Prevalence and prognostic impact of frailty and its components in non-dependent elderly patients with heart failure (original) (raw)
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Considering the increasing age of individuals affected with heart failure (HF), a specific approach to their treatment is required, with more attention paid to geriatric conditions such as poor mobility, multiple disabilities, and cognitive impairment. Frailty is a distinct biological syndrome reflecting decreased physiologic reserve and resistance to stressors. It was shown to occur frequently in patients with heart failure, with the prevalence ranging from 15 to 74 %, depending on the studied population and the method of assessment. We reviewed literature data on the influence of frailty, skeletal abnormalities, comorbidities and geriatric condition on diagnosis, treatment, and outcomes in elderly patients with HF. Identification of frailty in patients with HF is important from the clinical point of view, as this condition exerts unfavorable effects on the course of heart failure. Frailty contributes to a higher frequency of visits to emergency departments, hospitalizations, and mortality in patients with HF. Exercise may improve mobility, and nursing support can be implemented to help the patients adhere to medications. Therefore, frail patients should be diagnosed and treated according to available guidelines, and successfully educated about their condition.
Frailty may be a risk marker for adverse outcome in patients with congestive heart failure
ESC Heart Failure
Aims To examine the availability of frailty concept with objective criteria for risk stratification in patients with congestive heart failure (CHF). Methods and results Study design was secondary analysis of our CHF cohort. We selected 181 patients who completed clinical assessments and were successfully followed 2-year post discharge. To set frailty criteria, grip strength <26 kg in men and <17 kg in women (weakness) and performance measure for activities of daily living-8 ≧21 points (exhaustion) were defined for predicting 6 min walking distance <300 m (slowness) by the receiver-operating characteristics. During 2 years of follow up, subjects who met all the criteria had a 4 times greater risk of cardiac event compared with those with no frailty criteria. Conclusion The findings of present study suggest that frailty criteria may serve as a new clinical marker for management of patients with CHF.
Frailty in advanced heart failure: a systematic review
Heart Failure Reviews, 2015
Frailty is a common geriatric syndrome of increased vulnerability to adverse events. The prevalence of frailty among chronic heart failure (CHF) is high and confers a greater risk of adverse events including falls, hospitalisation and mortality. There have been few studies assessing frailty in CHF. A review of the key databases was conducted from 2004 to 2014 including the key search terms 'frail elderly' and 'heart failure'. The following electronic databases were searched: Medline, Cumulative Index for Nursing and Allied Health and Academic Search Complete, with reference lists being manually searched. Articles were included if frailty was assessed using a valid measuring tool in a population with a confirmed diagnosis of CHF. The search yielded a total of 393 articles with 8 articles being selected for review. The prevalence of frailty among those with CHF was high, ranging from 18 to 54 %. The frailty phenotype and geriatric assessments tools were the most common frailty measures utilised; high rates of co-morbidity, hospitalisation and mortality were identified.
Frailty significantly impairs the short term prognosis in elderly patients with heart failure
Journal of Geriatric Cardiology : JGC, 2018
Background Frailty is a condition of elderly characterized by increased vulnerability to stressful events with high risk of adverse outcomes. The purpose of this study was to evaluate the association between frailty and adverse outcomes including death and hospitalization due to heart failure in elderly patients. Methods We included patients aged ≥ 65 years with the diagnosis of heart failure. The clinical and laboratory data, echocardiography and ECGs were recorded. Additionally, the frailty scores of the patients were evaluated according to Canadian Study of Health and Aging. All the patients were divided as frail or non-frail. The groups were compared for their characteristics and the occurrence of clinical outcomes. Results We included 86 eligible patients. The median follow-up time was four months. The mean age was 75 ± 6.5 years. Of these 86 patients, 17 (19.7%) patients encountered an event (death and/or hospitalization). Nine patients (10.4%) died during follow-up. Thirty pa...
The American Journal of Cardiology, 2016
Older patients with acute decompensated heart failure (ADHF) have persistently poor outcomes including frequent rehospitalization despite guidelines based therapy. We hypothesized that such patients have multiple, severe impairments in physical function, cognition, and mood that are not addressed by current care pathways. We prospectively examined frailty, physical function, cognition, mood and quality of life in 27 consecutive older ADHF patients at 3 medical centers and compared these to 197 participants in 3 age-matched cohorts: stable heart failure with preserved ejection fraction (n=80); stable heart failure with reduced ejection fraction (n=56) and healthy older adults (n=61). Based on Fried criteria, frailty was present in 56% of ADHF patients vs. 0 for the age-matched chronic heart failure and health cohorts. ADHF patients had markedly reduced Short Physical Performance Battery score (5.3±2.8) and six-minute walk distance (178±102 meters) (p<0.001 vs other cohorts), with severe deficits in all domains of physical function: balance, mobility, strength and endurance. In the ADHF patients, cognitive impairment
Frailty predicts long-term mortality in elderly subjects with chronic heart failure
European Journal of Clinical Investigation, 2005
Background The elderly are characterized by a high prevalence of chronic heart failure (CHF) and frailty, which is a complex interaction of physical, psychological and social impairment. This study aimed to examine the predictive role of frailty on long-term mortality in elderly subjects with CHF.
