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Zheng X, Zhang K, Ma J. The Longitudinal Relationship between Frailty, Loneliness and Cardiovascular Disease: A Prospective Cohort Study. J Nutr Health Aging 2023; 27:1212-1218. [PMID: 38151872 DOI: 10.1007/s12603-023-2037-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 10/25/2023] [Indexed: 12/29/2023]
Abstract
OBJECTIVES Previous studies had reported that frailty and loneliness were associated with increased risk of cardiovascular disease (CVD). The aim of present study was to evaluate the combined effect of frailty and loneliness on the risk of CVD. METHODS A total of 9,674 participants from the China Health and Retirement Longitudinal Study were included. Multivariate Cox proportional hazards regression model was used to explore the associations between frailty, loneliness and new-onset CVD, stroke and cardiac events. RESULTS During the 7-year follow-up, a total of 1,758 respondents experienced CVD (including 584 stroke and 1,324 cardiac events). Compared to those without loneliness or frailty, individuals with loneliness alone, or with frailty alone, or with both loneliness and frailty were significantly associated with increased risk of CVD, with corresponding HRs (95%CIs) were 1.21(1.07-1.37), 1.57(1.32-1.86) and 1.78(1.52-2.10), respectively. Similarly, participants with loneliness alone, or with frailty alone, or with both loneliness and frailty were associated with higher risk of cardiac events. The significant associations were consistent in age subgroups (participants aged less or more than 60 years). CONCLUSION Our study indicated that there was a combined effect of effect of frailty and loneliness on the risk of CVD, stroke and cardiac events. These findings highlighted the importance of identifying loneliness and frailty, and intervening much earlier both in older and younger population.
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Affiliation(s)
- X Zheng
- Jiawei Ma, MD, Department of Critical Care Medicine, Jiangnan University Medical Center, Wuxi, Jiangsu, 214122, China. E-mail:
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Yu J, Liu X, Zhu Z, Yang Z, He J, Zhang L, Lu H. Prediction models for cardiovascular disease risk among people living with HIV: A systematic review and meta-analysis. Front Cardiovasc Med 2023; 10:1138234. [PMID: 37034346 PMCID: PMC10077152 DOI: 10.3389/fcvm.2023.1138234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 03/08/2023] [Indexed: 04/11/2023] Open
Abstract
Background HIV continues to be a major global health issue. The relative risk of cardiovascular disease (CVD) among people living with HIV (PLWH) was 2.16 compared to non-HIV-infections. The prediction of CVD is becoming an important issue in current HIV management. However, there is no consensus on optional CVD risk models for PLWH. Therefore, we aimed to systematically summarize and compare prediction models for CVD risk among PLWH. Methods Longitudinal studies that developed or validated prediction models for CVD risk among PLWH were systematically searched. Five databases were searched up to January 2022. The quality of the included articles was evaluated by using the Prediction model Risk Of Bias ASsessment Tool (PROBAST). We applied meta-analysis to pool the logit-transformed C-statistics for discrimination performance. Results Thirteen articles describing 17 models were included. All the included studies had a high risk of bias. In the meta-analysis, the pooled estimated C-statistic was 0.76 (95% CI: 0.72-0.81, I 2 = 84.8%) for the Data collection on Adverse Effects of Anti-HIV Drugs Study risk equation (D:A:D) (2010), 0.75 (95% CI: 0.70-0.79, I 2 = 82.4%) for the D:A:D (2010) 10-year risk version, 0.77 (95% CI: 0.74-0.80, I 2 = 82.2%) for the full D:A:D (2016) model, 0.74 (95% CI: 0.68-0.79, I 2 = 86.2%) for the reduced D:A:D (2016) model, 0.71 (95% CI: 0.61-0.79, I 2 = 87.9%) for the Framingham Risk Score (FRS) for coronary heart disease (CHD) (1998), 0.74 (95% CI: 0.70-0.78, I 2 = 87.8%) for the FRS CVD model (2008), 0.72 (95% CI: 0.67-0.76, I 2 = 75.0%) for the pooled cohort equations of the American Heart Society/ American score (PCE), and 0.67 (95% CI: 0.56-0.77, I 2 = 51.3%) for the Systematic COronary Risk Evaluation (SCORE). In the subgroup analysis, the discrimination of PCE was significantly better in the group aged ≤40 years than in the group aged 40-45 years (P = 0.024) and the group aged ≥45 years (P = 0.010). No models were developed or validated in Sub-Saharan Africa and the Asia region. Conclusions The full D:A:D (2016) model performed the best in terms of discrimination, followed by the D:A:D (2010) and PCE. However, there were no significant differences between any of the model pairings. Specific CVD risk models for older PLWH and for PLWH in Sub-Saharan Africa and the Asia region should be established.Systematic Review Registration: PROSPERO CRD42022322024.
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Affiliation(s)
- Junwen Yu
- School of Nursing, Fudan University, Shanghai, China
| | - Xiaoning Liu
- Department of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Shenzhen Third People's Hospital, Guangdong, China
- National Heart & Lung Institute, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Zheng Zhu
- School of Nursing, Fudan University, Shanghai, China
- Fudan University Centre for Evidence-Based Nursing: A Joanna Briggs Institute Centre of Excellence, Shanghai, China
- NYU Rory Meyers College of Nursing, New York University, New York City, NY, United States
- Correspondence: Zheng Zhu Hongzhou Lu
| | - Zhongfang Yang
- School of Nursing, Fudan University, Shanghai, China
- Fudan University Centre for Evidence-Based Nursing: A Joanna Briggs Institute Centre of Excellence, Shanghai, China
- Shanghai Institute of Infectious Disease and Biosecurity, Fudan University, Shanghai, China
| | - Jiamin He
- School of Nursing, Fudan University, Shanghai, China
| | - Lin Zhang
- Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Hongzhou Lu
- Department of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Shenzhen Third People's Hospital, Guangdong, China
- Correspondence: Zheng Zhu Hongzhou Lu
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Zhou Q, He J, Yang X, Yin H, Zhang Z, He N. The association between physical frailty and injurious falls and all-cause mortality as negative health outcomes in people living with HIV: A systematic review and meta-analysis. Int J Infect Dis 2023; 126:193-199. [PMID: 36455810 DOI: 10.1016/j.ijid.2022.11.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 11/21/2022] [Accepted: 11/23/2022] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES Physical frailty is one of the major concerns among older people living with HIV (PLWH). This meta-analysis aimed to explore the association between physical frailty and negative health outcomes among PLWH. METHODS We systematically searched six electronic databases including PubMed, Embase, Web of Science, the Cochrane Library, and Chinese databases up to April 10, 2022, for studies examining the association between physical frailty and risk of negative health outcomes among PLWH. Risk ratios (RRs), odds ratios, and hazard ratios with 95% CIs were extracted, and meta-analyses were conducted by using a fixed or random-effects model. RESULTS In total, 10 studies incorporating 7755 HIV-seropositive patients (mean age 49.4 years) were included in the meta-analysis. Overall, five studies with 3434 participants reported the effect of physical frailty on falls. Results showed that physical frailty in HIV-seropositive individuals demonstrated a higher risk of future falls (pooled RR 3.74, 95% CI 1.42-9.86) compared with robust HIV-seropositive patients. In addition, a meta-analysis of five studies (4321 participants) reporting the frailty-mortality association showed that physical frailty was significantly associated with a higher risk of all-cause mortality (RR 1.70, 95% CI 1.32-2.19) among PLWH. CONCLUSION Physical frailty is a significant risk factor for negative health outcomes in PLWH, including falls and all-cause mortality, underscoring the need for routine screening and early intervention of physical frailty among PLWH.
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Affiliation(s)
- Qionggui Zhou
- Department of Epidemiology, School of Public Health and the Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China; Yi-Wu Research Institute, Fudan University, Shanghai, China
| | - Jiayu He
- Department of Epidemiology, School of Public Health and the Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China
| | - Xuan Yang
- Department of Epidemiology, School of Public Health and the Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China
| | - Hao Yin
- Department of Epidemiology, School of Public Health and the Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China
| | - Zhiyi Zhang
- Department of Epidemiology, School of Public Health and the Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China
| | - Na He
- Department of Epidemiology, School of Public Health and the Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China; Yi-Wu Research Institute, Fudan University, Shanghai, China.
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Bai W, Hao B, Meng W, Qin J, Xu W, Qin L. Association between frailty and short- and long-term mortality in patients with critical acute myocardial infarction: Results from MIMIC-IV. Front Cardiovasc Med 2022; 9:1056037. [PMID: 36588580 PMCID: PMC9797732 DOI: 10.3389/fcvm.2022.1056037] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 11/30/2022] [Indexed: 12/23/2022] Open
Abstract
Background Frailty has been recognized as an important prognostic indicator in patients with acute myocardial infarction (AMI). However, no study has focused on critical AMI patients. We aimed to determine the impact of frailty on short- and long-term mortality risk in critical AMI patients. Methods Data from the Medical Information Mart for Intensive Care (MIMIC)-IV database was used. Frailty was assessed using the Hospital Frailty Risk Score (HFRS). Outcomes were in-hospital mortality and 1-year mortality. Logistic regression and Cox proportional-hazards models were used to investigate the association between frailty and outcomes. Results Among 5,003 critical AMI patients, 2,176 were non-frail (43.5%), 2,355 were pre-frail (47.1%), and 472 were frail (9.4%). The in-hospital mortality rate was 13.8%, and the 1-year mortality rate was 29.5%. In our multivariable model, frailty was significantly associated with in-hospital mortality [odds ratio (OR) = 1.30, 95% confidence interval (CI): 1.20-1.41] and 1-year mortality [hazard ratio (HR) = 1.29, 95% CI: 1.24-1.35] as a continuous variable (per five-score increase). When assessed as categorical variables, pre-frailty and frailty were both associated with in-hospital mortality (OR = 2.80, 95% CI: 2.19-3.59 and OR = 2.69, 95% CI: 1.93-3.73, respectively) and 1-year mortality (HR = 2.32, 95% CI: 2.00-2.69 and HR = 2.81, 95% CI: 2.33-3.39, respectively) after adjustment for confounders. Subgroup analysis showed that frailty was only associated with in-hospital mortality in critically ill patients with non-ST-segment elevation myocardial infarction (STEMI) but not STEMI (p for interaction = 0.012). In addition, frailty was associated with 1-year mortality in both STEMI and non-STEMI patients (p for interaction = 0.447). The addition of frailty produced the incremental value over the initial model generated by baseline characteristics for both in-hospital and 1-year mortality. Conclusion Frailty, as assessed by the HFRS, was associated with both in-hospital and 1-year mortality in critical AMI patients. Frailty improves the prediction of short- and long-term mortality in critical AMI patients and may have potential clinical applications.
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Affiliation(s)
- Weimin Bai
- Department of Emergency, Henan Provincial People’s Hospital, People’s Hospital of Zhengzhou University, People’s Hospital of Henan University, Zhengzhou, China
| | - Benchuan Hao
- Medical School of Chinese People’s Liberation Army (PLA), Beijing, China,Department of Cardiology, The Second Medical Center and National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
| | - Wenwen Meng
- The Northern District of PLA General Hospital, Beijing, China
| | - Ji Qin
- Medical School of Chinese People’s Liberation Army (PLA), Beijing, China,Department of Cardiology, The Second Medical Center and National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
| | - Weihao Xu
- Haikou Cadre’s Sanitarium of Hainan Military Region, Haikou, China,*Correspondence: Weihao Xu,
| | - Lijie Qin
- Department of Emergency, Henan Provincial People’s Hospital, People’s Hospital of Zhengzhou University, People’s Hospital of Henan University, Zhengzhou, China,Lijie Qin,
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Presta R, Brunetti E, Polidori MC, Bo M. Impact of frailty models on the prescription of oral anticoagulants and on the incidence of stroke, bleeding, and mortality in older patients with atrial fibrillation: a systematic review. Ageing Res Rev 2022; 82:101761. [PMID: 36270605 DOI: 10.1016/j.arr.2022.101761] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 09/30/2022] [Accepted: 10/14/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND Frailty is common in older patients with atrial fibrillation (AF). Current guidelines recommend oral anticoagulant therapy (OAT) except in case of severe frailty or reduced life expectancy, but definitive evidence on which "frailty" tools may help to identify older AF patients expected to derive little or no benefit from OAT is still lacking. Some persistent uncertainties may derive from the different clinical implications that the two major models of frailty, namely the frail phenotype (FP) and the deficit accumulation model (DAM), underlie. We thus conducted a systematic review of published studies to examine the association of the presence of frailty, categorized according to the FP and DAM, with 1) OAT prescription and 2) incidence of clinical outcomes (all-cause mortality, stroke and/or systemic embolism and major or clinically relevant non-major bleeding) in patients receiving OAT. METHODS Embase and MEDLINE were searched from inception until May 31st, 2022, for studies using a validated tool to identify frailty in subjects aged 65 years or older with a diagnosis of non-valvular AF; only studies on patients prescribed an OAT were considered eligible for the analyses involving clinical outcomes. The protocols for each review question have been registered in PROSPERO database (CRD42022308623 and CRD42022308628). FINDINGS Twenty-three studies exploring the association between frailty and OAT prescription on a total of 504 719 subjects were included. Patients with increasing severity of DAM frailty showed consistently lower OAT prescription rates than non-frail patients, whereas use of OAT did not significantly differ between patients with the FP compared with non-frail subjects. Eleven studies exploring the association between frailty and clinical outcomes on a total of 41 985 individuals receiving oral anticoagulation were included. Compared with non-frail subjects, a higher risk of all-cause mortality and clinical outcomes could be observed for AF patients prescribed with OAT with severe frailty according to the DAM, with inconclusive findings for the FP. High levels of heterogeneity were observed in both groups of studies; therefore, a meta-analysis was not performed. CONCLUSIONS Due to the great heterogeneity among different validated frailty measures, indiscriminately relying on "frailty" should not be regarded as the gold standard for clinical decision-making about stroke prevention in older AF patients. Present findings suggest that severe frailty according to the DAM is associated with less use of OAT and increased risk of all-cause mortality, thereby representing at the moment the most reasonable tool to efficiently recognize patients with limited life expectancy and for whom there is so far scant, if any, evidence of a clinical benefit of OAT.
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Affiliation(s)
- Roberto Presta
- Section of Geriatrics, Department of Medical Sciences, University of Turin, AOU Città della Salute e della Scienza - Molinette, Corso Bramante 88-90, 10126 Turin, Italy.
| | - Enrico Brunetti
- Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla 3, 50134 Florence, Italy; Section of Internal Medicine, Department of Medical Sciences, University of Turin, AOU Città della Salute e della Scienza - Sant'Anna, Corso Bramante 88-90, 10126 Turin, Italy.
| | - Maria Cristina Polidori
- Ageing Clinical Research, Department II of Internal Medicine and Center for Molecular Medicine Cologne, University of Cologne, Faculty of Medicine and University Hospital Cologne, Kerpener Straße 62, 50937 Cologne, Germany; Cologne Excellence Cluster On Cellular Stress-Responses in Aging-Associated Diseases (CECAD), University of Cologne, Faculty of Medicine and University Hospital Cologne, Joseph-Stelzmann Straße 26, 50931 Cologne, Germany.
| | - Mario Bo
- Section of Geriatrics, Department of Medical Sciences, University of Turin, AOU Città della Salute e della Scienza - Molinette, Corso Bramante 88-90, 10126 Turin, Italy.
