFO was conducted. All randomised controlled trials, which examined an intervention strategy to help heart failure patients with mild cognitive impairment or dementia cope with self-care, were included. An initial search yielded 1622 citations, six studies were included (N= 595 participants, mean age 68 years). There were no significant improvements in cognitive function and depression. However, significant improvements were seen in memory (p=0.015), working memory (p=0.029) and instrumental activities of daily living (p=0.006). Nurse led interventions improved the patient's heart failure knowledge (p=0.001), self-care (p<0.05) and quality of life (p=0.029). Key elements of these interventions include brain exercises, for example, syllable stacks, individualised assessment and customised education, personalised self-care schedule development, interactive problem-solving training on scenarios and association techniques to prompt self-care activities. CONCLUSIONS Modest evidence for nurse led interventions among heart failure patients with mild cognitive impairment or dementia was identified. These results must be interpreted with caution in light of the limited number of available included studies.
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Affiliation(s)
| | - Caleb Ferguson
- Western Sydney University, Australia.,Western Sydney Local Health District
| | | | | | | | | | - Meera Agar
- University of Technology Sydney, Australia
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40
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Uchmanowicz I, Nessler J, Gobbens R, Gackowski A, Kurpas D, Straburzynska-Migaj E, Kałuzna-Oleksy M, Jankowska EA. Coexisting Frailty With Heart Failure. Front Physiol 2019; 10:791. [PMID: 31333480 PMCID: PMC6616269 DOI: 10.3389/fphys.2019.00791] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Accepted: 06/04/2019] [Indexed: 12/25/2022] Open
Abstract
People over 65 years of age constitute over 80% of patients with heart failure (HF) and the incidence of HF is 10 per 1,000 in people aged above 65 years. Approximately 25% of older patients with HF exhibit evidence of frailty. Frail patients with cardiovascular disease (CVD) have a worse prognosis than non-frail patients, and frailty is an independent risk factor for incident HF among older people. Planning the treatment of individuals with HF and concomitant frailty, one should consider not only the limitations imposed by frailty syndrome (FS) but also those associated with the underlying heart disease. It needs to be emphasized that all patients with HF and concomitant FS require individualized treatment.
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Affiliation(s)
- Izabella Uchmanowicz
- Department of Clinical Nursing, Faculty of Health Sciences, Wroclaw Medical University, Wroclaw, Poland
| | - Jadwiga Nessler
- Department of Coronary Heart Disease, Institute of Cardiology, Jagiellonian University Medical College, The John Paul II Hospital, Krakow, Poland
| | - Robbert Gobbens
- Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, Amsterdam, Netherlands.,Zonnehuisgroep Amstelland, Amstelveen, Netherlands.,Department of Primary and Interdisciplinary Care, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Andrzej Gackowski
- Department of Coronary Heart Disease, Institute of Cardiology, Jagiellonian University Medical College, The John Paul II Hospital, Krakow, Poland
| | - Donata Kurpas
- Department of Family Medicine, Faculty of Postgraduate Medical Training, Wroclaw Medical University, Wroclaw, Poland
| | - Ewa Straburzynska-Migaj
- Department of Cardiology, Faculty of Medicine, Poznan University of Medical Science, Poznan, Poland
| | - Marta Kałuzna-Oleksy
- Department of Coronary Heart Disease, Institute of Cardiology, Jagiellonian University Medical College, The John Paul II Hospital, Krakow, Poland
| | - Ewa A Jankowska
- Cardiology Department, Centre for Heart Diseases, 4th Military Clinical Hospital in Wrocław, Wrocław, Poland
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41
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Milinković I, Polovina M, Seferović PM. Age old problem: heart failure treatment in elderly. Eur J Prev Cardiol 2019; 26:1396-1398. [PMID: 31161936 DOI: 10.1177/2047487319853643] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Ivan Milinković
- 1 Department of Cardiology, Clinical Center of Serbia, Serbia.,2 Faculty of Medicine, University of Belgrade, Serbia
| | - Marija Polovina
- 1 Department of Cardiology, Clinical Center of Serbia, Serbia.,2 Faculty of Medicine, University of Belgrade, Serbia
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Uchmanowicz I, Młynarska A, Lisiak M, Kałużna-Oleksy M, Wleklik M, Chudiak A, Dudek M, Migaj J, Hinterbuchner L, Gobbens R. Heart Failure and Problems with Frailty Syndrome: Why it is Time to Care About Frailty Syndrome in Heart Failure. Card Fail Rev 2019; 5:37-43. [PMID: 30847244 PMCID: PMC6396065 DOI: 10.15420/cfr.2018.37.1] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Frailty syndrome (FS) is an independent predictor of mortality in cardiovascular disease and is found in 15–74% of patients with heart failure (HF). The syndrome has a complex, multidimensional aetiology and contributes to adverse outcomes. Proper FS diagnosis and treatment determine prognosis and support the evaluation of treatment outcomes. Routine FS assessment for HF patients should be included in daily clinical practice as an important prognostic factor within a holistic process of diagnosis and treatment. Multidisciplinary team members, particularly nurses, play an important role in FS assessment in hospital and primary care settings, and in the home care environment. Raising awareness of concurrent FS in patients with HF patients and promoting targeted interventions may contribute to a decreased risk of adverse events, and a better prognosis and quality of life.
