Frailty and Post-hospitalization Outcomes in Patients With Heart Failure With Preserved Ejection Fraction

Goyal, Parag; Yum, Brian; Navid, Pedram; Chen, Ligong; Kim, Dae; Roh, Jason D.; Jaeger, Byron C.; Levitan, Emily B.

doi:10.1016/j.amjcard.2021.02.019

Cited by 20 publications

(20 citation statements)

References 30 publications

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“… 21 Overweight and obesity is highly prevalent in patients with HFpEF (up to 80%), as is frailty. 20 , 22 , 23 A recent analysis of 4605 older patients (mean age 80.3 years) with HFpEF hospitalisation found that 41% had frailty, and that frailty was the most important predictor of re-hospitalisation, and second (after age) for mortality. 23 …”

Section: Discussionmentioning

confidence: 99%

“…Multiple studies have shown a greater prevalence of women among populations with HFpEF, although unclear if this is related to higher survival rates of women at older ages, or factors such as the stronger relationship between obesity and incident HFpEF among women compared to men [20]. Overweight and obesity is highly prevalent in patients with HFpEF (up to 80%) as is frailty [19,21,22]. A recent analysis of 4605 older patients (mean age 80.3) with HFpEF hospitalisation found that 41% had frailty, and that frailty was the most important predictor of re-hospitalisation, and second (after age) for mortality [22].…”

Section: Comparison With Other Studiesmentioning

confidence: 99%

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Characteristics of patients with heart failure with preserved ejection fraction in primary care: a cross-sectional analysis

et al. 2021

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BackgroundMany patients with heart failure with preserved ejection fraction (HFpEF) are undiagnosed, and UK general practice registers do not typically record HF sub-type. Improvements in management of HFpEF is dependent on improved identification and characterisation of patients in primary care.AimsTo describe a cohort of patients recruited from primary care with suspected HFpEF and compare patients in whom HFpEF was confirmed and refuted.Design and SettingBaseline data from a longitudinal cohort study of patients with suspected HFpEF recruited from primary care in two areas of England.MethodsA screening algorithm and review were used to find patients on HF registers without a record of reduced ejection fraction. Baseline evaluation included cardiac, mental and physical function, clinical characteristics and patient reported outcomes. Confirmation of HFpEF was clinically adjudicated by a cardiologist.ResultsNinety-three (61%) of 152 patients were confirmed HFpEF. The mean age of patients with HFpEF was 79.3, 46% were female, 80% had hypertension, and 37% took 10 or more medications. Patients with HFpEF were more likely to be obese, pre-frail/frail, report more dyspnoea and fatigue, were more functionally impaired, and less active than patients in whom HFpEF was refuted. Few had attended cardiac rehabilitation.ConclusionsPatients with confirmed HFpEF had frequent multimorbidity, functional impairment, frailty and polypharmacy. Although comorbid conditions were similar between people with and without HFpEF, the former had more obesity, symptoms and worse physical function. These findings highlight the potential to optimise well-being through comorbidity management, medication rationalisation, rehabilitation, and supported self-management.

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Section: Discussionmentioning

confidence: 99%

Section: Comparison With Other Studiesmentioning

confidence: 99%

Characteristics of patients with heart failure with preserved ejection fraction in primary care: a cross-sectional analysis

et al. 2021

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“…The main findings of this study are that older age, females, clinical conditions (such as arthritis, hypertension, osteoporosis, and diabetes), high use of healthcare utilization, and adverse health outcomes (such as fractures, prolonged length of hospital stay, and number of hospitalizations) were the most significant predictive variables for the screening outcomes in frail persons. Previous studies reported that frailty was the most important predictor of rehospitalization and the second most important predictor of mortality in patients with cardiovascular disease [ 39 ]. Not surprisingly, the sociodemographic questions revealed importance.…”

Section: Discussionmentioning

confidence: 99%

Machine Learning Approaches for the Frailty Screening: A Narrative Review

Oliosi

Guede-Fernández

Londral

2022

IJERPH

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Frailty characterizes a state of impairments that increases the risk of adverse health outcomes such as physical limitation, lower quality of life, and premature death. Frailty prevention, early screening, and management of potential existing conditions are essential and impact the elderly population positively and on society. Advanced machine learning (ML) processing methods are one of healthcare’s fastest developing scientific and technical areas. Although research studies are being conducted in a controlled environment, their translation into the real world (clinical setting, which is often dynamic) is challenging. This paper presents a narrative review of the procedures for the frailty screening applied to the innovative tools, focusing on indicators and ML approaches. It results in six selected studies. Support vector machine was the most often used ML method. These methods apparently can identify several risk factors to predict pre-frail or frailty. Even so, there are some limitations (e.g., quality data), but they have enormous potential to detect frailty early.

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“…Strategies to rehabilitate and reverse frailty status can offer valuable opportunities to improve prognosis and customise medication management to mitigate the increased risk of adverse outcomes in frail older people with heart failure. Age and frailty are important characteristics to predict mortality and rehospitalisation [ 44 ]. Due to potential multisystem deficiencies, frailty and associated disabilities may predispose patients to decompensate at lower thresholds and increase health care utilisation, requiring more outpatient and hospital visits [ 8 ].…”

Section: Discussionmentioning

confidence: 99%

The Prevalence of Adverse Drug Reactions and Adverse Drug Events from Heart Failure Medications in Frail Older Adults: A Systematic Review

et al. 2022

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Introduction Frailty is highly prevalent in heart failure populations and a major risk factor for adverse drug reactions (ADRs) and adverse drug events (ADEs). This review aimed to describe the prevalence, causality and severity of ADRs or ADEs from heart failure medications among frail compared with non-frail older adults. Methods A systematic search of CENTRAL, MEDLINE, Embase, Ageline, CINAHL, International Pharmaceutical Abstracts, PsychInfo, Scopus, registries and citations prior to 18 May 2021 was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 checklist. Risk of bias and quality of evidence were assessed. Eligible studies included randomised controlled trials (RCTs) and observational studies of people diagnosed with heart failure, aged ≥ 65 years, with frailty defined by an objective measurement, and reported ADRs/ADEs from/with heart failure medications. Results Two reviewers screened 2419 articles; interrater reliability kappa = 0.88. Three observational studies (n = 2596), a secondary analysis of two RCTs (n = 2098) and two cohort studies (n = 498) were included in a narrative synthesis. Frail patients in randomised trials of sacubitril/valsartan, aliskiren, or enalapril had twice the risk of mortality (hazard ratio [HR] 2.09, 1.62-2.71) and hospitalisations (HR 1.82, 1.37-2.41) compared with robust patients, which may reflect responsiveness to medications and/or factors unrelated to medication use. Hospitalisations from falls, tiredness and nausea were probably attributable to digoxin and possibly preventable according to the Naranjo and Hallas scales, respectively. Conclusion The potential harms from heart failure medications in frail older people are poorly studied and understood. Clinical trials and pharmacovigilance studies should include frailty as a covariate to inform medication optimisation for this vulnerable and growing population. Registration Prospero registration number: CRD 42021253762.

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Frailty and Post-hospitalization Outcomes in Patients With Heart Failure With Preserved Ejection Fraction

Cited by 20 publications

References 30 publications

Characteristics of patients with heart failure with preserved ejection fraction in primary care: a cross-sectional analysis

Characteristics of patients with heart failure with preserved ejection fraction in primary care: a cross-sectional analysis

Machine Learning Approaches for the Frailty Screening: A Narrative Review

The Prevalence of Adverse Drug Reactions and Adverse Drug Events from Heart Failure Medications in Frail Older Adults: A Systematic Review

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