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Zhang M, Zhang L, Hu Y, Wang Y, Xu S, Xie X, Xu T, Li Z, Jin H, Liu H. Sarcopenia and echocardiographic parameters for prediction of cardiovascular events and mortality in patients undergoing maintenance hemodialysis. PeerJ 2022; 10:e14429. [PMID: 36444383 PMCID: PMC9700452 DOI: 10.7717/peerj.14429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 10/30/2022] [Indexed: 11/24/2022] Open
Abstract
Background Sarcopenia is prevalent and is associated with the occurrence of cardiovascular complications in patients undergoing maintenance hemodialysis (MHD). It is unknown how skeletal muscle may be associated with aspects of myocardial structure and function. This study aimed to evaluate the association between sarcopenia and cardiac structure and function in patients undergoing MHD. We also examined the prognostic role of sarcopenia for mortality and cardiovascular events (CVE) in this population. Methods Participants from a single center underwent bioimpedance body composition analysis to measure skeletal muscle and echocardiography to assess myocardial structure and function. Sarcopenia was diagnosed based on the Asian Working Group for Sarcopenia criteria. The end points were all-cause mortality and CVE. Results Of the 158 participants, 46 (29.1%) had sarcopenia, 102 (64.6%) had left ventricular diastolic dysfunction (LVDD), and 106 (67.0%) had left ventricular hypertrophy (LVH). Participants with sarcopenia had smaller right ventricular sizes (2.54 ± 0.77 vs 2.76 ± 0.28; P < 0.01), inter-ventricular thickness (1.07 ± 0.19 vs 1.14 ± 0.20; P = 0.039), and left ventricular posterior wall thickness (0.96, 0.89-1.10 vs 1.06, 0.95-1.20; P = 0.018). Skeletal muscle mass was strongly correlated with left ventricular mass (LVM) (r = 0.577; P < 0.0001). Furthermore, the risk of LVDD (OR: 4.92, 95% confidence interval (CI) [1.73-13.95]) and LVH (OR: 4.88, 95% CI [1.08-21.96]) was much higher in the sarcopenic group than in the non-sarcopenic group. During a follow-up period of 18 months, 11 (6.9%) patients died, of which seven died (4.4%) of CVE, and 36 (22.8%) experienced CVE. The presence of sarcopenia (adjusted hazard ratio (HR), 6.59; 95% CI [1.08-39.91]; P = 0.041) and low skeletal muscle index (HR, 3.41; 95% CI [1.01-11.57]; P = 0.049) and handgrip strength (HR, 0.88; 95% CI [0.78-0.99]; P = 0.037) independently predicted death. Sarcopenia was a significant predictor of CVE (HR, 10.96; 95% CI [1.14-105.10]; P = 0.038). Conclusion Our findings demonstrated that sarcopenia is associated with LVDD and LVH, and is associated with a higher probability of death and CVE.
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Affiliation(s)
- Mengyan Zhang
- Zhongda Hospital, Southeast University School of Medicine, Institute of Nephrology, Nanjing, Jiangsu Province, China
| | - Liuping Zhang
- Zhongda Hospital, Southeast University School of Medicine, Institute of Nephrology, Nanjing, Jiangsu Province, China
| | - Yezi Hu
- Zhongda Hospital, Southeast University School of Medicine, Institute of Nutrition, Nanjing, Jiangsu Province, China
| | - Ying Wang
- Zhongda Hospital, Southeast University School of Medicine, Institute of Nephrology, Nanjing, Jiangsu Province, China
| | - Shengchun Xu
- Zhongda Hospital, Southeast University School of Medicine, Institute of Nephrology, Nanjing, Jiangsu Province, China
| | - Xiaotong Xie
- Zhongda Hospital, Southeast University School of Medicine, Institute of Nephrology, Nanjing, Jiangsu Province, China
| | - Tian Xu
- Zhongda Hospital, Southeast University School of Medicine, Institute of Nephrology, Nanjing, Jiangsu Province, China
| | - Zuolin Li
- Zhongda Hospital, Southeast University School of Medicine, Institute of Nephrology, Nanjing, Jiangsu Province, China
| | - Hui Jin
- Zhongda Hospital, Southeast University School of Medicine, Institute of Nutrition, Nanjing, Jiangsu Province, China
| | - Hong Liu
- Zhongda Hospital, Southeast University School of Medicine, Institute of Nephrology, Nanjing, Jiangsu Province, China
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Meng L, Xu J, Li J, Hu J, Xu H, Wu D, Hu X, Zeng X, Zhang Q, Li J, Gong T, Liu D. Self-reported prevalence and potential factors influencing cardio-cerebral vascular disease among the Chinese elderly: A national cross-sectional study. Front Cardiovasc Med 2022; 9:979015. [PMID: 36337863 PMCID: PMC9630358 DOI: 10.3389/fcvm.2022.979015] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 10/03/2022] [Indexed: 08/10/2023] Open
Abstract
BACKGROUND Aging is an essential national condition throughout China in the 21st century. Cardio-cerebral vascular disease (CCVD) is a common chronic vascular disease in the elderly. Despite aging becoming an increasingly pressing issue, there has been no comprehensive national investigation into the risk factors, prevalence, and management of CCVD among the elderly population in China. MATERIALS AND METHODS Through the 4th Survey of the Aged Population in Urban and Rural China (SSAPUR), a nationally representative sample of 224,142 adults aged more than 60 years was surveyed using a multistage, stratified sampling method. The 4th SSAPUR was used to investigate CCVD in the elderly. Univariate and multivariate logistic proportional regression analyses explored the risk factors. These risk factors were then entered into a multivariate linear regression model to identify independent predictive factors for CCVD. Disease management was assessed from the self-reported history of physician diagnosis, treatments, and hospital visits among individuals with CCVD. RESULTS After excluding samples with missing information, 215,041 individuals were included in the analysis. The overall prevalence of CCVD was 26%. Living in a rural area, being older, being female, having low literacy, smoking, getting little sleep, losing a spouse, being single, not getting enough exercise, having a bad financial situation, and not taking part in public welfare programs were the main risk factors for CCVD among the elderly in China (P < 0.05). In the multivariate linear regression model, holding all other variables at any fixed value, CCVD remained associated with "urban and rural" (β = 0.012, P < 0.001), "age" (β = -0.003, P < 0.001), "sex" (β = -0.022, P < 0.001), "education level" (β = -0.017, P < 0.001), "marriage" (β = 0.004, P = 0.047), "smoking" (β = 0.012, P = 0.003), "drinking" (β = -0.015, P = 0.001), and "sleep" (β = 0.008, P = 0.005). There were no collinearity problems among these factors. CONCLUSION Major risk factors for prevalent CCVD among the elderly in China include the following: rural residence, female, low literacy level, poor sleep quality, bereavement, non-marriage, living alone, lack of exercise, poor financial situation, and non-participation in public welfare activities. Chinese national policies for preventing, controlling, and managing risk factors for CCVD in the elderly must be urgently developed.
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Affiliation(s)
- Lingbing Meng
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
- Graduate School, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jiapei Xu
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
- Graduate School, Peking University Fifth School of Clinical Medicine (Beijing Hospital), Beijing, China
| | - Jianyi Li
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
- Graduate School, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jiabin Hu
- Health Service Department of the Guard Bureau of the Joint Staff Department, Beijing, China
| | - Hongxuan Xu
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Dishan Wu
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
- Graduate School, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xing Hu
- Health Service Department of the Guard Bureau of the Joint Staff Department, Beijing, China
| | - Xuezhai Zeng
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | | | - Juan Li
- Center on Aging Psychology, Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
- State Key Laboratory of Brain and Cognitive Science, Institute of Biophysics, Chinese Academy of Sciences, Beijing, China
| | - Tao Gong
- Department of Neurology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Deping Liu
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
- Graduate School, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Macêdo GAD, Freire YA, Browne RAV, Câmara M, Cabral LLP, Schwade D, Paulo-Pereira R, Silva RDM, Silva AMB, Farias-Junior LF, Duhamel TA, Costa EC. Pre-Frailty Phenotype and Arterial Stiffness in Older Adults Free of Cardiovascular Diseases. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph192013469. [PMID: 36294048 PMCID: PMC9603482 DOI: 10.3390/ijerph192013469] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 10/06/2022] [Accepted: 10/11/2022] [Indexed: 06/02/2023]
Abstract
PURPOSE Arterial stiffness is a subclinical marker of cardiovascular disease (CVD). The pre-frailty phenotype is associated with a higher risk for CVD. This study investigated the association between the pre-frailty phenotype and arterial stiffness in community-dwelling older adults without diagnosed CVD. METHODS In total, 249 community-dwelling older adults aged 60-80 years were included in this cross-sectional study. The pre-frailty phenotype was defined by the standardized Fried criteria (muscle weakness; slow walking speed; low physical activity; unintentional weight loss; self-reported exhaustion). Participants with one or two standardized Fried criteria were classified as pre-frail and those with zero criteria as robust. Arterial stiffness was measured by aortic pulse wave velocity (aPWV). The data were analyzed using the generalized linear model. RESULTS From 249 participants (66.1 ± 5.3 years; 79.5% females), 61.8% (n = 154) were pre-frail and 38.2% (n = 95) robust. Pre-frail older adults had a higher aPWV (β = 0.19 m/s; p = 0.007) compared to their robust peers. CONCLUSIONS The pre-frailty phenotype was associated with higher arterial stiffness in community-dwelling older adults aged 60-80 years. Pre-frail older adults may have a higher risk for CVD.
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Affiliation(s)
- Geovani Araújo Dantas Macêdo
- ExCE Research Group, Department of Physical Education, Federal University of Rio Grande do Norte, Natal 59078-970, RN, Brazil
| | - Yuri Alberto Freire
- ExCE Research Group, Department of Physical Education, Federal University of Rio Grande do Norte, Natal 59078-970, RN, Brazil
- Graduate Program in Health Sciences, Federal University of Rio Grande do Norte, Natal 59012-570, RN, Brazil
| | - Rodrigo Alberto Vieira Browne
- ExCE Research Group, Department of Physical Education, Federal University of Rio Grande do Norte, Natal 59078-970, RN, Brazil
- Graduate Program in Health Sciences, Federal University of Rio Grande do Norte, Natal 59012-570, RN, Brazil
| | - Marcyo Câmara
- ExCE Research Group, Department of Physical Education, Federal University of Rio Grande do Norte, Natal 59078-970, RN, Brazil
- Graduate Program in Health Sciences, Federal University of Rio Grande do Norte, Natal 59012-570, RN, Brazil
| | - Ludmila Lucena Pereira Cabral
- ExCE Research Group, Department of Physical Education, Federal University of Rio Grande do Norte, Natal 59078-970, RN, Brazil
- Graduate Program in Health Sciences, Federal University of Rio Grande do Norte, Natal 59012-570, RN, Brazil
| | - Daniel Schwade
- ExCE Research Group, Department of Physical Education, Federal University of Rio Grande do Norte, Natal 59078-970, RN, Brazil
- Faculty of Kinesiology and Recreation Management, University of Manitoba, Winnipeg, MB R3T 2N2, Canada
- Institute of Cardiovascular Sciences, St. Boniface General Hospital Research Centre, Winnipeg, MB R3T 2N2, Canada
| | - Ronildo Paulo-Pereira
- ExCE Research Group, Department of Physical Education, Federal University of Rio Grande do Norte, Natal 59078-970, RN, Brazil
- Graduate Program in Health Sciences, Federal University of Rio Grande do Norte, Natal 59012-570, RN, Brazil
| | - Raíssa de Melo Silva
- ExCE Research Group, Department of Physical Education, Federal University of Rio Grande do Norte, Natal 59078-970, RN, Brazil
| | - Alana Monteiro Bispo Silva
- ExCE Research Group, Department of Physical Education, Federal University of Rio Grande do Norte, Natal 59078-970, RN, Brazil
| | - Luiz Fernando Farias-Junior
- ExCE Research Group, Department of Physical Education, Federal University of Rio Grande do Norte, Natal 59078-970, RN, Brazil
- Graduate Program in Psychobiology, Federal University of Rio Grande do Norte, Natal 59078-970, RN, Brazil
| | - Todd A. Duhamel
- Faculty of Kinesiology and Recreation Management, University of Manitoba, Winnipeg, MB R3T 2N2, Canada
- Institute of Cardiovascular Sciences, St. Boniface General Hospital Research Centre, Winnipeg, MB R3T 2N2, Canada
| | - Eduardo Caldas Costa
- ExCE Research Group, Department of Physical Education, Federal University of Rio Grande do Norte, Natal 59078-970, RN, Brazil
- Graduate Program in Health Sciences, Federal University of Rio Grande do Norte, Natal 59012-570, RN, Brazil
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Bao X, Chung LYF, Wen Y, Du Y, Sun Q, Wang Y. A visualization analysis of hotspots and frontiers of cardiovascular diseases with frailty. Front Public Health 2022; 10:915037. [PMID: 36299762 PMCID: PMC9589423 DOI: 10.3389/fpubh.2022.915037] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 09/12/2022] [Indexed: 01/22/2023] Open
Abstract
Cardiovascular diseases (CVD) and frailty are common health problems among the elderly. This research aims to investigate the hotspots and frontiers of the field of CVD with frailty. Data of publications between 2000 and 2021 were collected from the Web of Science Core Collection (WoSCC) and CiteSpace was used for analyzing the hotspots and frontiers of cardiovascular diseases with frailty research from high-impact countries/regions, institutions, authors, cited references, cited journals, high-frequency keywords, and burst keywords. The results showed that the USA, England, and Canada were the leading countries/regions in research on CVD with frailty. Other countries/regions and regions lagged behind these developed countries/regions. There is a need to establish cooperation between developed countries/regions and developing countries/regions. Research hotspots focused on frailty in the elderly with CVD, exercise intervention, assessment for CVD patients with frailty, quality of life, and common diseases related to CVD with frailty. The frontier fields include care and intervention of CVD patients with frailty, social frailty, and validation of CVD with frailty.
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Affiliation(s)
- Xuping Bao
- Evidence-Based Nursing Center, School of Nursing, Lanzhou University, Lanzhou, China
| | - Loretta Yuet Foon Chung
- Evidence-Based Nursing Center, School of Nursing, Lanzhou University, Lanzhou, China,*Correspondence: Loretta Yuet Foon Chung
| | - Yujie Wen
- Department of Cardiovascular Medicine, Gansu Provincial Hospital, Lanzhou, China
| | - Yifei Du
- Evidence-Based Nursing Center, School of Nursing, Lanzhou University, Lanzhou, China
| | - Qiyu Sun
- Evidence-Based Nursing Center, School of Nursing, Lanzhou University, Lanzhou, China
| | - Yi Wang
- Evidence-Based Nursing Center, School of Nursing, Lanzhou University, Lanzhou, China
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Liu X, Tou NX, Gao Q, Gwee X, Wee SL, Ng TP. Frailty and risk of cardiovascular disease and mortality. PLoS One 2022; 17:e0272527. [PMID: 36121826 PMCID: PMC9484650 DOI: 10.1371/journal.pone.0272527] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 07/20/2022] [Indexed: 11/18/2022] Open
Abstract
Background Prospective cohort studies suggest that frailty is associated with an increased risk of incident cardiovascular disease (CVD) morbidity and mortality, but their mechanistic and developmental relations are not fully understood. We investigated whether frailty predicted an increased risk of incident nonfatal and fatal CVD among community-dwelling older adults. Methods A population cohort of 5015 participants aged 55 years and above free of CVD at baseline was followed for up to 10 years. Pre-frailty and frailty were defined as the presence of 1–2 and 3–5 modified Fried criteria (unintentional weight loss, weakness, slow gait speed, exhaustion, and low physical activity), incident CVD events as newly diagnosed registered cases of myocardial infarction (MI), stroke, and CVD-related mortality (ICD 9: 390 to 459 or ICD-10: I00 to I99). Covariate measures included traditional cardio-metabolic and vascular risk factors, medication therapies, Geriatric Depression Scale (GDS), Mini-Mental State Exam (MMSE), and blood biomarkers (haemoglobin, albumin, white blood cell counts and creatinine). Results Pre-frailty and frailty were significantly associated with elevated HR = 1.26 (95%CI: 1.02–1.56) and HR = 1.54 (95%CI:1.00–2.35) of overall CVD, adjusted for cardio-metabolic and vascular risk factors and medication therapies, but not after adjustment for GDS depression and MMSE cognitive impairment. The HR of association between frailty status and both CVD mortality and overall mortality, however, remained significantly elevated after full adjustment for depression, cognitive and blood biomarkers. Conclusion Frailty was associated with increased risk of CVD morbidity and especially mortality, mediated in parts by traditional cardio-metabolic and vascular risk factors, and co-morbid depression and associated cognitive impairment and chronic inflammation. Given that pre-frailty and frailty are reversible by multi-domain lifestyle and health interventions, there is potential benefits in reducing cardiovascular diseases burden and mortality from interventions targeting pre-frailty and early frailty population.