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Affiliation(s)
- Izabella Uchmanowicz
- Department of Clinical Nursing, Faculty of Health Science, Wroclaw Medical University Poland
| | - Agnieszka Młynarska
- Department of Gerontology and Geriatric Nursing, School of Health Sciences, Medical University of Silesia Poland
| | - Magdalena Lisiak
- Department of Clinical Nursing, Faculty of Health Science, Wroclaw Medical University Poland
| | | | - Marta Wleklik
- Department of Clinical Nursing, Faculty of Health Science, Wroclaw Medical University Poland
| | - Anna Chudiak
- Department of Clinical Nursing, Faculty of Health Science, Wroclaw Medical University Poland
| | - Magdalena Dudek
- Department of Cardiology, Poznan University of Medical Sciences Poland
| | - Jacek Migaj
- Department of Cardiology, Poznan University of Medical Sciences Poland
| | - Lynne Hinterbuchner
- Department for Internal Medicine and Cardiology, Salzburg University Hospital Austria
| | - Robbert Gobbens
- Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences Amsterdam, the Netherlands.,Zonnehuisgroep Amstelland, Amstelveen the Netherlands.,Department of Primary and Interdisciplinary Care, Faculty of Medicine and Health Sciences, University of Antwerp Antwerp, Belgium
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43
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Díez-Villanueva P, Arizá-Solé A, Vidán MT, Bonanad C, Formiga F, Sanchis J, Martín-Sánchez FJ, Ruiz Ros V, Sanmartín Fernández M, Bueno H, Martínez-Sellés M. Recomendaciones de la Sección de Cardiología Geriátrica de la Sociedad Española de Cardiología para la valoración de la fragilidad en el anciano con cardiopatía. Rev Esp Cardiol 2019. [DOI: 10.1016/j.recesp.2018.06.015] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Schmidt T, Bohné M, Schlüter M, Kitamura M, Wohlmuth P, Schewel D, Schewel J, Schmoeckel M, Kuck KH, Frerker C. The impact of biventricular heart failure on outcomes after transcatheter aortic valve implantation. Clin Res Cardiol 2018; 108:741-748. [PMID: 30506481 DOI: 10.1007/s00392-018-1400-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 11/29/2018] [Indexed: 11/24/2022]
Abstract
AIMS We sought to assess the impact of different manifestations of heart failure (HF) at baseline on the short- and long-term outcomes of transcatheter aortic valve implantation (TAVI) for aortic stenosis (AS). METHODS AND RESULTS Of 361 patients undergoing TAVI between May 2013 and April 2015, 185 (51%) showed clinical signs of HF at the time of admission. HF was diagnosed as isolated left ventricular (LV) and biventricular in 63 (34%) and 122 patients (66%), respectively. Acute device success (VARC-2) was achieved in 97% of patients without HF, in all patients with LV HF, and in 97% of patients with biventricular HF. Follow-up for a median of 427 days revealed significantly poorer survival in patients with biventricular HF (1-year estimate, 72.1% [95% confidence interval, 64.0-80.2%]) than in patients with LV HF (84.5% [75.2-93.8%]; p = 0.0203) or no HF (94.3% [90.7-97.9%]; p < 0.0001). Survival in the latter two patient subgroups was statistically not different. A diagnosis of biventricular HF was associated with a hazard ratio of 2.62 (p = 0.0089) vs. no HF in the likelihood of death; NT-proBNP and the logistic EuroSCORE were not significantly associated with survival. Half of all deaths in patients with biventricular HF occurred within 42 days of TAVI. CONCLUSION Biventricular HF is a strong predictor of mortality following TAVI for severe AS. AS in patients with LV HF should be treated without delay to avoid progression to biventricular HF. Patients with AS and biventricular HF should be monitored closely after TAVI to possibly prevent early death.
