Impact of Social Frailty in Hospitalized Elderly Patients With Heart Failure: A FRAGILE‐HF Registry Subanalysis

Jujo, Kentaro; Kagiyama, Nobuyuki; Saito, Kazuya; Kamiya, Kentaro; Saitô, Hiroshi; Maekawa, Emi; Konishi, Masaaki; Kitai, Takeshi; Iwata, K.; Wada, Hiroshi; Kasai, Takatoshi; Nagamatsu, Hirofumi; Ozawa, Tetsuya; Izawa, Katsuya; Yamamoto, Shuhei; Aizawa, Naoki; Yonezawa, Ryusuke; Oka, Kazuhiro; Makizako, Hyuma; Momomura, Shin‐ichi; Matsue, Yuya

doi:10.1161/jaha.120.019954

Cited by 37 publications

(41 citation statements)

References 27 publications

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“…Despite the negative attitudes toward ACP, we also clarified the poor prognostic outcomes for SI in hospitalized patients with HF, concordant with previous studies on patients with HF with various severities and settings. 16 , 32 , 38 , 39 Among heart transplant recipients, SI, defined as the number of contacts with close friends and relatives during 1 month, was associated with reduced survival after heart transplantation. 38 In a Japanese study of hospitalized patients with HF, SI, evaluated using the LSNS‐6, was associated with 90‐day HF readmission.…”

Section: Discussionmentioning

confidence: 99%

“… 39 Furthermore, most recently, social frailty, evaluated using Makizako's 5 items, was associated with all‐cause death and rehospitalization among hospitalized geriatric patients with HF. 16 Taken together, regardless of the HF severity, region, and indicators for SI evaluation, SI patients may have limited worse clinical outcomes in HF. Although elucidating its mechanism is beyond the scope of our study, patients' perception of SI could be the result of individual, circumstantial, or environmental conditions, and therapeutic targets of SI will vary accordingly.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, previous literature demonstrated that SI was associated with all‐cause death and rehospitalization among patients with HF. 15 , 16 Despite the worse prognostic outcomes of SI in HF, its impact on patients' preference for ACP remains to be fully elucidated.…”

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confidence: 99%

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Social Isolation and Implementation of Advanced Care Planning Among Hospitalized Patients With Heart Failure

Kitakata

Kohno

Kohsaka

et al. 2022

JAHA

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Background The implementation of advance care planning (ACP) in heart failure management is insufficient. Social isolation (SI) could be a barrier to ACP initiation, albeit the relationship between SI and patients' preference for ACP or end‐of‐life care remains unknown. Methods and Results We conducted a questionnaire survey, including assessments of SI using the 6‐item Lubben Social Network Scale as well as patients' perspectives on ACP and end‐of‐life care. Of the 160 patients approached by our multidisciplinary heart failure team during admission, 120 patients (75.0%) completed the survey (median age, 73.0 years; men, 74.2%). A Cox proportional hazard model was constructed to elucidate the short‐term (180‐day) prognostic impact of SI. Overall, 28.3% of participants were at high risk for SI (6‐item Lubben Social Network Scale score <12). High‐risk patients had more negative attitudes toward ACP than those without (61.8% versus 80.2%; P =0.035). The actual performance of ACP conversation in patients with and without high risk were 20.6% and 30.2%, respectively. Regarding preference in end‐of‐life care, “Saying what one wants to tell loved ones” (73.5% versus 90.6%; P =0.016) and “Spending enough time with family” (58.8% versus 77.9%; P =0.035) were less important in high‐risk patients. High risk for SI was associated with higher 180‐day risk‐adjusted all‐cause mortality (hazard ratio, 7.89 [95% CI, 1.53–40.75]). Conclusions In hospitalized patients with heart failure, high risk for SI was frequently observed. High‐risk patients were associated with a negative attitude toward ACP, despite higher mortality. Further research is required to establish an ideal approach to provide ACP in socially vulnerable patients.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Social Isolation and Implementation of Advanced Care Planning Among Hospitalized Patients With Heart Failure