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Affiliation(s)
- Xiao Liu
- Geriatric Education and Research Institute, Singapore, Singapore
| | - Nien Xiang Tou
- Geriatric Education and Research Institute, Singapore, Singapore
| | - Qi Gao
- Gerontology Research Programme, Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Xinyi Gwee
- Gerontology Research Programme, Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Shiou Liang Wee
- Geriatric Education and Research Institute, Singapore, Singapore
- Health and Social Sciences Cluster, Singapore Institute of Technology, Singapore, Singapore
| | - Tze Pin Ng
- Geriatric Education and Research Institute, Singapore, Singapore
- Gerontology Research Programme, Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- * E-mail:
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Peng Y, Zhong GC, Zhou X, Guan L, Zhou L. Frailty and risks of all-cause and cause-specific death in community-dwelling adults: a systematic review and meta-analysis. BMC Geriatr 2022; 22:725. [PMID: 36056319 PMCID: PMC9437382 DOI: 10.1186/s12877-022-03404-w] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Accepted: 08/22/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The associations of frailty with all-cause and cause-specific mortality remain unclear. Therefore, we performed this meta-analysis to fill this gap. METHODS We searched the PubMed and Embase databases through June 2022. Prospective cohort studies or clinical trials examining frailty were evaluated, and the multiple adjusted risk estimates of all-cause and cause-specific mortality, such as death from cardiovascular disease (CVD), cancer, respiratory illness, dementia, infection, and coronavirus disease 2019 (COVID-19), were included. A random effects model was used to calculate the summary hazard ratio (HR). RESULTS Fifty-eight studies were included for the qualitative systematic review, of which fifty-six studies were eligible for the quantitative meta-analysis, and the studies included a total of 1,852,951 individuals and more than 145,276 deaths. Compared with healthy adults, frail adults had a significantly higher risk of mortality from all causes (HR 2.40; 95% CI 2.17-2.65), CVD (HR 2.64; 95% CI 2.20-3.17), respiratory illness (HR 4.91; 95% CI 2.97-8.12), and cancer (HR 1.97; 95% CI 1.50-2.57). Similar results were found for the association between prefrail adults and mortality risk. In addition, based on the studies that have reported the HRs of the mortality risk per 0.1 and per 0.01 increase in the frailty index, we obtained consistent results. CONCLUSIONS The present study demonstrated that frailty was not only significantly related to an increased risk of all-cause mortality but was also a strong predictor of cause-specific mortality from CVD, cancer, and respiratory illness in community-dwelling adults. More studies are warranted to clarify the relationship between frailty and cause-specific mortality from dementia, infection, and COVID-19. TRIAL REGISTRATION PROSPERO (CRD42021276021).
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Affiliation(s)
- Yang Peng
- Geriatric Diseases Institute of Chengdu, Department of Geriatrics, Chengdu Fifth People's Hospital, Chengdu, 611137, China.
- The Second Clinical Medical College, Affiliated Fifth People's Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, 611137, China.
| | - Guo-Chao Zhong
- Department of Hepatobiliary Surgery, the Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xiaoli Zhou
- Department of Laboratory Medicine, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
- Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, China
| | - Lijuan Guan
- Geriatric Diseases Institute of Chengdu, Department of Geriatrics, Chengdu Fifth People's Hospital, Chengdu, 611137, China
- The Second Clinical Medical College, Affiliated Fifth People's Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, 611137, China
| | - Lihua Zhou
- Geriatric Diseases Institute of Chengdu, Department of Geriatrics, Chengdu Fifth People's Hospital, Chengdu, 611137, China
- The Second Clinical Medical College, Affiliated Fifth People's Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, 611137, China
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Abstract
Hypertension is a frequent finding in elderly patients. Hypertension in older age can be both associated with frailty and represent a risk factor for frailty. Hypertension is recognized as a main risk factor for cardiovascular diseases such as heart failure, atrial fibrillation, and stroke and the occurrence of these diseases may provoke a decline in health status and/or worsen the degree of frailty. Blood pressure targets in hypertensive older and frail patients are not completely defined. However, specific evaluations of individual patients and their co-morbidities and assessment of domains and components of frailty, together with weighted consideration of drug use, may help in finding the appropriate therapy.
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Daou T, Abi Kharma J, Daccache A, Bassil M, Naja F, Rahi B. Association between Lebanese Mediterranean Diet and Frailty in Community-Dwelling Lebanese Older Adults-A Preliminary Study. Nutrients 2022; 14:nu14153084. [PMID: 35956260 PMCID: PMC9370448 DOI: 10.3390/nu14153084] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 07/22/2022] [Accepted: 07/26/2022] [Indexed: 02/05/2023] Open
Abstract
Discrepancies in the characteristics of the food components of a Mediterranean diet exist based on the country of origin. In Lebanon, a traditional Mediterranean diet emphasizes the high intakes of fruits (including dried), vegetables, burghol, and dairy products. Therefore, this cross-sectional study aimed to explore the association between adherence to the Lebanese Mediterranean diet (LMD) and frailty among older adults in Lebanon. A total of 112 community-dwelling older adults aged ≥65 years were recruited. Demographic and clinical characteristics were collected through face-to-face interviews. A 61-item food frequency questionnaire (FFQ) was used to collect dietary intake data, and adherence to LMD was calculated. Physical frailty was defined by the presence of three out of the five criterion: weight loss, weakness, exhaustion, slowness, and low activity. Binary logistic regression was used to examine the relationship between LMD adherence and frailty while adjusting for several confounders. The participants’ mean age was 73 ± 12.8 and 65% were females. Sixteen (14.3%) individuals were identified as frail. Frail individuals were significantly older (p = 0.001), depressed (p < 0.001), at risk of cognitive impairment (p = 0.006), and reported polypharmacy (p = 0.003). No significant association was found between LMD adherence and frailty in fully adjusted models (OR = 0.195; 95% CI: 0.033−1.154; p = 0.071 when categorical and OR = 0.856; 95% CI: 0.668−1.097; p = 0.218 when continuous). We also performed additional analyses with a modified frailty index where house chores were not considered as part of leisure activities of the physical activity criterion. The results showed that a higher LMD adherence was associated with a significantly decreased frailty prevalence (OR = 0.123, 95% CI: 0.022−0.676, p = 0.016 when categorical and OR = 0.773, 95% CI 0.608−0.983, p = 0.036). Larger, longitudinal studies are needed to clarify the relationship between the adherence to the Lebanese Mediterranean diet and frailty in Lebanese older adults.
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Affiliation(s)
- Tracy Daou
- Department of Natural Sciences, School of Arts and Sciences, Lebanese American University, P.O. Box 13-5053, Chouran, Beirut 1102 2801, Lebanon; (T.D.); (J.A.K.); (A.D.)
| | - Joelle Abi Kharma
- Department of Natural Sciences, School of Arts and Sciences, Lebanese American University, P.O. Box 13-5053, Chouran, Beirut 1102 2801, Lebanon; (T.D.); (J.A.K.); (A.D.)
| | - Alexandra Daccache
- Department of Natural Sciences, School of Arts and Sciences, Lebanese American University, P.O. Box 13-5053, Chouran, Beirut 1102 2801, Lebanon; (T.D.); (J.A.K.); (A.D.)
| | - Maya Bassil
- Department of Human Nutrition, College of Health Sciences, Qatar University, Doha P.O. Box 2713, Qatar;
| | - Farah Naja
- Department of Clinical Nutrition and Dietetics, Research Institute of Medical & Health Sciences (RIMHS), College of Health Sciences, University of Sharjah, Sharjah 27272, United Arab Emirates;
- Department of Nutrition and Food Sciences, Faculty of Agriculture and Food Sciences, American University of Beirut, P.O. Box 11-0236, Riad El Solh, Beirut 1107 2020, Lebanon
| | - Berna Rahi
- Department of Family and Consumer Sciences, College of Health Sciences, Sam Houston State University, Huntsville, TX 77304, USA
- Correspondence: ; Tel.: +1-936-294-1986
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Benefits of a Balance Exercise Assist Robot in the Cardiac Rehabilitation of Older Adults with Cardiovascular Disease: A Preliminary Study. J Cardiovasc Dev Dis 2022; 9:jcdd9060191. [PMID: 35735820 PMCID: PMC9224750 DOI: 10.3390/jcdd9060191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Revised: 06/09/2022] [Accepted: 06/10/2022] [Indexed: 12/10/2022] Open
Abstract
We examined whether adding robot-supported balance exercises to cardiac rehabilitation improves the ability to balance in older adults with cardiovascular disease (CVD). We conducted a prospective study in 52 older adults who had been hospitalized for worsening CVD. Once weekly for four months, for a total of sixteen sessions as outpatients, the subjects used a Balance Exercise Assist Robot (BEAR) to perform balance exercises and an ergometer for aerobic exercises. Participants’ mean age was 76.9 ± 6.8 years (range, 65−95 years), and their mean brain natriuretic protein level was 164.0 ± 190.0 pg/mL. After the intervention, participants showed significant improvements in gait speed (before, 1.06 ± 0.33 m/s; after, 1.23 ± 0.30 m/s; p < 0.001), Short Physical Performance Battery score (before, 10.02 ± 2.25; after, 10.88 ± 1.79; p ˂ 0.001), timed up-and-go (before, 11.11 ± 5.07 s; after, 9.45 ± 3.45 s; p ˂ 0.001), and knee extension (before, 26.97 ± 11.78 kgf; after, 30.13 ± 13.04 kgf; p = 0.001). Cardiac rehabilitation including exercises using BEAR improved physical functioning and the ability to balance in older adults with CVD. Frail and prefrail patients improved, whereas robust ones did not change.
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Qiao X, Ji L, Jin Y, Si H, Bian Y, Wang W, Liu Q, Yu J, Wang C. A theory-driven exercise intervention among community-dwelling (pre)frail older adults: Protocol for a stepped-wedge cluster-randomized trial. J Adv Nurs 2022; 78:2634-2645. [PMID: 35621366 DOI: 10.1111/jan.15303] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 05/07/2022] [Accepted: 05/07/2022] [Indexed: 11/26/2022]
Abstract
AIM This study is aimed to evaluate the effectiveness of a theory-driven exercise intervention for Chinese community-dwelling (pre)frail older adults, and to clarify the underlying mechanisms of the exercise intervention in this population. DESIGN A stepped-wedge cluster-randomized trial. METHODS A stepped-wedge cluster-randomized trial will be conducted among (pre)frail older adults at six communities in a county of central China. A 12-week multicomponent exercise intervention based on the integration of the Health Belief Model (HBM) and the Theory of Planned Behaviour (TPB) will be implemented to all participants during the study period. The primary outcomes are frailty, muscle mass, muscle strength and physical performance. Secondary outcomes include beliefs in exercise, exercise behaviours and other physical, mental and social functioning. Assessments will be conducted at baseline and at week 12, 24 and 36. A multilevel regression model will be used to evaluate the effectiveness of exercise interventions. A multilevel mediation model will be used to clarify the underlying mechanisms of this exercise intervention. DISCUSSION This study is expected to provide an effective and practical mode for exercise interventions among Chinese community-dwelling (pre)frail older adults, and contribute to the existing evidence in this field. TRIAL REGISTRATION Chinese Clinical Trial Registry ChiCTR2100041981.
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Affiliation(s)
- Xiaoxia Qiao
- School of Nursing, Peking University, Beijing, China
| | - Lili Ji
- School of Nursing, Peking University, Beijing, China
| | - Yaru Jin
- School of Nursing, Peking University, Beijing, China
| | - Huaxin Si
- School of Nursing, Peking University, Beijing, China
| | - Yanhui Bian
- School of Nursing, Peking University, Beijing, China
| | - Wenyu Wang
- School of Nursing, Peking University, Beijing, China
| | - Qinqin Liu
- School of Nursing, Peking University, Beijing, China
| | - Jiaqi Yu
- School of Nursing, Peking University, Beijing, China
| | - Cuili Wang
- School of Nursing, Peking University, Beijing, China
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Shakya S, Bajracharya R, Ledbetter L, Cary MP. The Association Between Cardiometabolic Risk Factors and Frailty in Older Adults: A Systematic Review. Innov Aging 2022; 6:igac032. [PMID: 35795135 PMCID: PMC9250659 DOI: 10.1093/geroni/igac032] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Indexed: 11/25/2022] Open
Abstract
Background and Objectives Enhanced management and prevention of frailty depend on our understanding of the association between potentially modifiable risk factors and frailty. However, the associations between potentially modifiable cardiometabolic risk factors and frailty are not clear. The purpose of this review was to appraise and synthesize the current evidence examining the associations between the cardiometabolic risk factors and frailty. Research Design and Methods Multiple databases, including MEDLINE (via PubMed), Embase (via Elsevier), and Web of Science (via Clarivate), were searched extensively. Studies that examined cardiometabolic risk factors and frailty as main predictors and outcome of interest, respectively, among older adults (≥60 years) were included. The Joanna Briggs Institute critical appraisal tools were used to evaluate the quality of studies. PRISMA (2020) guided this review, and findings were synthesized without meta-analysis. This systematic review was registered in PROSPERO (CRD42021252565). Results Twelve studies met the eligibility criteria and were included in the review. Abdominal obesity, hyperglycemia, and multiple co-occurring cardiometabolic risk factors were associated with the increased likelihood of frailty in older adults. There was inconsistency across the studies regarding the associations between dyslipidemia, elevated blood pressure, and frailty. Discussion and Implications Understanding the association between cardiometabolic risk factors and frailty can have translational benefits in developing tailored interventions for the prevention and management of frailty. More studies are needed to validate predictive and clinically significant associations between single and specific combinations of co-occurring cardiometabolic risk factors and frailty.
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Affiliation(s)
| | | | - Leila Ledbetter
- School of Medicine, Medical Center Library and Archives, Duke University, Durham, North Carolina, USA
| | - Michael P Cary
- School of Nursing, Duke University, Durham, North Carolina, USA
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McKechnie DGJ, Patel M, Papacosta AO, Lennon LT, Ellins EA, Halcox JPJ, Ramsay SE, Whincup PH, Wannamethee SG. Associations between inflammation, coagulation, cardiac strain and injury, and subclinical vascular disease with frailty in older men: a cross-sectional study. BMC Geriatr 2022; 22:405. [PMID: 35527242 PMCID: PMC9082861 DOI: 10.1186/s12877-022-03106-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 04/27/2022] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Inflammation, coagulation activation, endothelial dysfunction and subclinical vascular disease are cross-sectionally associated with frailty. Cardiac-specific biomarkers are less-well characterised. We assessed associations between these and frailty, in men with, and without, cardiovascular disease (CVD). METHODS Cross-sectional analysis of 1096 men without, and 303 with, CVD, aged 71-92, from the British Regional Heart Study. Multinominal logistic regression was performed to examine the associations between frailty status (robust/pre-frail/frail) and, separately, C-reactive protein (CRP), interleukin-6 (IL-6), tissue plasminogen activator (tPA), D-dimer, von Willebrand factor (vWF), high-sensitivity cardiac troponin-T (hs-cTnT), N-terminal pro B-type natriuretic peptide (NT-proBNP) (all natural log-transformed), and, in men without CVD, carotid intima-media thickness (CIMT), carotid-femoral pulse wave velocity (cfPWV), carotid distensibility coefficient (DC), and ankle-brachial pressure index (ABPI), adjusted for age, renal function, BMI, social class, smoking, polypharmacy, cognition, multimorbidity and systolic blood pressure. Explanatory variables with p < 0.05 were carried forward into mutually-adjusted analysis. RESULTS In men without CVD, higher CRP, IL-6, vWF, tPA, hs-cTnT, NT-proBNP, cfPWV, and lower DC were significantly associated with frailty; mutually-adjusted, log IL-6 (OR for frailty = 2.02, 95%CI 1.38-2.95), log hs-cTnT (OR = 1.95, 95%CI 1.24-3.05) and DC (OR = 0.92, 95%CI 0.86-0.99) retained associations. In men with CVD, higher CRP, IL-6, and hs-cTnT, but not vWF, tPA, NT-proBNP or D-dimer, were significantly associated with frailty; mutually-adjusted, log hs-cTnT (OR 3.82, 95%CI 1.84-7.95) retained a significant association. CONCLUSIONS In older men, biomarkers of myocardial injury are associated with frailty. Inflammation is associated with frailty in men without CVD. Carotid artery stiffness is associated with frailty in men without CVD, independently of these biomarkers.
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Affiliation(s)
- Douglas G J McKechnie
- Department of Primary Care and Population Health, University College London, London, NW3 2PF, UK.
| | - Meera Patel
- Department of Primary Care and Population Health, University College London, London, NW3 2PF, UK
| | - A Olia Papacosta
- Department of Primary Care and Population Health, University College London, London, NW3 2PF, UK
| | - Lucy T Lennon
- Department of Primary Care and Population Health, University College London, London, NW3 2PF, UK
| | | | | | - Sheena E Ramsay
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Peter H Whincup
- Population Health Research Institute, St George's University of London, London, UK
| | - S Goya Wannamethee
- Department of Primary Care and Population Health, University College London, London, NW3 2PF, UK
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Impact of Frailty on the Relationship between Blood Pressure and Cardiovascular Diseases and Mortality in Young-Old Adults. J Pers Med 2022; 12:jpm12030418. [PMID: 35330418 PMCID: PMC8949292 DOI: 10.3390/jpm12030418] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 03/05/2022] [Accepted: 03/06/2022] [Indexed: 12/04/2022] Open
Abstract
The optimal blood pressure (BP) target in older people according to frailty status remains uncertain. This article investigates how frailty affects the association between BP and cardiovascular diseases or mortality, specifically in young-old adults. A retrospective cohort was created for 708,964 older adults with a uniform age of 66 years. The association between BP and myocardial infarction (MI), stroke, or mortality was analyzed using Cox proportional hazards models. The Timed Up and Go test (TUG) was used as a measure of physical frailty. Mean follow-up was 6.8 years, detecting 38,963 (5.5%) events. There was a linear association between increasing systolic BP (SBP) or diastolic BP (DBP) and increased risk of incident MI and stroke, compared to the reference BP (SBP, 110−119 mmHg or DBP, 80−89 mmHg). The risk patterns with high BP remained similar in each TUG group (<10, 10−14, or ≥15 s). A similar pattern of increased risks was found in those who took antihypertensive drugs and who did not, however they were more pronounced in those who did not. The findings support the need to achieve the same BP target in young-old adults with or without frailty to lower the risk of MI, stroke, and mortality.