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Affiliation(s)
- Tobias Schmidt
- Department of Cardiology, Asklepios Klinik St. Georg, Lohmühlenstr. 5, 20099, Hamburg, Germany.
| | - Mintje Bohné
- Department of Cardiology, Asklepios Klinik St. Georg, Lohmühlenstr. 5, 20099, Hamburg, Germany
| | | | - Mitsunobu Kitamura
- Department of Cardiology, Asklepios Klinik St. Georg, Lohmühlenstr. 5, 20099, Hamburg, Germany
| | | | - Dimitry Schewel
- Department of Cardiology, Asklepios Klinik St. Georg, Lohmühlenstr. 5, 20099, Hamburg, Germany
| | - Jury Schewel
- Department of Cardiology, Asklepios Klinik St. Georg, Lohmühlenstr. 5, 20099, Hamburg, Germany
| | - Michael Schmoeckel
- Department of Cardiovascular Surgery, Asklepios Klinik St. Georg, Hamburg, Germany
| | - Karl-Heinz Kuck
- Department of Cardiology, Asklepios Klinik St. Georg, Lohmühlenstr. 5, 20099, Hamburg, Germany
| | - Christian Frerker
- Department of Cardiology, Asklepios Klinik St. Georg, Lohmühlenstr. 5, 20099, Hamburg, Germany
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Díez-Villanueva P, Arizá-Solé A, Vidán MT, Bonanad C, Formiga F, Sanchis J, Martín-Sánchez FJ, Ruiz Ros V, Sanmartín Fernández M, Bueno H, Martínez-Sellés M. Recommendations of the Geriatric Cardiology Section of the Spanish Society of Cardiology for the Assessment of Frailty in Elderly Patients With Heart Disease. ACTA ACUST UNITED AC 2018; 72:63-71. [PMID: 30269913 DOI: 10.1016/j.rec.2018.06.035] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 06/25/2018] [Indexed: 12/27/2022]
Abstract
Frailty is an age-associated clinical syndrome characterized by a decrease in physiological reserve in situations of stress, constituting a state of vulnerability that involves a higher risk of adverse events. Its prevalence in Spain is high, especially in elderly individuals with comorbidity and chronic diseases. In cardiovascular disease, frailty is associated worse clinical outcomes and higher morbidity and mortality in all scenarios, in both acute and chronic settings, and could consequently influence diagnosis and treatment. However, frailty is often not addressed or included when planning the management of elderly patients with heart disease. In this article, we review the available scientific evidence and highlight the most appropriate scales for the measurement and assessment of frailty, some of which are more useful and have better predictive capacity than others, depending on the clinical context. We also underline the importance of properly identifying and assessing frailty in order to include it in the treatment and care plan that best suits each patient.
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Affiliation(s)
| | - Albert Arizá-Solé
- Servicio de Cardiología, Área de Enfermedades del Corazón, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - María Teresa Vidán
- Servicio de Geriatría, Hospital General Universitario Gregorio Marañón (IiSGM), Universidad Complutense de Madrid, Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (CIBERFES), Madrid, Spain
| | - Clara Bonanad
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - Francesc Formiga
- Programa de Geriatría, Servicio de Medicina Interna, Instituto de Investigación Biomédica de Bellvitge (IDIBELL), Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Juan Sanchis
- Servei de Cardiologia, Hospital Clínic Universitari, INCLIVA, Universitat de València, Valencia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Valencia, Spain
| | - F Javier Martín-Sánchez
- Servicio de Urgencias, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria Hospital Clínico San Carlos (IdISSC), Universidad Complutense de Madrid, Madrid, Spain
| | - Vicente Ruiz Ros
- Servei de Cardiologia, Hospital Clínic Universitari, INCLIVA, Universitat de València, Valencia, Spain
| | | | - Héctor Bueno
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; Servicio de Cardiología, Hospital Universitario 12 de Octubre, Madrid, Spain; Instituto de Investigación Sanitaria Hospital 12 de Octubre (i+12), Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Manuel Martínez-Sellés
- Servicio de Cardiología, Hospital Universitario Gregorio Marañón, Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Universidad Complutense de Madrid, Universidad Europea de Madrid, Madrid, Spain
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Säfström E, Jaarsma T, Strömberg A. Continuity and utilization of health and community care in elderly patients with heart failure before and after hospitalization. BMC Geriatr 2018; 18:177. [PMID: 30103688 PMCID: PMC6090801 DOI: 10.1186/s12877-018-0861-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Accepted: 07/11/2018] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The period after hospitalization due to deteriorated heart failure (HF) is characterized as a time of high generalized risk. The transition from hospital to home is often problematic due to insufficient coordination of care, leading to a fragmentation of care rather than a seamless continuum of care. The aim was to describe health and community care utilization prior to and 30 days after hospitalization, and the continuity of care in patients hospitalized due to de novo or deteriorated