BMC Cardiovascular Disorders
Background: Heart failure (HF) and frailty often co-exist, and frailty in HF results in a poor prognosis. However, in Asian populations, prognostic criteria are needed to examine the effect of frailty on HF. Therefore, we conducted a nationwide cohort study to develop frailty-based prognostic criteria in HF patients (FLAGSHIP). FLAGSHIP mainly aims to 1) develop the frailty criteria based on HF-specific outcomes, 2) propose a hypothesis of the potential mechanisms of frailty manifestations in HF, and 3) examine the effects of outpatient cardiac rehabilitation on frailty. Methods: In this prospective study, we consecutively enroll ambulatory patients admitted because of acute HF or exacerbation of HF and elderly patients admitted for acute myocardial infarction (age ≥ 70 years). They will be followed up for 2 years to assess frailty and hard clinical events. The primary endpoints of FLAGSHIP are cardiac events including cardiac mortality and HF-related readmission after discharge. Secondary endpoints are readmissions because of fracture or pneumonia and all-cause mortality. We used clinical data, including the items related to the frailty phenotype to develop diagnostic criteria for frailty and known prognostic factors of HF. Cognitive function, depression, and anorexia are also considered as potential components of frailty. As of March 2018, 2650 patients (85% was patients admitted for HF) have been registered from 30 collaborating hospitals nationwide in Japan. Discussion: FLAGSHIP provides diagnostic criteria and fundamental information on frailty manifestations to develop the best practices for the long-term management of HF. Diagnostic criteria on frailty developed by FLAGSHIP is expected to become a novel indicator for the stratification of patients at risk to functional decline after medical or surgical treatment, and in turn to contribute to the best practices in the long-term management of HF.
Cardiac Failure Review, 2019
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.
The impact of frailty on health related quality of life in heart failure
European Journal of Cardiovascular Nursing, 2011
Background/Aims: Most heart failure (HF) hospital discharges involve people N 65 years, many frail. The purpose of this study was to determine if frailty explains variability in health related quality of life (HRQOL) in older adults with HF over and above known correlates. Methods: A frailty index score was developed by weighting age, number of comorbid conditions, and symptom severity. A multivariate hierarchical regression analysis of known predictors of HRQOLgender, income, ethnicity, health perception, NYHA classwere entered first and then the frailty index was entered and regressed on HRQOL in 2 unique samples. Results: When known predictors were tested on a sample they explained 11% (p 0.14) of the variance in HRQOL; when the frailty index score was added 24% (p 0.001) was explained. When the index was validated in a second sample, known predictors explained 15% (p 0.04) of the variance; with the frailty index score 40% (p 0.000) was explained. Conclusion: Frailty explains significant amounts of variance in HRQOL in HF. Treating comorbid conditions and controlling symptoms may improve HRQOL in HF patients. These findings support the need for further research into the impact of frailty on HRQOL in HF patients.
Academic emergency medicine : official journal of the Society for Academic Emergency Medicine, 2016
To determine the effect of frailty on risk of 30-day mortality in non-severely disabled older patients with acute heart failure (AHF) attended in emergency departments (EDs). The Frailty-AHF Study is a retrospective analysis of a multicentre, observational, prospective, cohort study (Older-AHF Register). This study included consecutive patients ≥ 65 years of age without severe functional dependence or dementia attended for AHF in 3 Spanish EDs during 4 months. Frailty was defined by frailty phenotype as the presence of 3 or more domains. Baseline and episode characteristics and 30-day mortality were collected in all the patients. A total of 465 patients with a mean age of 82 (SD 7) years were included, 283 (61.0%) being female and 225 (51.3%) with severe comorbidity (Charlson index ≥ 3). Frailty was present in 169 (36.3%). The rate of 30-day mortality was 7.3%. Frailty adjusted for potential confounding factors was an independent factor associated with 30-day mortality (adjusted HR=...