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Sezgin D, O'Donovan M, Woo J, Bandeen-Roche K, Liotta G, Fairhall N, Rodríguez-Laso A, Apóstolo J, Clarnette R, Holland C, Roller-Wirnsberger R, Illario M, Mañas LR, Vollenbroek-Hutten M, Doğu BB, Balci C, Pernas FO, Paul C, Ahern E, Romero-Ortuno R, Molloy W, Cooney MT, O'Shea D, Cooke J, Lang D, Hendry A, Kennelly S, Rockwood K, Clegg A, Liew A, O'Caoimh R. Early identification of frailty: Developing an international delphi consensus on pre-frailty. Arch Gerontol Geriatr 2022; 99:104586. [DOI: 10.1016/j.archger.2021.104586] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 11/11/2021] [Accepted: 11/17/2021] [Indexed: 01/07/2023]
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Otsuji H, Kanda D, Takumi T, Tokushige A, Sonoda T, Arikawa R, Anzaki K, Ikeda Y, Ohishi M. Association of wound, ischemia, and foot infection clinical stage with frailty and malnutrition in chronic limb-threatening ischemia patients undergoing endovascular intervention. Vascular 2022; 31:504-512. [PMID: 35226573 DOI: 10.1177/17085381221076943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE The Wound, Ischemia, and foot Infection (WIfI) clinical stage has been thought to have a prognostic value in Chronic limb-threatening ischemia (CLTI) patients, and frailty and nutritional status appear to represent pivotal factor affecting prognosis among CLTI patients. The purpose of this study was to examine clinical factors (including frailty and nutritional status) relevant to WIfI clinical stage. METHODS This retrospective study investigated 200 consecutive CLTI patients. We individually assessed WIfI clinical stage, frailty according to the Clinical Frailty Scale (CFS) score, and malnutrition according to Geriatric Nutritional Risk Index (GNRI). We then compared mortality after endovascular intervention between a WIfI stage 1, 2 group and a stage 3, 4 group, and investigated associations between baseline characteristics (including CFS and GNRI) and WIfI clinical stage. RESULTS Among 200 patients, 123 patients (62%) showed WIfI stage 1 or 2, and the remaining 77 patients (38%) had WIfI stage 3 or 4. CFS score was significantly higher in the WIfI stage 3, 4 group [median 6.0, interquartile range (IQR) 5.5-7.0] compared with the WIfI stage 1, 2 group (median 5.0, IQR 4.0-6.0, p < 0.001), and GNRI was significantly lower in the WIfI stage 3, 4 group (median 88, IQR 80-97) than in the WIfI stage 1, 2 (median 103, IQR 94-111, p < 0.001). Forty patients (20%) died after endovascular intervention. Incidences of all-cause and cardiac deaths were higher in the WIfI stage 3, 4 group than in the WIfI stage 1, 2 group (27% vs. 15%, p = 0.047 and 12% vs. 3%, p = 0.040, respectively). Kaplan-Meier analysis showed a significantly lower survival rate in the WIfI stage 3, 4 group than in the WIfI stage 1, 2 group (p = 0.002 by log-rank test). Multivariate logistic regression analysis using relevant factors from univariate analysis showed CFS score [odds ratio (OR) 2.06, 95% confidence interval (CI) 1.41-3.13, p < 0.001), diabetes mellitus (OR 3.17, 95%CI 1.17-8.61, p = 0.023) and GNRI (OR 0.93, 95%CI 0.89-0.97, p = 0.002) significantly associated with WIfI stage 3 or 4. In addition, multivariate ordinal logistic regression analysis for WIfI clinical stage showed CFS score (OR 1.43, 95%CI 1.09-1.89, p = 0.011), diabetes mellitus (OR 1.77, 95%CI 1.26-2.54, p < 0.001), and high-sensitivity C-reactive protein (OR 1.14, 95%CI 1.02-1.28, p = 0.041) were positively associated with WIfI clinical stage, and GNRI correlated negatively with WIfI clinical stage (OR 0.95, 95%CI 0.91-0.97, p < 0.001). CONCLUSIONS These results indicate that CLTI patients with high WIfI clinical stage may be more frail and malnourished, and be associated with poor prognosis after endovascular intervention.
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Affiliation(s)
- Hideaki Otsuji
- Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, 12851Kagoshima University, Kagoshima, Japan
| | - Daisuke Kanda
- Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, 12851Kagoshima University, Kagoshima, Japan
| | - Takuro Takumi
- Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, 12851Kagoshima University, Kagoshima, Japan
| | - Akihiro Tokushige
- Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, 12851Kagoshima University, Kagoshima, Japan
| | - Takeshi Sonoda
- Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, 12851Kagoshima University, Kagoshima, Japan
| | - Ryo Arikawa
- Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, 12851Kagoshima University, Kagoshima, Japan
| | - Kazuhiro Anzaki
- Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, 12851Kagoshima University, Kagoshima, Japan
| | - Yoshiyuki Ikeda
- Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, 12851Kagoshima University, Kagoshima, Japan
| | - Mitsuru Ohishi
- Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, 12851Kagoshima University, Kagoshima, Japan
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Chan KS, Chan YM, Chin YS, Mohd Shariff Z. Dietary Quality, Sleep Quality and Muscle Mass Predicted Frailty among Chinese Postmenopausal Women in Malaysia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19052565. [PMID: 35270257 PMCID: PMC8910042 DOI: 10.3390/ijerph19052565] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 11/18/2021] [Accepted: 11/29/2021] [Indexed: 02/04/2023]
Abstract
The older adult population is growing faster than any age group, which increases their risk of frailty. Studies conducted among older adult are relatively scarce in Malaysia, especially among Chinese postmenopausal women, who have the longest life expectancy. Thus, the present study aimed to determine the prevalence of frailty and its associated factors among Chinese postmenopausal women. A total of 220 eligible respondents were recruited, with information on sociodemographic background, comorbidities, dietary intake and lifestyle behaviour were obtained using a structured questionnaire, while anthropometry indicators were assessed according to standard protocol. Fasting blood was withdrawn for the analysis of serum 25(OH)D. Multinomial logistic regression was used to determine factors that predict pre-frailty and frailty. Prevalence of pre-frailty and prevalence of frailty were 64.5 and 7.3%, respectively, and most of the respondents presented with weak handgrip strength. Pre-frailty was prevalent among the younger population. Dietary quality was unsatisfactory among the respondents, and the majority of them presented with a high percentage of body fat. An increased dietary quality index (DQI), poor sleep and low muscle mass were factors that contributed to frailty. In conclusion, nutritional factors should be considered in developing health-related policies and programs in reducing and delaying the onset of frailty.
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Affiliation(s)
- Kai Sze Chan
- Department of Dietetics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Seri Kembangan 43400, Selangor, Malaysia;
| | - Yoke Mun Chan
- Department of Dietetics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Seri Kembangan 43400, Selangor, Malaysia;
- Research Center of Excellence, Nutrition and Non-Communicable Diseases, Universiti Putra Malaysia, Seri Kembangan 43400, Selangor, Malaysia
- Malaysian Research Institute on Ageing, Universiti Putra Malaysia, Seri Kembangan 43400, Selangor, Malaysia
- Correspondence: ; Tel.: +60-39769-2433
| | - Yit Siew Chin
- Department of Nutrition, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Seri Kembangan 43400, Selangor, Malaysia; (Y.S.C.); (Z.M.S.)
| | - Zalilah Mohd Shariff
- Department of Nutrition, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Seri Kembangan 43400, Selangor, Malaysia; (Y.S.C.); (Z.M.S.)
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Wannamethee SG. Frailty and increased risk of cardiovascular disease: are we at a crossroad to include frailty in cardiovascular risk assessment in older adults? Eur Heart J 2022; 43:827-829. [PMID: 34935046 DOI: 10.1093/eurheartj/ehab818] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 11/19/2021] [Indexed: 12/17/2022] Open
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Wleklik M, Denfeld Q, Lisiak M, Czapla M, Kałużna-Oleksy M, Uchmanowicz I. Frailty Syndrome in Older Adults with Cardiovascular Diseases-What Do We Know and What Requires Further Research? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19042234. [PMID: 35206422 PMCID: PMC8872246 DOI: 10.3390/ijerph19042234] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Revised: 02/08/2022] [Accepted: 02/14/2022] [Indexed: 02/07/2023]
Abstract
Cardiovascular diseases (CVD) affect 60% of people over 60 years of age and are one of the main causes of death in the world. Diagnosed cardiovascular disease also triples the likelihood of Frailty syndrome (FS). FS has become increasingly relevant in cardiology and cardiac surgery and occurs in a significant number of patients with CVD, with prevalence ranging from 25% to 62%. Viewed in a multidimensional, biopsychosocial perspective, FS increases a patient's vulnerability, making them susceptible to several adverse clinical outcomes. Frailty syndrome also is a predictor of mortality in patients with CVD regardless of age, severity of disease, multi-morbidity, and disability. Frailty syndrome potentially can be prevented in patients with CVD and its early identification is important to avoid the development of disability, dependence on others and reduced quality of life. The aim of this paper is to show the relationship between FS and specific CVDs (coronary artery disease, hypertension, atrial fibrillation, heart failure) and cardiac procedures (device implantation, cardiac surgery, and transcatheter aortic valve implantation). Furthermore, we highlight those areas that require further research to fully understand the relationship between FS and CVD and to be able to minimize or prevent its adverse effects.
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Affiliation(s)
- Marta Wleklik
- Department of Nursing and Obstetrics, Faculty of Health Sciences, Wroclaw Medical University, 51-618 Wroclaw, Poland; (M.W.); (M.L.); (I.U.)
- Institute of Heart Diseases, University Hospital, 50-566 Wroclaw, Poland
| | - Quin Denfeld
- School of Nursing, Oregon Health and Science University, Portland, OR 97239, USA;
| | - Magdalena Lisiak
- Department of Nursing and Obstetrics, Faculty of Health Sciences, Wroclaw Medical University, 51-618 Wroclaw, Poland; (M.W.); (M.L.); (I.U.)
- Institute of Heart Diseases, University Hospital, 50-566 Wroclaw, Poland
| | - Michał Czapla
- Institute of Heart Diseases, University Hospital, 50-566 Wroclaw, Poland
- Laboratory for Experimental Medicine and Innovative Technologies, Department of Emergency Medical Service, Wroclaw Medical University, 51-616 Wroclaw, Poland
- Correspondence:
| | - Marta Kałużna-Oleksy
- 1st Department of Cardiology, University of Medical Sciences in Poznan, 61-848 Poznan, Poland;
| | - Izabella Uchmanowicz
- Department of Nursing and Obstetrics, Faculty of Health Sciences, Wroclaw Medical University, 51-618 Wroclaw, Poland; (M.W.); (M.L.); (I.U.)
- Institute of Heart Diseases, University Hospital, 50-566 Wroclaw, Poland
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Sunayama T, Matsue Y, Dotare T, Maeda D, Iso T, Morisawa T, Saitoh M, Yokoyama M, Jujo K, Takahashi T, Minamino T. Multidomain Frailty as a Therapeutic Target in Elderly Patients with Heart Failure. Int Heart J 2022; 63:1-7. [DOI: 10.1536/ihj.21-839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Tsutomu Sunayama
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine
| | - Yuya Matsue
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine
| | - Taishi Dotare
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine
| | - Daichi Maeda
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine
| | - Takashi Iso
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine
| | - Tomoyuki Morisawa
- Department of Physical Therapy Faculty of Health Science, Juntendo University
| | - Masakazu Saitoh
- Department of Physical Therapy Faculty of Health Science, Juntendo University
| | - Miho Yokoyama
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine
| | - Kentaro Jujo
- Department of Cardiology, Nishiarai Heart Center Hospital
| | - Tetsuya Takahashi
- Department of Physical Therapy Faculty of Health Science, Juntendo University
| | - Tohru Minamino
- Japan Agency for Medical Research and Development-Core Research for Evolutionary Medical Science and Technology (AMED-CREST), Japan Agency for Medical Research and Development
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Uchmanowicz I, Pasieczna AH, Wójta-Kempa M, Gobbens RJJ, Młynarska A, Faulkner KM, Czapla M, Szczepanowski R. Physical, Psychological and Social Frailty Are Predictive of Heart Failure: A Cross-Sectional Study. J Clin Med 2022; 11:jcm11030565. [PMID: 35160017 PMCID: PMC8836458 DOI: 10.3390/jcm11030565] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 01/18/2022] [Accepted: 01/21/2022] [Indexed: 02/07/2023] Open
Abstract
Background: Little is known about frailty among patients hospitalized with heart failure (HF). To date, the limited information on frailty in HF is based on a unidimensional view of frailty, in which only physical aspects are considered when determining frailty. The aims of this study were to study different dimensions of frailty (physical, psychological and social) in patients with HF and the effect of different dimensions of frailty on the incidence of heart failure. Methods: The study used a cross-sectional design and included 965 patients hospitalized for heart failure and 164 healthy controls. HF was defined according to the ESC guidelines. The Tilburg Frailty Indicator (TFI) was used to assess frailty. Probit regression analyses and chi-square statistics were used to examine associations between the occurrence of heart failure and TFI domains of frailty. Results: Patients diagnosed with frailty were 15.3% more likely to develop HF compared to those not diagnosed with frailty (p < 0.001). An increase in physical, psychological and social frailty corresponded to an increased risk of HF of 2.9% (p < 0.001), 4.4% (p < 0.001) and 6.6% (p < 0.001), respectively. Conclusions: We found evidence of the association between different dimensions of frailty and incidence of HF.
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Affiliation(s)
- Izabella Uchmanowicz
- Department of Nursing and Obstetrics, Faculty of Health Sciences, Wroclaw Medical University, 51-618 Wrocław, Poland;
- Institute of Heart Diseases, University Hospital, 50-566 Wroclaw, Poland
| | | | - Monika Wójta-Kempa
- Department of Health Humanities and Social Science, Wroclaw Medical University, 51-618 Wrocław, Poland;
| | - Robbert J. J. Gobbens
- Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, 1081 HV Amsterdam, The Netherlands;
- Zonnehuisgroep Amstelland, 1186 AA Amstelveen, The Netherlands
- Department Family Medicine and Population Health, Faculty of Medicine and Health Sciences, University of Antwerp, 2610 Wilrijk, Belgium
| | - Agnieszka Młynarska
- Department of Gerontology and Geriatric Nursing, School of Health Sciences, Medical University of Silesia, 40-055 Katowice, Poland;
| | | | - Michał Czapla
- Institute of Heart Diseases, University Hospital, 50-566 Wroclaw, Poland
- Laboratory for Experimental Medicine and Innovative Technologies, Department of Emergency Medical Service, Wroclaw Medical University, 51-616 Wroclaw, Poland
- Correspondence:
| | - Remigiusz Szczepanowski
- Department of Computer Science and Systems Engineering, Wrocław University of Science and Technology, 50-370 Wrocław, Poland;
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Rech DA, da Silveira LS, Martins EM, de Oliveira Roque ABA, Althoff A, Maiorana AJ, Vieira AM, Karsten M. Frailty influences the vascular responsiveness of elderly individuals with chronic heart failure. Microvasc Res 2022; 141:104316. [PMID: 35038445 DOI: 10.1016/j.mvr.2022.104316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 12/23/2021] [Accepted: 01/03/2022] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Frailty is highly prevalent in heart failure (HF) patients. HF is associated with oxidative stress and chronic inflammation, which impair oxygen use by skeletal muscles. Little is known about the influence of frailty on vascular responsiveness and tissue oxygenation. OBJECTIVE Analyze the influence of frailty on vascular responsiveness and muscle oxygenation in elderly individuals with and without HF. METHODS Individuals aged ≥60 years, with or without HF, were evaluated for frailty (phenotype). Near-infrared spectroscopy (NIRS) was used to assess muscle oxygenation at rest (oxygen saturation - StO2 and deoxyhemoglobin) and during handgrip exercise (minimum StO2 and maximum deoxyhemoglobin), and oxygenation variables. STATISTICAL ANALYSIS Results were grouped according to the frailty phenotype: non-frail, pre-frail, and frail. Shapiro-Wilk test was used to assess normality. Data were compared using a two-way analysis of variance (ANOVA). Bonferroni post hoc test was applied to determine the influence of frailty or HF on NIRS variables. SPSS software was used in the analyses; p < 0.05 was considered significant. RESULTS 55 elderly participants (61.8% female; 70.4 ± 7.2 years old; 28 HF patients) participated in the study. 32.7% (n = 18) were classified as non-frail, 43.3% (n = 24) as pre-frail, and 23.6% (n = 13) as frail. The analysis of vascular responsiveness (n = 52) identified an influence (p < 0.05) of frailty on the reperfusion rate (slope 2 and ∆StO2 of nadir-peak) and desaturation during occlusion (area under the curve of StO2) in HF patients. There was no influence of frailty or HF on muscle oxygenation at rest and during exercise (n = 54; p > 0.05). CONCLUSION The coexistence of frailty and HF seems to impair vascular responsiveness, as frail elderly participants with HF presented lower reperfusion rates and higher desaturation levels during the arterial occlusion test. However, the presence of frailty or HF alone had no influence on muscle oxygenation at rest or during exercise.