HF from the patients' perspective and from a medical chart review. METHODS This was a cross-sectional study with consecutive inclusion of patients hospitalized at a county hospital in Sweden due to deteriorated HF during 2014. Data were collected by structured telephone interviews and medical chart review and analyzed with the Spearman's rank correlation coefficient and Chi square. A P value of 0.05 was considered significant. RESULTS A total of 121 patients were included in the study, mean age 82.5 (±6.8) and 49% were women. Half of the patients had not visited any health care facility during the month prior to the index hospital admission, and 79% of the patients visited the emergency room (ER) without a referral. Among these elderly patients, a total of 40% received assistance at home prior to hospitalization and 52% after discharge. A total of 86% received written discharge information, one third felt insecure after hospitalization and lacked knowledge of which health care provider to consult with and contact in the event of deterioration or complications. Health care utilization increased significantly after hospitalization. CONCLUSION Most patients had not visited any health care facility within 30 days before hospitalization. Health care utilization increased significantly after hospitalization. Flaws in the continuity of care were found; even though most patients received written information at discharge, one third of the patients lacked knowledge about which health care provider to contact in the event of deterioration and felt insecure at home after discharge.
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Affiliation(s)
- Emma Säfström
- Sörmland County Council, Nyköping Hospital, Nyköping, Sweden
- Department of Medical and Health Sciences, Division of Nursing Science, Linköping University, Linköping, Sweden
- Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden
| | - Tiny Jaarsma
- Department of Social and Welfare Studies, Linköping University, Linköping, Sweden
| | - Anna Strömberg
- Department of Medical and Health Sciences, Division of Nursing Science, Linköping University, Linköping, Sweden
- Department of Cardiology, Linköping University, Linköping, Sweden
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47
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Brennan EJ. Chronic heart failure nursing: integrated multidisciplinary care. ACTA ACUST UNITED AC 2018; 27:681-688. [DOI: 10.12968/bjon.2018.27.12.681] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Emma Jane Brennan
- Heart Failure Specialist Nurse, Whittington Health NHS Trust, London
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48
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Theou O, Squires E, Mallery K, Lee JS, Fay S, Goldstein J, Armstrong JJ, Rockwood K. What do we know about frailty in the acute care setting? A scoping review. BMC Geriatr 2018; 18:139. [PMID: 29898673 PMCID: PMC6000922 DOI: 10.1186/s12877-018-0823-2] [Citation(s) in RCA: 174] [Impact Index Per Article: 24.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 05/22/2018] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The ability of acute care providers to cope with the influx of frail older patients is increasingly stressed, and changes need to be made to improve care provided to older adults. Our purpose was to conduct a scoping review to map and synthesize the literature addressing frailty in the acute care setting in order to understand how to tackle this challenge. We also aimed to highlight the current gaps in frailty research. METHODS This scoping review included original research articles with acutely-ill Emergency Medical Services (EMS) or hospitalized older patients who were identified as frail by the authors. We searched Medline, CINAHL, Embase, PsycINFO, Eric, and Cochrane from January 2000 to September 2015. RESULTS Our database search initially resulted in 8658 articles and 617 were eligible. In 67% of the articles the authors identified their participants as frail but did not report on how they measured frailty. Among the 204 articles that did measure frailty, the most common disciplines were geriatrics (14%), emergency department (14%), and general medicine (11%). In total, 89 measures were used. This included 13 established tools, used in 51% of the articles, and 35 non-frailty tools, used in 24% of the articles. The most commonly used tools were the Clinical Frailty Scale, the Frailty Index, and the Frailty Phenotype (12% each). Most often (44%) researchers used frailty tools to predict adverse health outcomes. In 74% of the cases frailty predicted the outcome examined, typically mortality and length of stay. CONCLUSIONS Most studies (83%) were conducted in non-geriatric disciplines and two thirds of the articles identified participants as frail without measuring frailty. There was great variability in tools used and more recently published studies were more likely to use established frailty tools. Overall, frailty appears to be a good predictor of adverse health outcomes. For frailty to be implemented in clinical practice frailty tools should help formulate the care plan and improve shared decision making. How this will happen has yet to be determined.