Kitakata

Kohno

Kohsaka

et al. 2022

JAHA

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“…Physical inactivity in heart disease patients may affect not only physical and mental functions but also social activity. As social activity frequently requires the integration of physical and mental capacities, social frailty may develop at a relatively early stage in the progressive trajectory of frailty [ 11 ]. However, the majority of reports on frailty in those with heart disease relate to physical frailty and cognitive functions, while the social domain of frailty has received little research attention.…”

Section: Introductionmentioning

confidence: 99%

Social Frailty and Meaningful Activities among Community-Dwelling Older Adults with Heart Disease

Akasaki¹,

Tabira

Maruta

et al. 2022

IJERPH

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Patients with heart disease are more likely to experience social frailty due to physical inactivity, which may affect meaningful activities such as hobbies. This study aimed to investigate (1) the association between heart disease and social frailty in community-dwelling older adults and (2) the characteristics of meaningful activities in community-dwelling older adults with heart disease. Data from 630 older adults who participated in a community-based health survey were obtained, including clinical history, meaningful activities, social frailty and psychosomatic functions. Participants were divided into two groups: those with heart disease (n = 79) and those without (n = 551), and comparisons were made. Social frailty was observed in 23.7% of participants with heart disease, and logistic regression revealed significant associations with heart disease and social frailty after adjusting for potential covariates (OR, 1.97; 95% CI, 1.06 3.67; p = 0.032). Participants with heart disease did not differ significantly in terms of satisfaction or performance; their frequency of engagement in meaningful activities was significantly lower than without heart disease (p = 0.041). These results suggest that heart disease and social frailty are associated in community-dwelling older adults, and that this demographic is inclined to engage in meaningful activities less frequently.

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“…55 In patients with HF, the QSFS of Makizako et al is frequently used. In the sub-analysis of FRAGILE-HF, 56 the QSFS was also used, showing that 825 (66.5%) of 1240 participants had social frailty, which was associated with all-cause mortality and rehospitalization at 1 year post-discharge. The QSFS is recommended for the assessment of social frailty in patients with HF due to multiple reports and its simplicity with only five questions.…”

Section: Prevalence and Diagnosismentioning

confidence: 99%

Clinical Perspectives on Cardiac Rehabilitation After Heart Failure in Elderly Patients with Frailty: A Narrative Review

Tsukakoshi¹,

Yamamoto²,

Takeda³

et al. 2022

TCRM

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The purpose of this narrative review is to examine rehabilitation modalities for patients with heart failure and Frailty who require comprehensive intervention. Ischemic heart disease is the leading cause of death worldwide, accounting for 16% of global mortality. Due to population growing and aging, the total number of heart failure patients continues to rise, a condition known as the heart failure pandemic. Furthermore, frailty has been associated with an increased risk for heart failure and increased morbidity and mortality. The 2021 update of the 2017 ACC expert consensus decision pathway for optimization of HF treatment has become more concerning, citing frailty as one of the 10 most important issues associated with heart failure with reduced ejection fraction (HFrEF). Frailty and heart failure share common pathological mechanisms and are associated with poor clinical outcomes. Most studies of frailty in patients with heart failure primarily focus on physical frailty, and associations between psycho-psychological and social factors such as cognitive dysfunction and social isolation have also been reported. These results suggest that a more comprehensive assessment of frailty is important to determine the risk in patients with heart failure. Therefore, mechanisms of the three domains, including not only physical frailty but also cognitive, psychological, spiritual, and social aspects, should be understood. In addition to interventions in these three domains, nutritional and pharmacological interventions are also important and require tailor-made interventions for the widely varied conditions associated with heart failure and frailty. Although several studies have shown a relationship between frailty and prognosis in patients with heart failure, interventions to improve the prognosis have not yet been established. Further information is needed on frailty intervention by a multidisciplinary team to improve the prognosis.

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Impact of Social Frailty in Hospitalized Elderly Patients With Heart Failure: A FRAGILE‐HF Registry Subanalysis

Cited by 37 publications

References 27 publications

Social Isolation and Implementation of Advanced Care Planning Among Hospitalized Patients With Heart Failure

Social Isolation and Implementation of Advanced Care Planning Among Hospitalized Patients With Heart Failure

Social Frailty and Meaningful Activities among Community-Dwelling Older Adults with Heart Disease

Clinical Perspectives on Cardiac Rehabilitation After Heart Failure in Elderly Patients with Frailty: A Narrative Review

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