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Affiliation(s)
- Daiana Aparecida Rech
- Programa de Pós-Graduação em Fisioterapia, Universidade do Estado de Santa Catarina (UDESC), Rua Pascoal Simone, 358, Florianópolis, SC 88080-350, Brazil; Grupo de Pesquisa em Saúde Cardiovascular e Exercício - GepCardio, UDESC, Rua Pascoal Simone, 358, Florianópolis, SC 88080-350, Brazil
| | - Lucas Santos da Silveira
- Programa de Pós-Graduação em Fisioterapia, Universidade do Estado de Santa Catarina (UDESC), Rua Pascoal Simone, 358, Florianópolis, SC 88080-350, Brazil; Grupo de Pesquisa em Saúde Cardiovascular e Exercício - GepCardio, UDESC, Rua Pascoal Simone, 358, Florianópolis, SC 88080-350, Brazil
| | - Edgar Manoel Martins
- Programa de Pós-Graduação em Fisioterapia, Universidade do Estado de Santa Catarina (UDESC), Rua Pascoal Simone, 358, Florianópolis, SC 88080-350, Brazil; Grupo de Pesquisa em Saúde Cardiovascular e Exercício - GepCardio, UDESC, Rua Pascoal Simone, 358, Florianópolis, SC 88080-350, Brazil
| | | | - Amanda Althoff
- Grupo de Pesquisa em Saúde Cardiovascular e Exercício - GepCardio, UDESC, Rua Pascoal Simone, 358, Florianópolis, SC 88080-350, Brazil
| | - Andrew John Maiorana
- Department of Allied Health, Fiona Stanley Hospital, 11 Robin Warren Drive, Murdoch, Western Australia 6150, Australia; School of Allied Health, Curtin University, Kent Street, Bentley, Western Australia 6102, Australia.
| | - Ariany Marques Vieira
- Programa de Pós-Graduação em Fisioterapia, Universidade do Estado de Santa Catarina (UDESC), Rua Pascoal Simone, 358, Florianópolis, SC 88080-350, Brazil; Grupo de Pesquisa em Saúde Cardiovascular e Exercício - GepCardio, UDESC, Rua Pascoal Simone, 358, Florianópolis, SC 88080-350, Brazil; Montreal Behavioural Medicine Centre, 5400 Boul Gouin O, Montréal, Québec, QC H4J 1C5, Canada
| | - Marlus Karsten
- Programa de Pós-Graduação em Fisioterapia, Universidade do Estado de Santa Catarina (UDESC), Rua Pascoal Simone, 358, Florianópolis, SC 88080-350, Brazil; Grupo de Pesquisa em Saúde Cardiovascular e Exercício - GepCardio, UDESC, Rua Pascoal Simone, 358, Florianópolis, SC 88080-350, Brazil; Programa de Pós-Graduação em Ciências da Reabilitação, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Rua Sarmento Leite, 245, Porto Alegre, RS 90050-170, Brazil.
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Kanda D, Ikeda Y, Takumi T, Tokushige A, Sonoda T, Arikawa R, Anzaki K, Kosedo I, Ohishi M. Impact of nutritional status on prognosis in acute myocardial infarction patients undergoing percutaneous coronary intervention. BMC Cardiovasc Disord 2022; 22:3. [PMID: 34996387 PMCID: PMC8742435 DOI: 10.1186/s12872-021-02448-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 12/28/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Malnutrition affects the prognosis of cardiovascular disease. Acute myocardial infarction (AMI) has been a major cause of death around the world. Thus, we investigated the impact of malnutrition as defined by Geriatric Nutritional Risk Index (GNRI) on mortality in AMI patients. METHODS In 268 consecutive AMI patients who underwent percutaneous coronary intervention (PCI), associations between all-cause death and baseline characteristics including malnutrition (GNRI < 92.0) and Global Registry of Acute Coronary Events (GRACE) risk score were assessed. RESULTS Thirty-three patients died after PCI. Mortality was higher in the 51 malnourished patients than in the 217 non-malnourished patients, both within 1 month after PCI (p < 0.001) and beyond 1 month after PCI (p = 0.017). Multivariate Cox proportional hazards regression modelling using age, left ventricular ejection fraction and GRACE risk score showed malnutrition correlated significantly with all-cause death within 1 month after PCI (hazard ratio [HR] 7.04; 95% confidence interval [CI] 2.30-21.51; p < 0.001) and beyond 1 month after PCI (HR 3.10; 95% CI 1.70-8.96; p = 0.037). There were no significant differences in area under the receiver-operating characteristic (ROC) curve between GRACE risk score and GNRI for predicting all-cause death within 1 month after PCI (0.90 vs. 0.81; p = 0.074) or beyond 1 month after PCI (0.69 vs. 0.71; p = 0.87). Calibration plots comparing actual and predicted mortality confirmed that GNRI (p = 0.006) was more predictive of outcome than GRACE risk score (p = 0.85) beyond 1 month after PCI. Furthermore, comparison of p-value for interaction of malnutrition and GRACE risk score for all-cause death within 1 month after PCI, beyond 1 month after PCI, and the full follow-up period after PCI were p = 0.62, p = 0.64 and p = 0.38, respectively. CONCLUSIONS GNRI may have a potential for predicting the mortality in AMI patients especially in beyond 1 month after PCI, separate from GRACE risk score. Assessment of nutritional status may help stratify the risk of AMI mortality.
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Affiliation(s)
- Daisuke Kanda
- Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima City, Kagoshima, 890-8520, Japan.
| | - Yoshiyuki Ikeda
- Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima City, Kagoshima, 890-8520, Japan
| | - Takuro Takumi
- Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima City, Kagoshima, 890-8520, Japan
| | - Akihiro Tokushige
- Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima City, Kagoshima, 890-8520, Japan
| | - Takeshi Sonoda
- Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima City, Kagoshima, 890-8520, Japan
| | - Ryo Arikawa
- Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima City, Kagoshima, 890-8520, Japan
| | - Kazuhiro Anzaki
- Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima City, Kagoshima, 890-8520, Japan
| | - Ippei Kosedo
- Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima City, Kagoshima, 890-8520, Japan
| | - Mitsuru Ohishi
- Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima City, Kagoshima, 890-8520, Japan
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Boreskie KF, Hay JL, Boreskie PE, Arora RC, Duhamel TA. Frailty-aware care: giving value to frailty assessment across different healthcare settings. BMC Geriatr 2022; 22:13. [PMID: 34979966 PMCID: PMC8722007 DOI: 10.1186/s12877-021-02722-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 12/15/2021] [Indexed: 12/14/2022] Open
Abstract
Healthcare systems need to adapt to better serve an aging population with complex presentations. Frailty assessments are a potential means to address this heterogeneity in aging to identify individuals at increased risk for adverse health outcomes. Furthermore, frailty assessments offer an opportunity to optimize patient care in various healthcare settings. While the vast number of frailty assessment tools available can be a source of confusion for clinicians, each tool has features adaptable to the constraints and goals of different healthcare settings. This review discusses and compares barriers, facilitators, and the application of frailty assessments in primary care, the emergency department/intensive care unit and surgical care to cover a breadth of settings with different frailty assessment considerations. The implementation of frailty-aware care across healthcare settings potentiates better healthcare outcomes for older adults.
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Affiliation(s)
- Kevin F Boreskie
- Faculty of Kinesiology and Recreation Management, University of Manitoba, Winnipeg, Manitoba, Canada.
- Institute of Cardiovascular Sciences, St. Boniface General Hospital Albrechtsen Research Centre, Winnipeg, Manitoba, Canada.
- Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.
| | - Jacqueline L Hay
- Faculty of Kinesiology and Recreation Management, University of Manitoba, Winnipeg, Manitoba, Canada
- Institute of Cardiovascular Sciences, St. Boniface General Hospital Albrechtsen Research Centre, Winnipeg, Manitoba, Canada
| | - Patrick E Boreskie
- Department of Emergency Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Rakesh C Arora
- Institute of Cardiovascular Sciences, St. Boniface General Hospital Albrechtsen Research Centre, Winnipeg, Manitoba, Canada
- Department of Surgery, Section of Cardiac Surgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Todd A Duhamel
- Faculty of Kinesiology and Recreation Management, University of Manitoba, Winnipeg, Manitoba, Canada
- Institute of Cardiovascular Sciences, St. Boniface General Hospital Albrechtsen Research Centre, Winnipeg, Manitoba, Canada
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Damluji AA, Cohen MG. The Influence of Frailty on Cardiovascular Disease: The Time for a "Frailty Academic Research Consortium" Is Now! Circ Cardiovasc Interv 2022; 15:e011669. [PMID: 35041458 PMCID: PMC8852245 DOI: 10.1161/circinterventions.121.011669] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
- Abdulla A Damluji
- The Inova Center of Outcomes Research, Inova Heart and Vascular Institute, Falls Church, VA (A.A.D.)
- Division of Cardiology, Johns Hopkins School of Medicine, Baltimore, MD (A.A.D.)
| | - Mauricio G Cohen
- Division of Cardiovascular Medicine, University of Miami Miller School of Medicine, FL (M.G.G.)
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Heller SR, Geybels MS, Iqbal A, Liu L, Wagner L, Chow E. A higher non-severe hypoglycaemia rate is associated with an increased risk of subsequent severe hypoglycaemia and major adverse cardiovascular events in individuals with type 2 diabetes in the LEADER study. Diabetologia 2022; 65:55-64. [PMID: 34704120 PMCID: PMC8660716 DOI: 10.1007/s00125-021-05556-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 07/05/2021] [Indexed: 11/06/2022]
Abstract
AIMS/HYPOTHESIS Hypoglycaemia is a common side effect of insulin and some other antihyperglycaemic agents used to treat diabetes. Severe hypoglycaemia has been associated with adverse cardiovascular events in trials of intensive glycaemic control in type 2 diabetes. The relationship between non-severe hypoglycaemic episodes (NSHEs) and severe hypoglycaemia in type 2 diabetes has been documented. However, an association between more frequent NSHEs and cardiovascular events has not been verified. This post hoc analysis of the LEADER (Liraglutide Effect and Action in Diabetes: Evaluation of Cardiovascular Outcome Results) trial aimed to confirm whether there is an association between NSHEs and severe hypoglycaemic episodes in individuals with type 2 diabetes. In addition, the possible association between NSHEs and major adverse cardiac events (MACE), cardiovascular death and all-cause mortality was investigated. METHODS LEADER was a double-blind, multicentre, placebo-controlled trial that found that liraglutide significantly reduced the risk of MACE compared with the placebo. In this post hoc analysis, we explored, in all LEADER participants, whether the annual rate of NSHEs (defined as self-measured plasma glucose <3.1 mmol/l [56 mg/dl]) was associated with time to first severe hypoglycaemic episode (defined as an episode requiring the assistance of another person), time to first MACE, time to cardiovascular death and time to all-cause mortality. Participants with <2 NSHEs per year were used as reference for HR estimates. Cox regression with a time-varying covariate was used. RESULTS We demonstrate that there is an association between NSHEs (2-11 NSHEs per year and ≥12 NSHEs per year) and severe hypoglycaemic episodes (unadjusted HRs 1.98 [95% CI 1.43, 2.75] and 5.01 [95% CI 2.84, 8.84], respectively), which was consistent when baseline characteristics were accounted for. Additionally, while no association was found between participants with 2-11 NSHEs per year and adverse cardiovascular outcomes, higher rates of NSHEs (≥12 episodes per year) were associated with higher risk of MACE (HR 1.50 [95% CI 1.01, 2.23]), cardiovascular death (HR 2.08 [95% CI 1.17, 3.70]) and overall death (HR 1.80 [95% CI 1.11, 2.92]). CONCLUSIONS/INTERPRETATION The analysis of data from the LEADER trial demonstrated that higher rates of NSHEs were associated with both a higher risk of severe hypoglycaemia and adverse cardiovascular outcomes in individuals with type 2 diabetes. Therefore, irrespective of the cause of this association, it is important that individuals with high rates of hypoglycaemia are identified so that the potentially increased risk of cardiovascular events can be managed and steps can be taken to reduce NSHEs. TRIAL REGISTRATION ClinicalTrials.gov (NCT01179048).
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Affiliation(s)
- Simon R Heller
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK.
| | | | - Ahmed Iqbal
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | - Lei Liu
- Novo Nordisk A/S, Søborg, Denmark
| | | | - Elaine Chow
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
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Blauth FG, Vilar LADS, Pontes VDCB, Moriguti JC, Ferriolli E, Lima NKDC. The effect of frailty on the 24-hour blood pressure pattern in the very elderly. J Clin Hypertens (Greenwich) 2022; 24:67-73. [PMID: 34882943 PMCID: PMC8783362 DOI: 10.1111/jch.14409] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 11/19/2021] [Accepted: 11/20/2021] [Indexed: 11/26/2022]
Abstract
Frailty plays a crucial role in the management of hypertension in the very elderly and has a strong association with cardiovascular diseases. Nevertheless, its influence on the 24-hour blood pressure pattern, including elevated asleep systolic blood pressure (BP) and the lack of BP fall during sleep (non-dipping) has not been explored in a population above 80 years. Patients older than 80 years were classified into frail or robust subtypes by the five item frailty phenotype criteria. All participants were submitted to office blood pressure measurements and ambulatory BP monitoring over a 24-hour period. Nocturnal dipping was defined as nighttime BP fall ≥10%. Thirty-eight frail and 36 non-frail individuals (mean age 85.3 ± 3.7 years; 67% females) were analyzed. Awake systolic and diastolic BP were similar for frail and robust individuals. Frail patients had higher systolic BP during sleep (128 ± 15 mm Hg vs. 122 ±13 mm Hg p = .04) and reduced systolic BP fall [1 (-4.5 - 5)% vs. 6.8 (2.1 - 12.8)% p < .01]. Frailty was independently associated with higher risk of non-dipping (OR 12.4; CI 1.79 - 85.9) and reduced nighttime systolic BP fall (-6.1%; CI -9.6 - -2.6%). In conclusions, frailty has a substantial influence on nighttime BP values and pattern in patients older than 80 years.