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Affiliation(s)
- Olga Theou
- Department of Medicine, Dalhousie University, Camp Hill Veterans’ Memorial Building, 5955 Veterans’ Memorial Lane, Halifax, NS B3H 2E1 Canada
- Geriatric Medicine, QEII Health Sciences Centre, Nova Scotia Health Authority, Camp Hill Veterans’ Memorial Building, 5955 Veterans’ Memorial Lane, Halifax, NS B3H 2E1 Canada
| | - Emma Squires
- Geriatric Medicine, QEII Health Sciences Centre, Nova Scotia Health Authority, Camp Hill Veterans’ Memorial Building, 5955 Veterans’ Memorial Lane, Halifax, NS B3H 2E1 Canada
| | - Kayla Mallery
- Geriatric Medicine, QEII Health Sciences Centre, Nova Scotia Health Authority, Camp Hill Veterans’ Memorial Building, 5955 Veterans’ Memorial Lane, Halifax, NS B3H 2E1 Canada
| | - Jacques S. Lee
- Sunnybrook Health Service, 2075 Bayview Avenue, BG-04, Toronto, ON M4N 3M5 Canada
| | - Sherri Fay
- Geriatric Medicine, QEII Health Sciences Centre, Nova Scotia Health Authority, Camp Hill Veterans’ Memorial Building, 5955 Veterans’ Memorial Lane, Halifax, NS B3H 2E1 Canada
| | - Judah Goldstein
- Emergency Health Services, 239 Brownlow Avenue, Suite 300, Dartmouth, NS B3B 2B2 Canada
| | - Joshua J. Armstrong
- Department of Health Sciences, Lakehead University, 955 Oliver Road, Thunder Bay, ON P7B 5E1 Canada
| | - Kenneth Rockwood
- Geriatric Medicine, QEII Health Sciences Centre, Nova Scotia Health Authority, Camp Hill Veterans’ Memorial Building, 5955 Veterans’ Memorial Lane, Halifax, NS B3H 2E1 Canada
- Division of Geriatric Medicine, Department of Medicine, Dalhousie University, Camp Hill Veterans’ Memorial Building, 5955 Veterans’ Memorial Lane, Halifax, NS B3H 2E1 Canada
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Frailty syndrome and rehospitalizations in elderly heart failure patients. Aging Clin Exp Res 2018; 30:617-623. [PMID: 28849550 PMCID: PMC5968054 DOI: 10.1007/s40520-017-0824-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Accepted: 08/11/2017] [Indexed: 11/04/2022]
Abstract
Background Heart failure (HF) patients with frailty syndrome (FS) are at higher risk of falling, decreased mobility, ability to perform the basic activities of daily living, frequent hospitalizations, and death. Aims The purpose of this study was to evaluate the correlations between FS and hospital readmissions, and to assess which factors are associated with rehospitalizations. Methods The study included 330 patients with a mean age of 72.1 ± 7.9 years, diagnosed with HF. Frailty was measured using the Polish version of the Tilburg Frailty Indicator (TFI). Demographic, sociodemographic, and clinical data, such as the New York Heart Association (NYHA) functional class, ejection fraction (EF), number of rehospitalizations, and the medications taken, were obtained. Results Positive correlation was observed between the number of hospitalizations and FS. In the single-factor correlation analysis, treatment with diuretics, a higher NYHA class, and a lower left ventricular EF were predictors of a higher number of hospitalizations. Additionally, the physical and psychological components of the TFI, as well as the total TFI score, predisposed HF patients to more frequent hospitalizations. Discussion It seems that a deterioration of functional capabilities and an increase in symptom severity naturally lead to increased hospitalization frequency in HF. In the own study, regression analysis indicates that high NYHA classes and TFI social component scores are significant predictors of the number of hospitalizations in the studied group. Conclusions FS is highly prevalent among elderly HF patients. Higher frailty levels in elderly patients are a determinant of more frequent rehospitalizations in HF.
