Heart failure management of the elderly patient: focus on frailty, sarcopaenia, cachexia, and dementia: conclusions

Coats, Andrew J.S.

doi:10.1093/eurheartj/suz236

Cited by 7 publications

(7 citation statements)

References 53 publications

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“…18 Generally, elderly patients with HF are more likely to be female and have HFpEF with a more complex pattern. 19 Our results revealed that an increasing number of proportions of female, HFpEF pattern and comorbidities. The available evidence for betablockers and ACEI/ARB is limited in HFpEF patients.…”

Section: Discussionmentioning

confidence: 56%

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Prognostic impact of hospital‐acquired disability in elderly patients with heart failure

et al. 2021

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Aims Functional decline is associated with worse outcomes in patients with elderly heart failure (HF), but little is known about the prognostic impact of hospital-acquired disability (HAD) during hospital stay after acute HF. The present study examines the prognostic significance of HAD in the prediction of all-cause mortality in elderly patients who admitted for acute HF.Methods and results This retrospective study was performed in 1941 elderly patients aged ≥65 years or older from the cardiovascular physiotherapy for acute HF patients in the Tokyo metropolitan area registry and excluded those who died in hospital. HAD was defined as any decline in the Barthel index (BI) before discharge compared with the BI within 1 month before hospital admission. The primary outcome of this study was all-cause death and HF readmission. A total of 565 (29%) deaths and 789 (41%) HF readmission occurred over a median follow-up period of 1.7 years. A total of 476 patients (25%) had HAD during hospital stay after acute HF. In multivariable analysis, HAD predicted all-cause death [hazard ratio (HR): 1.772; 95% confidence interval (CI): 1.450-2.167; P < 60; 0.001] and with risk of HF readmission (HR: 1.193; 95% CI: 1.005-1.416; P = 0.043) after adjusting for the Meta-analysis Global Group in Chronic Heart Failure risk score. Conclusions Hospital-acquired disability is associated with an increased risk of all-cause death and readmission for HF in elderly patients with acute HF.

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Section: Discussionmentioning

confidence: 56%

“…Elderly patients with HF show a different clinical profile compared with younger patients 18 . Generally, elderly patients with HF are more likely to be female and have HFpEF with a more complex pattern 19 . Our results revealed that an increasing number of proportions of female, HFpEF pattern and comorbidities.…”

Section: Resultsmentioning

confidence: 65%

Prognostic impact of hospital‐acquired disability in elderly patients with heart failure

et al. 2021

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“…The CFS level was low (1-3) in 232 (38.9%) patients, intermediate [4][5][6] in 230 (38.6%) patients, and high [7][8][9] in 134 (22.5%) patients ( Figure 1). None of the patients with HF were comparable with CFS1.…”

Section: Baseline Characteristicsmentioning

confidence: 99%

“…These trials tend to exclude frail patients because of their various co-morbidities, unwillingness to participate, or physicians discouraging participation. 4 There are emerging data that suggest that frailty is an independent prognostic factor for HF patients, which formed the basis for assessing frailty in HF patients. Moreover, frailty is an important factor from the view of quality of life enhancement and appropriate end-of-life care.…”

Section: Introductionmentioning

confidence: 99%

“…While previous large‐scale trials have enabled the development of effective treatments for HF, especially for reduced ejection fraction, the findings of these trials were less applicable to frail patients. These trials tend to exclude frail patients because of their various co‐morbidities, unwillingness to participate, or physicians discouraging participation 4 . There are emerging data that suggest that frailty is an independent prognostic factor for HF patients, which formed the basis for assessing frailty in HF patients.…”

Section: Introductionmentioning

confidence: 99%

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The impact of frailty according to Clinical Frailty Scale on clinical outcome in patients with heart failure

et al. 2021

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Aims There is currently no gold standard in evaluating frailty in patients with heart failure (HF), and the prognostic value of frailty according to the Canadian Study of Health and Aging Clinical Frailty Scale (CFS) on mortality in patients with HF is still unknown. Methods and results Among consecutive 596 patients after their discharge from HF in Kokura Memorial Hospital (Kitakyushu, Japan) during 2015, their frailty at discharge was assessed according to CFS. Patients were classified into three groups: low (N = 232, 38.9%), intermediate (N = 230, 38.6%), and high (N = 134, 22.5%). The primary endpoint was defined as 2 year all-cause death. The mean age was 76.6 ± 10.1 years, and 55.3% were men in entire cohort. There were significant differences in age, living environment, and dementia among low, intermediate, and high CFS groups. Left ventricular ejection fraction (LVEF) and co-morbidities such as severe renal failure and severe anaemia tended to increase with frailty severity, while body mass index (BMI) and albumin level tended to decrease with frailty severity. Two year cumulative incidences of all-cause death for the three groups were 12.8%, 25.4%, and 52.7% (P < 0.001), respectively. This significant difference in the risk for all-cause death among the CFS groups was driven by the risk for cardiac (8.6%, 14.2%, and 31.0%, respectively, P < 0.001) and non-cardiac death (4.6%, 13.0%, and 31.4%, respectively, P < 0.001). The multivariate analysis showed that high frailty was independently associated with all-cause death (intermediate CFS group: adjusted hazard ratio, 1.43, 95% confidence interval, 0.86-2.36, P = 0.16; high CFS group: adjusted hazard ratio, 3.90, 95% confidence interval, 2.32-6.55, P < 0.001), and this result was consistent, irrespective of stratification based on age, sex, BMI, and LVEF without significant interaction. Conclusions The simple CFS tool was successful in predicting the risk for all-cause death in patients with HF, and frailty according to CFS was independently associated with all-cause death irrespective of stratification based on age, sex, BMI, and LVEF without significant interaction. The CFS is a valuable prognostic tool in clinical settings.

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Association between sleep disordered breathing, neurocognitive impairment and diastolic function in acute heart failure patients: an insight after the vulnerable phase of the hospitalization

D’Elia

Stamerra

Vecchi³

et al. 2020

Intern Emerg Med

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Heart failure management of the elderly patient: focus on frailty, sarcopaenia, cachexia, and dementia: conclusions

Cited by 7 publications

References 53 publications

Prognostic impact of hospital‐acquired disability in elderly patients with heart failure

Prognostic impact of hospital‐acquired disability in elderly patients with heart failure

The impact of frailty according to Clinical Frailty Scale on clinical outcome in patients with heart failure

Association between sleep disordered breathing, neurocognitive impairment and diastolic function in acute heart failure patients: an insight after the vulnerable phase of the hospitalization

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