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Affiliation(s)
- Fernando Gioppo Blauth
- Division of Internal Medicine and GeriatricsDepartment of Internal MedicineRibeirão Preto Medical SchoolUniversity of São Paulo, Ribeirão PretoBrazil
| | - Laís Araújo dos Santos Vilar
- Division of Internal Medicine and GeriatricsDepartment of Internal MedicineRibeirão Preto Medical SchoolUniversity of São Paulo, Ribeirão PretoBrazil
| | - Victor de Carvalho Brito Pontes
- Division of Internal Medicine and GeriatricsDepartment of Internal MedicineRibeirão Preto Medical SchoolUniversity of São Paulo, Ribeirão PretoBrazil
| | - Júlio César Moriguti
- Division of Internal Medicine and GeriatricsDepartment of Internal MedicineRibeirão Preto Medical SchoolUniversity of São Paulo, Ribeirão PretoBrazil
| | - Eduardo Ferriolli
- Division of Internal Medicine and GeriatricsDepartment of Internal MedicineRibeirão Preto Medical SchoolUniversity of São Paulo, Ribeirão PretoBrazil
| | - Nereida Kilza da Costa Lima
- Division of Internal Medicine and GeriatricsDepartment of Internal MedicineRibeirão Preto Medical SchoolUniversity of São Paulo, Ribeirão PretoBrazil
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Veronese N, Smith L, Zigoura E, Barbagallo M, Dominguez LJ, Barone A, Cella A, Cooper C, Rizzoli R, Reginster JY, Maggi S, Pilotto A. Multidimensional prognostic index and the risk of fractures: an 8-year longitudinal cohort study in the Osteoarthritis Initiative. Arch Osteoporos 2021; 17:5. [PMID: 34905117 PMCID: PMC8669664 DOI: 10.1007/s11657-021-01015-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 09/27/2021] [Indexed: 02/03/2023]
Abstract
In this longitudinal study, with a follow-up of 8 years, multidimensional prognostic index (MPI), a product of the comprehensive geriatric assessment, significantly predicted the onset of fractures in older people affected by knee osteoarthritis. PURPOSE Frailty may be associated with higher fracture risk, but limited research has been carried out using a multidimensional approach to frailty assessment and diagnosis. The present research aimed to investigate whether the MPI, based on comprehensive geriatric assessment (CGA), is associated with the risk of fractures in the Osteoarthritis Initiative (OAI) study. METHODS Community-dwellers affected by knee OA or at high risk for this condition were followed-up for 8 years. A standardized CGA including information on functional, nutritional, mood, comorbidity, medication, quality of life, and co-habitation status was used to calculate the MPI. Fractures were diagnosed using self-reported information. Cox's regression analysis was carried out and results are reported as hazard ratios (HRs), with their 95% confidence intervals (CIs), adjusted for potential confounders. RESULTS The sample consisted of 4024 individuals (mean age 61.0 years, females = 59.0%). People with incident fractures had a significant higher MPI baseline value than those without (0.42 ± 0.18 vs. 0.40 ± 0.17). After adjusting for several potential confounders, people with an MPI over 0.66 (HR = 1.49; 95%CI: 1.11-2.00) experienced a higher risk of fractures. An increase in 0.10 point in MPI score corresponded to an increase in fracture risk of 4% (HR = 1.04; 95%CI: 1.008-1.07). Higher MPI values were also associated with a higher risk of non-vertebral clinical fractures. CONCLUSION Higher MPI values at baseline were associated with an increased risk of fractures, reinforcing the importance of CGA in predicting fractures in older people affected by knee OA.
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Affiliation(s)
- Nicola Veronese
- Geriatric Unit, Department of Internal Medicine and Geriatrics, University of Palermo, Via del Vespro, 141 90127, Palermo, Italy.
- Biochemistry Department, College of Science, King Saud University, Riyadh, Saudi Arabia.
| | - Lee Smith
- The Cambridge Centre for Sport and Exercise Sciences, Anglia Ruskin University, Cambridge, UK
| | - Ekaterini Zigoura
- Department Geriatric Care, Orthogeriatrics and Rehabilitation, Frailty Area, E.O. Galliera Hospital, Genova, Italy
| | - Mario Barbagallo
- Geriatric Unit, Department of Internal Medicine and Geriatrics, University of Palermo, Via del Vespro, 141 90127, Palermo, Italy
| | - Ligia J Dominguez
- Geriatric Unit, Department of Internal Medicine and Geriatrics, University of Palermo, Via del Vespro, 141 90127, Palermo, Italy
| | - Antonella Barone
- Department Geriatric Care, Orthogeriatrics and Rehabilitation, Frailty Area, E.O. Galliera Hospital, Genova, Italy
| | - Alberto Cella
- Department Geriatric Care, Orthogeriatrics and Rehabilitation, Frailty Area, E.O. Galliera Hospital, Genova, Italy
| | - Cyrus Cooper
- MRC Lifecourse Epidemiology Unit, Southampton General Hospital, University of Southampton, Southampton, UK
- NIHR Musculoskeletal Biomedical Research Unit, University of Oxford, Oxford, UK
| | - Renè Rizzoli
- Division of Bone Diseases, Faculty of Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Jean-Yves Reginster
- WHO Collaborating Centre for Public Health Aspects of Musculoskeletal Health and Aging, Liège, Belgium
- Department of Public Health, Epidemiology and Health Economics, University of Liège, CHU Sart Tilman B23, 4000, Liège, Belgium
- Biochemistry Department, College of Science, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Stefania Maggi
- Aging Branch, Neuroscience Institute, National Research Council, Padua, Italy
| | - Alberto Pilotto
- Department Geriatric Care, Orthogeriatrics and Rehabilitation, Frailty Area, E.O. Galliera Hospital, Genova, Italy
- Department of Interdisciplinary Medicine, University of Bari, Bari, Italy
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83
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Hospital readmission and mortality associations to frailty in hospitalized patients with coronary heart disease. AGING AND HEALTH RESEARCH 2021. [DOI: 10.1016/j.ahr.2021.100042] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
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Multidimensional Frailty Predicts Mortality Better than Physical Frailty in Community-Dwelling Older People: A Five-Year Longitudinal Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182312435. [PMID: 34886161 PMCID: PMC8657374 DOI: 10.3390/ijerph182312435] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 11/16/2021] [Accepted: 11/22/2021] [Indexed: 11/17/2022]
Abstract
Frailty is a common syndrome in older people that carries an increased risk of mortality. Two main models describe frailty, either as a loss of physical functions or as an accumulation of multiple deficits. The aim of our study was to compare the physical frailty index developed in the Cardiovascular Health Study (CHS) with a multidimensional frailty tool, the Multidimensional Prognostic Index (MPI), in predicting death in community-dwelling older subjects. Four hundred and seven community-dwelling older subjects were enrolled. Each subject underwent a comprehensive geriatric assessment (CGA) with calculation of the MPI and CHS index. Mortality was recorded over the following 5 years. In the overall sample (mean age of 77.9 ± 4.5 years; 51.6% female), 53 subjects (13%) died during the 5-year follow-up period. Both the MPI and CHS index were able to predict mortality; however, the MPI was significantly more accurate than the CHS index in predicting mortality (C-index = 0.69 and 0.59, respectively; p < 0.001), with a statistically significant difference of 10%. In conclusion, multidimensional frailty, assessed by the MPI, predicts five-year mortality in community-dwelling older people better than physical frailty, as assessed by the CHS index. These findings suggest the usefulness of assessing frailty by means of CGA-based tools to predict relevant health-negative outcomes in older people.
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McKechnie DGJ, Papacosta AO, Lennon LT, Ramsay SE, Whincup PH, Wannamethee SG. Associations between inflammation, cardiovascular biomarkers and incident frailty: the British Regional Heart Study. Age Ageing 2021; 50:1979-1987. [PMID: 34254997 PMCID: PMC8675445 DOI: 10.1093/ageing/afab143] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Indexed: 11/17/2022] Open
Abstract
Introduction cardiovascular disease (CVD) and chronic inflammation are implicated in the development of
frailty. Longitudinal analyses of inflammatory markers, biomarkers of cardiac dysfunction and
incidence of frailty are limited. Methods in the British Regional Heart Study, 1,225 robust or pre-frail men aged 71–92 years
underwent a baseline examination, with questionnaire-based frailty assessment after 3 years.
Frailty definitions were based on the Fried phenotype. Associations between incident frailty
and biomarkers of cardiac dysfunction (high-sensitivity cardiac troponin T (hs-cTnT),
N-terminal pro B-type natriuretic peptide (NT-proBNP)) and inflammation (C-reactive protein
(CRP) and interleukin-6 (IL-6)) were examined, by tertile, with the lowest as reference. Results follow-up data were available for 981 men. Ninety one became frail. Adjusted for age,
pre-frailty, prevalent and incident CVD, comorbidity, polypharmacy and socioeconomic status,
IL-6 (third tertile OR 2.36, 95% CI 1.07–5.17) and hs-cTnT (third tertile OR 2.24, 95% CI
1.03–4.90) were associated with increased odds of frailty. CRP (third tertile OR 1.83, 95% CI
0.97–4.08) and NT-proBNP (second tertile OR 0.48, 95% CI 0.23–1.01) showed no significant
association with incident frailty. The top tertiles of CRP, IL-6, hscTnT and NT-proBNP were
strongly associated with mortality prior to follow-up. Conclusion IL-6 is associated with incident frailty, supporting the prevailing argument that
inflammation is involved in the pathogenesis of frailty. Cardiomyocyte injury may be
associated with frailty risk. Associations between elevated CRP and frailty cannot be fully
discounted; NT-proBNP may have a non-linear relationship with incident frailty. CRP, IL-6,
hs-cTnT and NT-proBNP are vulnerable to survivorship bias.
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Affiliation(s)
- Douglas G J McKechnie
- Department of Primary Care and Population Health, University College London, London, UK
| | - A Olia Papacosta
- Department of Primary Care and Population Health, University College London, London, UK
| | - Lucy T Lennon
- Department of Primary Care and Population Health, University College London, London, UK
| | - Sheena E Ramsay
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Peter H Whincup
- Population Health Research Institute, St George’s University of London, London, UK
| | - S Goya Wannamethee
- Department of Primary Care and Population Health, University College London, London, UK
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86
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Impact of thrombus aspiration in frail STEMI patients. Aging Clin Exp Res 2021; 33:3081-3089. [PMID: 33817772 PMCID: PMC8488061 DOI: 10.1007/s40520-021-01848-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 03/24/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Despite primary percutaneous coronary intervention (PPCI) is generally considered the best therapy in older frail adults with ST-segment elevation myocardial infarction (STEMI), the incidence of re-hospitalization for cardiovascular diseases remains significant in these patients. AIMS We hypothesized that thrombus aspiration (TA) before PPCI could be a useful treatment for reducing mortality and rehospitalizations in frail patients undergoing PPCI for STEMI. METHODS We conducted a study comparing PPCI alone vs TA + PPCI in frail STEMI patients. We examined a cohort of consecutive frail patients aged ≥ 65 years with first STEMI treated with PPCI between February 2008 and July 2015 at the Department of Cardiology of the "Cardarelli" Hospital in Naples, Italy. RESULTS The study was completed by 389 patients (PPCI: 195, TA + PPCI: 194). At 1-month follow-up, the rate of death from any cause was 7.0% in patients treated with PPCI alone vs 3.0% in patients treated with TA + PPCI (p 0.036), whereas death from cardiovascular causes was 6.0% in the PPCI group vs 3.0% in the TA + PPCI group (p 0.028). Equally important, the rate of re-hospitalization due to heart failure was 7.5% in the PPCI group vs 4.0% in TA + PPCI group (p 0.025) and the rate of re-hospitalization due to acute coronary syndrome was 10.0% in the PPCI group vs 4.5% in the TA + PPCI group (p 0.016). CONCLUSION These results indicate the importance of TA in the treatment of STEMI in a group of high-risk patients such as elderly with frailty.
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87
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McKechnie DGJ, Papacosta AO, Lennon LT, Ellins EA, Halcox JPJ, Ramsay SE, Whincup PH, Wannamethee SG. Subclinical cardiovascular disease and risk of incident frailty: The British Regional Heart Study. Exp Gerontol 2021; 154:111522. [PMID: 34428478 DOI: 10.1016/j.exger.2021.111522] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 08/03/2021] [Accepted: 08/16/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND/OBJECTIVES Subclinical cardiovascular disease (CVD) is cross-sectionally associated with frailty, but the relationship between subclinical CVD and incident frailty has not been reported. We aimed to assess this prospective association. DESIGN Longitudinal analysis of data from the British Regional Heart Study, a prospective cohort study. PARTICIPANTS 1057 men, aged 71-92 years, robust or pre-frail at baseline, and without a clinical diagnosis of CVD. MEASUREMENTS Participants underwent baseline measurement of carotid-femoral pulse wave velocity (cfPWV), carotid intima-media thickness (CIMT), carotid distensibility coefficient (DC), and ankle-brachial pressure index (ABPI), and had questionnaire-based frailty assessment after three years. Frailty status was based on the Fried phenotype. Multivariate logistic regressions examined associations between incident frailty and tertile of cfPWV, CIMT, DC, and ABPI group (<0.9, 0.9-1.4, ≥1.4). RESULTS 865 men were examined and completed the 3 year follow-up questionnaire, of whom 78 became frail. Adjusted for age, prefrailty, body mass index, diabetes, smoking, atrial fibrillation, blood pressure, renal function, and incident CVD, higher CIMT was associated with greater odds of incident frailty (2nd tertile OR 1.62, 95% CI 0.78-3.35, 3rd tertile OR 2.61, 95% CI 1.30-5.23, p = 0.007, trend p = 0.006). cfPWV showed a weaker, non-significant association (2nd tertile OR 1.79, 95% CI 0.85-3.78, 3rd tertile OR 1.73, OR 0.81-3.72, p = 0.16, trend p = 0.20). There was no clear association between incident frailty and DC or ABPI. In subgroup analyses, CIMT was significantly associated with incident frailty in men ≥80 years (3rd tertile OR 6.99, 95%CI 1.42-34.5), but not in men aged 75-80 or < 75 years. CONCLUSION Subclinical CVD, as measured by CIMT, is associated with greater risk of incident frailty in older men over three year follow-up, independent of the development of clinically-apparent stroke, heart failure, or myocardial infarction, and may be a modifiable risk factor for frailty. This association may be stronger in very old age.
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Affiliation(s)
- Douglas G J McKechnie
- Department of Primary Care and Population Health, University College London, London, UK.
| | - A Olia Papacosta
- Department of Primary Care and Population Health, University College London, London, UK
| | - Lucy T Lennon
- Department of Primary Care and Population Health, University College London, London, UK
| | | | | | - Sheena E Ramsay
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Peter H Whincup
- Population Health Research Institute, St George's University of London, London, UK
| | - S Goya Wannamethee
- Department of Primary Care and Population Health, University College London, London, UK
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Qiao X, Ji L, Jin Y, Si H, Bian Y, Wang W, Wang C. Development and validation of an instrument to measure beliefs in physical activity among (pre)frail older adults: An integration of the Health Belief Model and the Theory of Planned Behavior. PATIENT EDUCATION AND COUNSELING 2021; 104:2544-2551. [PMID: 33722429 DOI: 10.1016/j.pec.2021.03.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 03/04/2021] [Accepted: 03/06/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To develop and evaluate the psychometric properties of an instrument assessing beliefs in physical activity based on the integration of the Health Belief Model (HBM) and the Theory of Planned Behavior (TPB) among (pre)frail older adults. METHODS A literature review and semi-structured interviews were conducted to generate the initial item pool of the instrument. A rural sample of 611 (pre)frail older adults was enrolled to examine the validity and reliability of the instrument. RESULTS The exploratory factor analysis extracted eight factors for this instrument, explaining 71.3% of the variance in beliefs in physical activity. The confirmatory factor analysis confirmed the eight-factor structure. Linear regression models found that the integrated HBM-TPB constructs explained 65.9% of the variance in physical activity intention and 13.6% in physical activity. The Cronbach's alpha coefficients for the factors ranged from 0.80 to 0.98, and ICCs ranged from 0.71 to 0.85. CONCLUSION This instrument has satisfactory construct validity, predictive validity, internal consistency reliability and test-retest reliability, and it can be used in (pre)frail older adults to measure beliefs in physical activity. PRACTICE IMPLICATIONS This instrument may help health care providers understand beliefs in physical activity and facilitate targeted interventions among (pre)frail older adults.
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Affiliation(s)
- Xiaoxia Qiao
- School of Nursing, Peking University, Beijing 100191, China.
| | - Lili Ji
- School of Nursing, Peking University, Beijing 100191, China.
| | - Yaru Jin
- School of Nursing, Peking University, Beijing 100191, China.
| | - Huaxin Si
- School of Nursing, Peking University, Beijing 100191, China.
| | - Yanhui Bian
- School of Nursing, Peking University, Beijing 100191, China.
| | - Wenyu Wang
- School of Nursing, Peking University, Beijing 100191, China.
| | - Cuili Wang
- School of Nursing, Peking University, Beijing 100191, China.