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Fung E, Hui E, Yang X, Lui LT, Cheng KF, Li Q, Fan Y, Sahota DS, Ma BHM, Lee JSW, Lee APW, Woo J. Heart Failure and Frailty in the Community-Living Elderly Population: What the UFO Study Will Tell Us. Front Physiol 2018; 9:347. [PMID: 29740330 PMCID: PMC5928128 DOI: 10.3389/fphys.2018.00347] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2017] [Accepted: 03/20/2018] [Indexed: 12/11/2022] Open
Abstract
Heart failure and frailty are clinical syndromes that present with overlapping phenotypic characteristics. Importantly, their co-presence is associated with increased mortality and morbidity. While mechanical and electrical device therapies for heart failure are vital for select patients with advanced stage disease, the majority of patients and especially those with undiagnosed heart failure would benefit from early disease detection and prompt initiation of guideline-directed medical therapies. In this article, we review the problematic interactions between heart failure and frailty, introduce a focused cardiac screening program for community-living elderly initiated by a mobile communication device app leading to the Undiagnosed heart Failure in frail Older individuals (UFO) study, and discuss how the knowledge of pre-frailty and frailty status could be exploited for the detection of previously undiagnosed heart failure or advanced cardiac disease. The widespread use of mobile devices coupled with increasing availability of novel, effective medical and minimally invasive therapies have incentivized new approaches to heart failure case finding and disease management.
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Affiliation(s)
- Erik Fung
- Department of Medicine and Therapeutics, Faculty of Medicine, Chinese University of Hong Kong, Sha Tin, Hong Kong
- Laboratory for Heart Failure and Circulation Research, Li Ka Shing Institute of Health Sciences, Prince of Wales Hospital, Sha Tin, Hong Kong
- Faculty of Medicine, Gerald Choa Cardiac Research Centre, Chinese University of Hong Kong, Sha Tin, Hong Kong
| | - Elsie Hui
- Department of Medicine and Therapeutics, Faculty of Medicine, Chinese University of Hong Kong, Sha Tin, Hong Kong
- Department of Medicine and Geriatrics, Shatin Hospital, Sha Tin, Hong Kong
| | - Xiaobo Yang
- Department of Medicine and Therapeutics, Faculty of Medicine, Chinese University of Hong Kong, Sha Tin, Hong Kong
- Laboratory for Heart Failure and Circulation Research, Li Ka Shing Institute of Health Sciences, Prince of Wales Hospital, Sha Tin, Hong Kong
- PhD Programme in Medical Sciences, Division of Medical Sciences, Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Leong T. Lui
- Department of Medicine and Therapeutics, Faculty of Medicine, Chinese University of Hong Kong, Sha Tin, Hong Kong
- Laboratory for Heart Failure and Circulation Research, Li Ka Shing Institute of Health Sciences, Prince of Wales Hospital, Sha Tin, Hong Kong
| | - King F. Cheng
- Department of Medicine and Therapeutics, Faculty of Medicine, Chinese University of Hong Kong, Sha Tin, Hong Kong
- Laboratory for Heart Failure and Circulation Research, Li Ka Shing Institute of Health Sciences, Prince of Wales Hospital, Sha Tin, Hong Kong
| | - Qi Li
- Department of Medicine and Therapeutics, Faculty of Medicine, Chinese University of Hong Kong, Sha Tin, Hong Kong
- Laboratory for Heart Failure and Circulation Research, Li Ka Shing Institute of Health Sciences, Prince of Wales Hospital, Sha Tin, Hong Kong
- PhD Programme in Medical Sciences, Division of Medical Sciences, Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Yiting Fan
- Department of Medicine and Therapeutics, Faculty of Medicine, Chinese University of Hong Kong, Sha Tin, Hong Kong
- PhD Programme in Medical Sciences, Division of Medical Sciences, Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Daljit S. Sahota
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Chinese University of Hong Kong, Sha Tin, Hong Kong
| | - Bosco H. M. Ma
- Department of Medicine and Therapeutics, Faculty of Medicine, Chinese University of Hong Kong, Sha Tin, Hong Kong
- Department of Medicine and Geriatrics, Shatin Hospital, Sha Tin, Hong Kong
| | - Jenny S. W. Lee
- Department of Medicine and Therapeutics, Faculty of Medicine, Chinese University of Hong Kong, Sha Tin, Hong Kong
- Department of Medicine, Alice Ho Miu Ling Nethersole Hospital and Tai Po Hospital, Tai Po, Hong Kong
| | - Alex P. W. Lee
- Department of Medicine and Therapeutics, Faculty of Medicine, Chinese University of Hong Kong, Sha Tin, Hong Kong
| | - Jean Woo
- Department of Medicine and Therapeutics, Faculty of Medicine, Chinese University of Hong Kong, Sha Tin, Hong Kong
- CUHK Jockey Club Institute of Ageing, Chinese University of Hong Kong, Sha Tin, Hong Kong
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