Physical Function, Frailty, Cognition, Depression, and Quality of Life in Hospitalized Adults ≥60 Years With Acute Decompensated Heart Failure With Preserved Versus Reduced Ejection Fraction

Abstract

Background: Older hospitalized acute decompensated heart failure (ADHF) patients have persistently poor outcomes and delayed recovery regardless of ejection fraction. We hypothesized that impairments in physical function, frailty, cognition, mood and quality-of-life (QoL) potentially contributing to poor clinical outcomes would be similarly severe in ADHF patients ≥60 years of age with preserved versus reduced ejection fraction (HFpEF, HFrEF). Methods and Results: In 202 consecutive older (≥60 years)hospitalized ADHF patients in a multicenter trial, we prospectively performed at baseline: Short Physical Performance Battery (SPPB), six-minute walk distance (6MWD), frailty assessment, Geriatric Depression Scale (GDS), Montreal Cognitive Assessment, and QoL assessments. Older acute decompensated HFpEF (EF ≥45%, n=96) and HFrEF (EF<45%, n=106) patients had similar impairments in all physical function measures (SPPB [5.9±0.3 versus 6.2±0.2]; 6MWD [184±10 vs 186±9m]; and gait speed [0.60±0.02 versus 0.61±0.02m/sec]) and rates of frailty (55% versus 52%; p=0.70) and cognitive impairment (77% versus 81%; p=0.56) when adjusted for differences in gender, BMI, and comorbidities. However, depression and QoL were consistently worse in HFpEF versus HFrEF. Depression was usually unrecognized clinically with 38% having GDS ≥5 and no documented history of depression. Conclusion: Patients ≥60 years hospitalized with ADHF patients have broad, marked impairments in physical function and high rates of frailty and impaired cognition: these impairments are similar in HFpEF versus HFrEF. Further, depression was common and QOL was reduced, and both were worse in HFpEF than HFrEF. Depression was usually unrecognized clinically. These findings suggest opportunities for novel interventions to improve these important patient-centered outcomes. Clinical Trial Registration: https://clinicaltrials.gov/ct2/show/NCT02196038 Identifier: NCT02196038

A human-origin probiotic cocktail ameliorates aging-related leaky gut and inflammation via modulating the microbiota/taurine/tight junction axis

“…Obese older adults face higher decline in physical function, such as reduced walking speed that is commonly associated with poor health outcomes and increased mortality in older adults (38)(39)(40). Interestingly, probiotic-fed obese older mice had higher walking speed than controls ( Figure 1E), suggesting that probiotic therapy attenuated physical function decline in older obese mice.…”

“…Here, we demonstrated that a human-origin probiotic therapy prevented HFD-induced metabolic dysfunctions -namely glucose intolerance, insulin resistance, hepatic steatosis, and fat tissue inflammation -in older mice. Reduced physical function and increased inflammation are major risk factors of increased morbidity and mortality of obese older adults (38)(39)(40), and probiotic therapy reduced both of these risk factors. Our findings indicate that such probiotic therapies could be beneficial for preventing aging-related metabolic dysfunctions, physical decline, and inflammation, and they may promote healthy aging.…”

<p>Examination of the Correlation Between Physical and Psychological Measures in Community-Dwelling Older Adults</p>

“…(p. 1414) 17 Multiple studies suggest associations between physical function and presence of mood disorders, such as depression and anxiety. [18][19][20] Nevertheless, limited research exists regarding measures of physical function such as grip strength, balance, gait speed, and fall risk, and their relationship to depression and anxiety.…”

Frailty Is Intertwined With Heart Failure

“…Even with evidence-based therapies to improve symptoms and long-term outcomes in patients with HF and reduced ejection fraction (HFrEF) (6), prognosis and quality of life of older patients with HF continue to be poor (7). This scenario may be especially true for patients with HF and preserved ejection fraction (HFpEF), the most common type of HF in the elderly, who report worse quality of life after an HF hospitalization compared with patients with HFrEF (8).…”