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89
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Damluji AA, Chung SE, Xue QL, Hasan RK, Moscucci M, Forman DE, Bandeen-Roche K, Batchelor W, Walston JD, Resar JR, Gerstenblith G. Frailty and cardiovascular outcomes in the National Health and Aging Trends Study. Eur Heart J 2021; 42:3856-3865. [PMID: 34324648 PMCID: PMC8487013 DOI: 10.1093/eurheartj/ehab468] [Citation(s) in RCA: 96] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 05/25/2021] [Accepted: 07/04/2021] [Indexed: 11/13/2022] Open
Abstract
AIMS Physical frailty is a commonly encountered geriatric syndrome among older adults without coronary heart disease (CHD). The impact of frailty on the incidence of long-term cardiovascular outcomes is not known.We aimed to evaluate the long-term association of frailty, measured by the Fried frailty phenotype, with all-cause-mortality and MACE among older adults without a history of CHD at baseline in the National Health and Aging Trends Study. METHODS AND RESULTS We used the National Health and Aging Trends Study, a prospective cohort study linked to a Medicare sample. Participants with a prior history of CHD were excluded. Frailty was measured during the baseline visit using the Fried physical frailty phenotype. Cardiovascular outcomes were assessed during a 6-year follow-up.Of the 4656 study participants, 3259 (70%) had no history of CHD 1 year prior to their baseline visit. Compared to those without frailty, subjects with frailty were older (mean age 82.1 vs. 75.1 years, P < 0.001), more likely to be female (68.3% vs. 54.9%, P < 0.001), and belong to an ethnic minority. The prevalence of hypertension, falls, disability, anxiety/depression, and multimorbidity was much higher in the frail and pre-frail than the non-frail participants. In a Cox time-to-event multivariable model and during 6-year follow-up, the incidences of death and of each individual cardiovascular outcomes were all significantly higher in the frail than in the non-frail patients including major adverse cardiovascular event (MACE) [hazard ratio (HR) 1.77, 95% confidence interval (CI) 1.53, 2.06], death (HR 2.70, 95% CI 2.16, 3.38), acute myocardial infarction (HR 1.95, 95% CI 1.31, 2.90), stroke (HR 1.71, 95% CI 1.34, 2.17), peripheral vascular disease (HR 1.80, 95% CI 1.44, 2.27), and coronary artery disease (HR 1.35, 95% CI 1.11, 1.65). CONCLUSION In patients without CHD, frailty is a risk factor for the development of MACEs. Efforts to identify frailty in patients without CHD and interventions to limit or reverse frailty status are needed and, if successful, may limit subsequent adverse cardiovascular events.
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Affiliation(s)
- Abdulla A Damluji
- The Inova Center of Outcomes Research, Inova Heart and Vascular Institute, 3300 Gallows Road, I-465, Falls Church, VA 22042, USA
- Division of Cardiology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD 21205, USA
| | - Shang-En Chung
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD 21224, USA
| | - Qian-Li Xue
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD 21224, USA
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Rani K Hasan
- Division of Cardiology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD 21205, USA
| | - Mauro Moscucci
- Division of Cardiovascular Medicine, Department of Medicine, University of Michigan, Ann Arbor, MI 48109, USA
| | - Daniel E Forman
- Geriatric Cardiology Section, University of Pittsburgh, Pittsburgh, PA, USA
- Geriatric Research, Education, and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | - Karen Bandeen-Roche
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Wayne Batchelor
- The Inova Center of Outcomes Research, Inova Heart and Vascular Institute, 3300 Gallows Road, I-465, Falls Church, VA 22042, USA
| | - Jeremy D Walston
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD 21224, USA
| | - Jon R Resar
- Division of Cardiology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD 21205, USA
| | - Gary Gerstenblith
- Division of Cardiology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD 21205, USA
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90
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Landré B, Nadif R, Goldberg M, Gourmelen J, Zins M, Ankri J, Herr M. Asthma is associated with frailty among community-dwelling adults: the GAZEL cohort. BMJ Open Respir Res 2021; 7:7/1/e000526. [PMID: 32066563 PMCID: PMC7047496 DOI: 10.1136/bmjresp-2019-000526] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 01/14/2020] [Accepted: 01/17/2020] [Indexed: 12/15/2022] Open
Abstract
Introduction Early management of chronic respiratory diseases (CRDs) and frailty have been identified as key targets towards healthy ageing, but the association between CRDs and frailty has been poorly investigated. We studied the association between asthma and frailty in adults of the GAZEL cohort using different definitions of asthma over the 26 years of follow-up. Methods Current asthma definitions are based on yearly self-reports of symptoms or medication (in 2015, constant reports or at least one report between 1990 and 2015), or on a detailed respiratory symptoms questionnaire in 2002. Frailty definition is based on weakness, fatigue, unintentional weight loss, low physical activity and mobility in 2015. Frail participants had three criteria or more, pre-frail 1 or 2, and robust 0. Multinomial regression models adjusted for age, sex, body mass index, smoking, education, marital status and comorbidities were performed. Results In 2015, 12 345 adults (73% men, 61 to 77 years old) were included: 3% of them reported current asthma, 1.6% had constant reports during the follow-up and 9% reported current asthma at least once. In 2015, 6% were frail, 34% pre-frail and 13% of current asthmatics and 6% of non-asthmatics were frail (adjusted OR (aOR) 2.19 (1.44 to 3.34)). Significant associations were also found with the 2002 definition (aOR 2.24 (1.73 to 2.90)), constant reports (aOR 3.67 (1.70 to 7.93)) or at least once (aOR 1.50 (1.15 to 1.98)). Current asthma was also associated with pre-frailty with the 2002 definition (aOR 1.46 (1.26 to 1.68)). Discussion Participants with asthma had increased risk of frailty. A better understanding of their relationship could help to define and evaluate strategies for a better ageing of asthmatics.
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Affiliation(s)
- Benjamin Landré
- Université Paris-Saclay, UVSQ, Univ. Paris-Sud, Inserm, Echappement aux anti-infectieux et pharmaco-épidémiologie, CESP, 94807, Villejuif, France
| | - Rachel Nadif
- Université Paris-Saclay, UVSQ, Univ. Paris-Sud, Inserm, Équipe d'Épidémiologie Respiratoire Intégrative, CESP, 94807, Villejuif, France
| | - Marcel Goldberg
- UMS 011: Population-based Epidemiological Cohorts, INSERM, Paris, France.,Faculty of Medicine, Université Paris Descartes, Paris, France
| | - Julie Gourmelen
- UMS 011: Population-based Epidemiological Cohorts, INSERM, Paris, France
| | - Marie Zins
- UMS 011: Population-based Epidemiological Cohorts, INSERM, Paris, France.,Faculty of Medicine, Université Paris Descartes, Paris, France
| | - Joël Ankri
- Université Paris-Saclay, UVSQ, Univ. Paris-Sud, Inserm, Echappement aux anti-infectieux et pharmaco-épidémiologie, CESP, 94807, Villejuif, France.,Département Hospitalier d'Epidémiologie et de Santé Publique, Groupe Hospitalier AP-HP, Université Paris Saclay, Assistance Publique Hopitaux de Paris, Paris, France
| | - Marie Herr
- Université Paris-Saclay, UVSQ, Univ. Paris-Sud, Inserm, Echappement aux anti-infectieux et pharmaco-épidémiologie, CESP, 94807, Villejuif, France.,Département Hospitalier d'Epidémiologie et de Santé Publique, Groupe Hospitalier AP-HP, Université Paris Saclay, Assistance Publique Hopitaux de Paris, Paris, France
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91
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Liperoti R, Vetrano DL, Palmer K, Targowski T, Cipriani MC, Lo Monaco MR, Giovannini S, Acampora N, Villani ER, Bernabei R, Onder G. Association between frailty and ischemic heart disease: a systematic review and meta-analysis. BMC Geriatr 2021; 21:357. [PMID: 34112104 PMCID: PMC8193864 DOI: 10.1186/s12877-021-02304-9] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 05/26/2021] [Indexed: 02/07/2023] Open
Abstract
Background Frailty is increasingly reported among older adults with cardiovascular diseases and it has been demonstrated to increase negative health outcomes and mortality. To date, no systematic review of the evidence is available regarding the association between frailty and ischemic heart disease (IHD). We performed a systematic review of literature and a meta-analysis to assess the association between frailty and IHD. Methods We selected all the studies that provided information on the association between frailty and IHD, regardless of the study setting, study design, or definition of IHD and frailty. PubMed, Web of Science and Embase were searched for relevant papers. Studies that adopted the Fried definition for frailty were included in the meta-analyses. For each measure of interest (proportions and estimates of associations), a meta-analysis was performed if at least three studies used the same definition of frailty. Pooled estimates were obtained through random effect models and Mantel-Haenszel weighting. Results Thirty-seven studies were included. Of these, 22 adopted the Fried criteria to define frailty and provided estimates of prevalence and therefore they were included in meta-analyses. The pooled prevalence of IHD in frail individuals was 17% (95% Confidence Interval [95%CI] 11–23%) and the pooled prevalence of frailty in individuals with IHD was 19% (95% CI 15–24%). The prevalence of frailty among IHD patients ranged from 4 to 61%. Insufficient data were found to assess longitudinal association between frailty and IHD. Conclusions Frailty is quite common in older persons with IHD. The identification of frailty among older adults with IHD should be considered relevant to provide individualized strategies of cardiovascular prevention and care. Further research should specifically explore the association between frailty and IHD and investigate the potential common biological ground. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-021-02304-9.
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Affiliation(s)
- Rosa Liperoti
- Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo F. Vito 1, 00168, Rome, Italy.,Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Davide L Vetrano
- Aging Research Center, Department of Neurobiology, Health Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Katie Palmer
- Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo F. Vito 1, 00168, Rome, Italy
| | - Tomasz Targowski
- Department of Geriatrics, National Institute of Geriatrics, Rheumatology, and Rehabilitation, Warsaw, Poland
| | - Maria C Cipriani
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | | | | | - Nicola Acampora
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Emanuele Rocco Villani
- Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo F. Vito 1, 00168, Rome, Italy.
| | - Roberto Bernabei
- Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo F. Vito 1, 00168, Rome, Italy.,Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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92
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Noguchi M, Kubo H, Kanai M, Nozoe M, Shimada S. Relationship between pre-stroke frailty status and short-term functional outcome in older patients with acute stroke–A mediation analysis-. Arch Gerontol Geriatr 2021; 94:104370. [DOI: 10.1016/j.archger.2021.104370] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Revised: 01/22/2021] [Accepted: 01/31/2021] [Indexed: 12/31/2022]
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93
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Cereda E, Pedrazzoli P, Lobascio F, Masi S, Crotti S, Klersy C, Turri A, Stobäus N, Tank M, Franz K, Cutti S, Giaquinto E, Filippi AR, Norman K, Caccialanza R. The prognostic impact of BIA-derived fat-free mass index in patients with cancer. Clin Nutr 2021; 40:3901-3907. [PMID: 34134007 DOI: 10.1016/j.clnu.2021.04.024] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 03/17/2021] [Accepted: 04/13/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND & AIMS Reduced muscle mass represents one of the top ranked phenotypic criteria for malnutrition proposed by the Global Leadership Initiative on Malnutrition. Although height-indexed fat-free mass (FFMI) thresholds have been proposed as useful surrogate measures of reduced muscle mass, the independent prognostic value of BIA-derived FFMI by bioelectric impedance analysis (BIA) in patients with cancer still needs to be fully explored. METHODS Data on body mass index (BMI), 6-month percentage of weight loss (%WL), FFMI by BIA and quality of life (QoL by EORTC Quality of Life Questionnaire [EORTC QLQ-C30]) of Italian and German patients observed prospectively until death or censoring were used (N = 1217). Patients were stratified in 5 risk categories according to a robustly validated scoring system based on BMI and %WL. Low FFMI was defined as follows: men, <17 kg/m2; women, <15 kg/m2. RESULTS Reduced FFMI was found in 234 patients (19.2%). After a median follow-up of 57 months [25th-75th, 31-60], 620 patients (50.9%) had died. The study detected differences in survival between patients presenting with and without reduced FFMI (14.0 months vs. 45.1 months; P < 0.001). The fully-adjusted hazard ratio of mortality for low FFMI was 1.46 [95%CI, 1.18-1.81] (P < 0.001). Low FFMI was also independently associated with reduced QoL: fully-adjusted odds ratio, 1.50 [95%CI, 1.00-2.25] (P = 0.050). CONCLUSIONS Reduced FFMI by BIA independently predicted survival and was associated with impaired QoL. Altered body composition should always be considered in all patients with cancer as additional phenotypic criterion of poor prognosis and BIA offers the possibility of multiple, noninvasive bedside assessments.
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Affiliation(s)
- Emanuele Cereda
- Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
| | - Paolo Pedrazzoli
- Medical Oncology Unit, Fondazione IRCCS Policlinico San Matteo and Department of Internal Medicine, University of Pavia, Pavia, Italy
| | - Federica Lobascio
- Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Sara Masi
- Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Silvia Crotti
- Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Catherine Klersy
- Clinical Epidemiology and Biometry Service, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Annalisa Turri
- Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Nicole Stobäus
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Clinical Research Unit, Berlin, Germany
| | - Maja Tank
- Medizinisches Versorgungszentrum Hämatologie-Onkologie Tempelhof Berlin, Germany; Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Germany; Department of Geriatrics, Research Group on Geriatrics, Berlin, Germany
| | - Kristina Franz
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Germany; Department of Geriatrics, Research Group on Geriatrics, Berlin, Germany; German Institute of Human Nutrition Potsdam-Rehbrücke, Department of Nutrition and Gerontology, Nuthetal, Germany; German Center for Diabetes Research (DZD), München-Neuherberg, Germany
| | - Sara Cutti
- Medical Direction, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Ester Giaquinto
- M. Bufalini Hospital, Dietetic and Nutrition Unit, Cesena, Italy
| | - Andrea Riccardo Filippi
- Radiation Oncology Department, Fondazione IRCCS Policlinico San Matteo and University of Pavia, Italy
| | - Kristina Norman
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Germany; Department of Geriatrics, Research Group on Geriatrics, Berlin, Germany; German Institute of Human Nutrition Potsdam-Rehbrücke, Department of Nutrition and Gerontology, Nuthetal, Germany
| | - Riccardo Caccialanza
- Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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94
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Asyakina L, Fotina N, Izgarysheva N, Slavyanskiy A, Neverova O. Geroprotective potential of in vitro bioactive compounds isolated from yarrow (Achilleae millefolii L.) cell cultures. FOODS AND RAW MATERIALS 2021. [DOI: 10.21603/2308-4057-2021-1-126-134] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Introduction. There is an urgent need for geroprotectors that prevent premature aging, especially antioxidants of plant origin. Due to the shortage of medicinal plant materials, scientists look for alternative sources of bioactive compounds of phenolic nature, for example, cell cultures and organs of higher plants. This paper describes a study of the geroprotective potential of in vitro bioactive compounds isolated from yarrow (Achilleae millefolii L.) cell cultures.
Study objects and methods. Callus, suspension and hairy root cultures of A. millefolii were obtained by in vitro cultivation on modified nutrient media. High performance liquid chromatography (HPLC) was used to analyze the composition of the cell cultures and ethanol extracts. The extracts’ antimicrobial activity was studied by the disk diffusion method and their antioxidant activity was measured based on titration of a potassium permanganate solution.
Results and discussion. The biomass of all yarrow cell cultures contained essential oils, flavonoids, glycosides, phenolic acids, carotenoids, as well as vitamins C and E. The suspension culture had a higher content of essential oils, flavonoids and glycosides than the callus and hairy root cultures. The extracts of the A. millefolii suspension culture also contained geroprotectors – phenylpropanoids, flavonoids, and simple phenols, with a prevalence of caffeic acid, cynaroside, 4,5-dicofeylquinic acid, apigenin, and luteolin. In addition, HPLC revealed the presence of cumic aldehyde, umbelliferone, 3-caffeylquinic acid, and caffeic acid – the bioactive compounds previously not reported in yarrow. In vitro experiments with the extracts proved their antimicrobial and antioxidant activity.
Conclusion. The complex of bioactive compounds isolated from the biomass of yarrow suspension culture provides this plant with potential geroprotective properties. Thus, yarrow can be used to create nutraceuticals that prevent premature aging.
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Affiliation(s)
| | | | | | - Anatoliy Slavyanskiy
- K.G. Razumovsky Moscow State University of technologies and management (the First Cossack University)
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95
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Giallauria F, Di Lorenzo A, Venturini E, Pacileo M, D’Andrea A, Garofalo U, De Lucia F, Testa C, Cuomo G, Iannuzzo G, Gentile M, Nugara C, Sarullo FM, Marinus N, Hansen D, Vigorito C. Frailty in Acute and Chronic Coronary Syndrome Patients Entering Cardiac Rehabilitation. J Clin Med 2021; 10:1696. [PMID: 33920796 PMCID: PMC8071180 DOI: 10.3390/jcm10081696] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 04/09/2021] [Accepted: 04/12/2021] [Indexed: 12/18/2022] Open
Abstract
Worldwide population ageing is partly due to advanced standard of care, leading to increased incidence and prevalence of geriatric syndromes such as frailty and disability. Hence, the age at the onset of acute coronary syndromes (ACS) keeps growing as well. Moreover, ageing is a risk factor for both frailty and cardiovascular disease (CVD). Frailty and CVD in the elderly share pathophysiological mechanisms and associated conditions, such as malnutrition, sarcopenia, anemia, polypharmacy and both increased bleeding/thrombotic risk, leading to a negative impact on outcomes. In geriatric populations ACS is associated with an increased frailty degree that has a negative effect on re-hospitalization and mortality outcomes. Frail elderly patients are increasingly referred to cardiac rehabilitation (CR) programs after ACS; however, plans of care must be tailored on individual's clinical complexity in terms of functional capacity, nutritional status and comorbidities, cognitive status, socio-economic support. Completing rehabilitative intervention with a reduced frailty degree, disability prevention, improvement in functional state and quality of life and reduction of re-hospitalization are the goals of CR program. Tools for detecting frailty and guidelines for management of frail elderly patients post-ACS are still debated. This review focused on the need of an early identification of frail patients in elderly with ACS and at elaborating personalized plans of care and secondary prevention in CR setting.
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Affiliation(s)
- Francesco Giallauria
- Department of Translational Medical Sciences, “Federico II” University of Naples, 80131 Naples, Italy; (A.D.L.); (U.G.); (F.D.L.); (C.T.); (G.C.); (C.V.)
| | - Anna Di Lorenzo
- Department of Translational Medical Sciences, “Federico II” University of Naples, 80131 Naples, Italy; (A.D.L.); (U.G.); (F.D.L.); (C.T.); (G.C.); (C.V.)
| | - Elio Venturini
- Cardiac Rehabilitation Unit, Azienda USL Toscana Nord-Ovest, Cecina Civil Hospital, 57023 Cecina (LI), Italy;
| | - Mario Pacileo
- Division of Cardiology/UTIC, “Umberto I” Hospital, Nocera Inferiore (ASL Salerno), 84014 Nocera Inferiore (SA), Italy; (M.P.); (A.D.)
| | - Antonello D’Andrea
- Division of Cardiology/UTIC, “Umberto I” Hospital, Nocera Inferiore (ASL Salerno), 84014 Nocera Inferiore (SA), Italy; (M.P.); (A.D.)
- Division of Cardiology, “Luigi Vanvitelli” University of Naples, 80131 Naples, Italy
| | - Umberto Garofalo
- Department of Translational Medical Sciences, “Federico II” University of Naples, 80131 Naples, Italy; (A.D.L.); (U.G.); (F.D.L.); (C.T.); (G.C.); (C.V.)
| | - Felice De Lucia
- Department of Translational Medical Sciences, “Federico II” University of Naples, 80131 Naples, Italy; (A.D.L.); (U.G.); (F.D.L.); (C.T.); (G.C.); (C.V.)
| | - Crescenzo Testa
- Department of Translational Medical Sciences, “Federico II” University of Naples, 80131 Naples, Italy; (A.D.L.); (U.G.); (F.D.L.); (C.T.); (G.C.); (C.V.)
| | - Gianluigi Cuomo
- Department of Translational Medical Sciences, “Federico II” University of Naples, 80131 Naples, Italy; (A.D.L.); (U.G.); (F.D.L.); (C.T.); (G.C.); (C.V.)
| | - Gabriella Iannuzzo
- Department of Clinical Medicine and Surgery, “Federico II” University of Naples, 80131 Naples, Italy; (G.I.); (M.G.)
| | - Marco Gentile
- Department of Clinical Medicine and Surgery, “Federico II” University of Naples, 80131 Naples, Italy; (G.I.); (M.G.)
| | - Cinzia Nugara
- Cardiovascular Rehabilitation Unit, Buccheri La Ferla Fatebenefratelli Hospital, 90123 Palermo, Italy; (C.N.); (F.M.S.)
| | - Filippo M Sarullo
- Cardiovascular Rehabilitation Unit, Buccheri La Ferla Fatebenefratelli Hospital, 90123 Palermo, Italy; (C.N.); (F.M.S.)
| | - Nastasia Marinus
- REVAL-Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, BE3590 Diepenbeek, Belgium; (N.M.); (D.H.)
- BIOMED-Biomedical Research Center, Hasselt University, BE3590 Diepenbeek, Belgium
| | - Dominique Hansen
- REVAL-Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, BE3590 Diepenbeek, Belgium; (N.M.); (D.H.)
- BIOMED-Biomedical Research Center, Hasselt University, BE3590 Diepenbeek, Belgium
- Heart Centre Hasselt, Jessa Hospital, BE3500 Hasselt, Belgium
| | - Carlo Vigorito
- Department of Translational Medical Sciences, “Federico II” University of Naples, 80131 Naples, Italy; (A.D.L.); (U.G.); (F.D.L.); (C.T.); (G.C.); (C.V.)
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96
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Pelà G, Tagliaferri S, Perrino F, Righelli I, Montanari R, Longobucco Y, Salvi M, Calvani R, Cesari M, Cherubini A, Bernabei R, Di Bari M, Landi F, Marzetti E, Lauretani F, Maggio M. Determinants of cardiac structure in frail and sarcopenic elderly adults. Exp Gerontol 2021; 150:111351. [PMID: 33864831 DOI: 10.1016/j.exger.2021.111351] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 04/05/2021] [Accepted: 04/08/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND Cardiac structure and function change with age. The higher prevalence of left ventricular hypertrophy (LVH) with concentric remodeling is indicative of a typical geometric pattern of aging associated with a higher cardiovascular (CV) risk and diseases. The recent associations found between low left ventricular and skeletal mass in older patients with frailty and sarcopenia have raised great interest in investigating cardiac characteristics and determinants of left ventricular mass (LVM) in this population. DESIGN Cross-sectional study. METHODS We evaluated 100 sarcopenic and physically frail outpatients, 33 men (M), 67 women (F), aged ≥70 years (mean age 79 ± 5) and enrolled in the Parma site of European multicenter SPRINTT population. RESULTS All male and female participants showed LVH, assessed as indexed LVM to body surface area (LVM/BSA) (M = 128 ± 39 g/m2; F = 104 ± 26 g/m2), and were more prone to have concentric geometry, as demonstrated by relative wall thickness value (0.41 in both sexes). After backward regression analysis, including covariates such as age, sex, office or ABPM systolic blood pressure (SBP), heart rate, BSA, use of β blockers, ACE-inhibitors, angiotensin receptor blockers, calcium channel blockers, diuretics, physical activity, hemoglobin level, and Mini Mental State examination - the most powerful determinants of LVM were clinical SBP (β = 1.51 ± 0.31, p = 0.0005), BSA (β = 165.9 ± 41.4, p = 0.0001), while less powerful determinants were 24 h, daily and nightly SBP (p = 0.02, p = 0.002, p = 0.004 respectively). CONCLUSIONS Older sarcopenic and physically frail patients showed LVH with a tendency towards concentric geometry. The main determinant of LVM was SBP, highlighting the key role that hemodynamic condition plays in determining LVH in this population.
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Affiliation(s)
- Giovanna Pelà
- Department of Medicine and Surgery, University Medical School of Parma, Parma, Italy; University-Hospital of Parma, Parma, Italy.
| | - Sara Tagliaferri
- Department of Medicine and Surgery, University Medical School of Parma, Parma, Italy
| | - Felice Perrino
- Department of Medicine and Surgery, University Medical School of Parma, Parma, Italy; University-Hospital of Parma, Parma, Italy
| | - Ilaria Righelli
- Department of Medicine and Surgery, University Medical School of Parma, Parma, Italy
| | - Rossella Montanari
- Department of Medicine and Surgery, University Medical School of Parma, Parma, Italy
| | - Yari Longobucco
- Department of Medicine and Surgery, University Medical School of Parma, Parma, Italy
| | - Marco Salvi
- Department of Medicine and Surgery, University Medical School of Parma, Parma, Italy; University-Hospital of Parma, Parma, Italy; Geriatric Clinic Unit, University-Hospital of Parma, Parma, Italy
| | - Riccardo Calvani
- Department of Geriatrics, Neurosciences and Orthopedics, Università Cattolica del Sacro Cuore and Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy
| | - Matteo Cesari
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy; Geriatric Unit, IRCCS Istituti Clinici Scientifici Maugeri, Milan, Italy
| | - Antonio Cherubini
- Geriatria, Accettazione Geriatrica e Centro di ricerca per l'invecchiamento, IRCCS INRCA, Ancona, Italy
| | - Roberto Bernabei
- Department of Geriatrics, Neurosciences and Orthopedics, Università Cattolica del Sacro Cuore and Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy
| | - Mauro Di Bari
- Research Unit of Medicine of Aging, Department of Clinical and Experimental Medicine, University of Florence, Firenze, Italy; Unit of Geriatrics - Geriatrics Intensive Care Unit, Department of Medicine and Geriatrics, University-Hospital Careggi, Firenze, Italy
| | - Francesco Landi
- Department of Geriatrics, Neurosciences and Orthopedics, Università Cattolica del Sacro Cuore and Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy
| | - Emanuele Marzetti
- Department of Geriatrics, Neurosciences and Orthopedics, Università Cattolica del Sacro Cuore and Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy
| | - Fulvio Lauretani
- Department of Medicine and Surgery, University Medical School of Parma, Parma, Italy; University-Hospital of Parma, Parma, Italy; Geriatric Clinic Unit, University-Hospital of Parma, Parma, Italy
| | - Marcello Maggio
- Department of Medicine and Surgery, University Medical School of Parma, Parma, Italy; University-Hospital of Parma, Parma, Italy; Geriatric Clinic Unit, University-Hospital of Parma, Parma, Italy
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97
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Tanaka S, Yamashita M, Saito H, Kamiya K, Maeda D, Konishi M, Matsue Y. Multidomain Frailty in Heart Failure: Current Status and Future Perspectives. Curr Heart Fail Rep 2021; 18:107-120. [PMID: 33835397 DOI: 10.1007/s11897-021-00513-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/22/2021] [Indexed: 12/15/2022]
Abstract
PURPOSE OF REVIEW With a worldwide aging population, frailty and heart failure (HF) have become issues that need to be addressed urgently in cardiovascular clinical practice. In this review, we outline the clinical implications of frailty in HF patients and the potential therapeutic strategies to improve the clinical outcomes of frail patients with HF. RECENT FINDINGS Frailty has physical, psychological, and social domains, each of which is a prognostic determinant for patients with HF, and each domain overlaps with the other, although there are no standardized criteria for diagnosing frailty. Frailty can be targeted for treatment with various interventions, and recent studies have suggested that multidisciplinary intervention could be a promising option for frail patients with HF. However, currently, there is limited data, and further research is needed before its clinical implementation. Frailty and HF share a common background and are strongly associated with each other. More comprehensive assessment and therapeutic interventions for frailty need to be developed to further improve the prognosis and quality of life of frail patients with HF.
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Affiliation(s)
- Shinya Tanaka
- Department of Rehabilitation, Nagoya University Hospital, Aichi, Japan
| | - Masashi Yamashita
- Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences, Kanagawa, Japan
| | - Hiroshi Saito
- Department of Rehabilitation, Kameda Medical Center, Chiba, Japan.,Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Kentaro Kamiya
- Department of Rehabilitation, School of Allied Health Sciences, Kitasato University, Kanagawa, Japan
| | - Daichi Maeda
- Department of Cardiology, Osaka Medical College, Osaka, Japan
| | - Masaaki Konishi
- Division of Cardiology, Yokohama City University Medical Center, Kanagawa, Japan
| | - Yuya Matsue
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan. .,Cardiovascular Respiratory Sleep Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.
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98
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Chung KJNC, Wilkinson C, Veerasamy M, Kunadian V. Frailty Scores and Their Utility in Older Patients with Cardiovascular Disease. ACTA ACUST UNITED AC 2021; 16:e05. [PMID: 33897831 PMCID: PMC8054346 DOI: 10.15420/icr.2020.18] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 12/09/2020] [Indexed: 12/13/2022]
Abstract
The world’s population is ageing, resulting in more people with frailty receiving treatment for cardiovascular disease (CVD). The emergence of novel interventions, such as transcatheter aortic valve implantation, has also increased the proportion of older patients being treated in later stages of life. This increasing population burden makes the assessment of frailty of utmost importance, especially in patients with CVD. Despite a growing body of evidence on the association between frailty and CVD, there is no consensus on the optimal frailty assessment tool for use in clinical settings. Previous studies have shown limited concordance between validated frailty instruments. This review evaluates the evidence on the utility of frailty assessment tools in patients with CVD, and the effect of frailty on different outcomes measured.
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Affiliation(s)
- Kenneth Jordan Ng Cheong Chung
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University Newcastle upon Tyne, UK.,Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundations Trust Newcastle upon Tyne, UK
| | - Chris Wilkinson
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University Newcastle upon Tyne, UK
| | - Murugapathy Veerasamy
- Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust Leeds, UK.,Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds UK
| | - Vijay Kunadian
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University Newcastle upon Tyne, UK.,Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundations Trust Newcastle upon Tyne, UK
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99
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Montazami M, Khalifehzadeh-Esfahani A, Keshvari M. Investigating the Effect of Family-Centered Self-Care Program based on Home Visits Regarding Dietary and Medication Regimen Adherence of Discharged Patients with Acute Coronary Syndrome. IRANIAN JOURNAL OF NURSING AND MIDWIFERY RESEARCH 2021; 26:113-119. [PMID: 34036057 PMCID: PMC8132869 DOI: 10.4103/ijnmr.ijnmr_105_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Revised: 08/06/2019] [Accepted: 11/25/2020] [Indexed: 11/04/2022]
Abstract
Background Dietary and medication regimen adherence in patients with history of Acute Coronary Syndrome (ACS) is very important in preventing readmission and reducing the complications of the disease. The objective of the present study was to investigate the effect of the family-centered self-care program based on home visits dietary and medication regimen adherence in patients with ACS discharged from Shahid Chamran Hospital during 2017-2018. Materials and Methods This clinical trial was conducted on 80 ACS patients. The samples by using the random numbers table, were randomly divided into control and experimental groups. The routine interventions were administered for the control group, and family-centered self-care was conducted on patients of the experiment group. In order to obtain the quantitative data of this study, three questionnaires were used including demographic characteristics, Morisky questionnaire, and dietary adherence. Results The difference between the mean score of medication and diet regimen adherence in both groups before the intervention was not significant (p > 0.05). data was demonstrated that scores of medication and diet regimen adherence were significantly higher immediately and 6 weeks after the intervention; (f = 64.06, p < 0.001). Conclusions Family-centered self-care program based on home visits can be used as an effective method to increase the dietary and medication regimen adherence in ACS patients.
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Affiliation(s)
- Maryam Montazami
- School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | | | - Mahrokh Keshvari
- Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
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100
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Lohman MC, Sonnega AJ, Resciniti NV, Leggett AN. Frailty Phenotype and Cause-Specific Mortality in the United States. J Gerontol A Biol Sci Med Sci 2021; 75:1935-1942. [PMID: 31956891 DOI: 10.1093/gerona/glaa025] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Frailty is a common condition among older adults increasing risk of adverse outcomes including mortality; however, little is known about the incidence or risk of specific causes of death among frail individuals. METHODS Data came from the Health and Retirement Study (HRS; 2004-2012), linked to underlying cause-of-death information from the National Death Index (NDI). Community-dwelling HRS participants aged 65 and older who completed a general health interview and physical measurements (n = 10,490) were included in analysis. Frailty was measured using phenotypic model criteria-exhaustion, low weight, low energy expenditure, slow gait, and weakness. Underlying causes of death were determined using International Classification of Diseases, Version 10 codes. We used Cox proportional hazards and competing risks regression models to calculate and compare incidence of cause-specific mortality by frailty status. RESULTS During follow-up, prefrail and frail older adults had significantly greater hazard of all-cause mortality compared to individuals without symptoms (adjusted hazard ratio [HR] prefrail: 1.85, 95% CI: 1.51, 2.25; HR frail: 2.75, 95% CI: 2.14, 3.53). Frailty was associated with 2.96 (95% CI: 2.17, 4.03), 2.82 (95% CI: 2.02, 3.94), 3.48 (95% CI: 2.17, 5.59), and 2.87 (95% CI: 1.47, 5.59) times greater hazard of death from heart disease, cancer, respiratory illness, and dementia, respectively. CONCLUSIONS Significantly greater risk of mortality from several different causes should be considered alongside the potential costs of screening and intervention for frailty in subspecialty and general geriatric clinical practice. Findings may help investigators estimate the potential impact of frailty reduction approaches on mortality.
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Affiliation(s)
- Matthew C Lohman
- Department of Epidemiology and Biostatistics, University of South Carolina, Arnold School of Public Health, Columbia
| | - Amanda J Sonnega
- Institute for Social Research, University of Michigan, Ann Arbor
| | - Nicholas V Resciniti
- Department of Epidemiology and Biostatistics, University of South Carolina, Arnold School of Public Health, Columbia
| | - Amanda N Leggett
- Department of Psychiatry, University of Michigan, Ann Arbor.,Institute for Health Policy and Innovation, University of Michigan, Ann Arbor
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