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Kennel PJ, Kneifati-Hayek J, Bryan J, Banerjee S, Sobol I, Lachs MS, Safford MM, Goyal P. Prevalence and determinants of Hyperpolypharmacy in adults with heart failure: an observational study from the National Health and Nutrition Examination Survey (NHANES). BMC Cardiovasc Disord 2019; 19:76. [PMID: 30935411 PMCID: PMC6444677 DOI: 10.1186/s12872-019-1058-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 03/21/2019] [Indexed: 01/08/2023] Open
Abstract
Background While an expanding armamentarium of pharmacologic therapies has contributed to improved outcomes among adults with heart failure (HF) over the past two decades, this has also been accompanied by an increase in the number of medications taken by adults with HF. The use of at least 10 medications, defined as hyperpolypharmacy, is particularly notable given its association with adverse outcomes. We aimed to assess the prevalence and identify determinants of hyperpolypharmacy among adults with HF. Methods We studied adults aged ≥50 years with self-reported HF from the National Health And Nutrition Examination Survey (NHANES) in 2003–2014. We calculated weighted means and percentages to describe patient characteristics. We conducted a multivariable Poisson regression analysis to identify factors independently associated with hyperpolypharmacy; we adjusted for survey sampling, socio-demographics, comorbidity, geriatric conditions, and health care utilization. We examined 947 participants, representing 4.6 million adults with HF. Results The prevalence of hyperpolypharmacy was 26%. In a multivariable regression analysis, comorbidity count, ≥10 ambulatory contacts, and ≥ 3 hospitalizations were independently associated with hyperpolypharmacy. Interestingly, functional impairment and cognitive impairment were not independently associated with hyperpolypharmacy; while low annual household income and low educational status were each associated with an almost 2-fold increase in hyperpolypharmacy. Conclusion Hyperpolypharmacy is a common condition among adults with HF. We additionally found that low household income and low educational status are independently associated with hyperpolypharmacy, suggesting that non-medical factors may be contributing to this potentially harmful condition.
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Affiliation(s)
- Peter J Kennel
- Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Jerard Kneifati-Hayek
- Division of General Internal Medicine/Department of Medicine, Weill Cornell Medicine, 525 East 68th Street, F-2010, New York, NY, 10021, USA
| | - Joanna Bryan
- Division of General Internal Medicine/Department of Medicine, Weill Cornell Medicine, 525 East 68th Street, F-2010, New York, NY, 10021, USA
| | - Samprit Banerjee
- Department of Healthcare Policy & Research, Weill Cornell Medicine, New York, NY, USA
| | - Irina Sobol
- Division of Cardiology/Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Mark S Lachs
- Division of Geriatrics/Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Monika M Safford
- Division of General Internal Medicine/Department of Medicine, Weill Cornell Medicine, 525 East 68th Street, F-2010, New York, NY, 10021, USA
| | - Parag Goyal
- Division of General Internal Medicine/Department of Medicine, Weill Cornell Medicine, 525 East 68th Street, F-2010, New York, NY, 10021, USA. .,Division of Geriatrics/Department of Medicine, Weill Cornell Medical College, New York, NY, USA.
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152
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Afilalo J, Joshi A, Mancini R. If You Cannot Measure Frailty, You Cannot Improve It. JACC-HEART FAILURE 2019; 7:303-305. [DOI: 10.1016/j.jchf.2018.12.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 12/15/2018] [Indexed: 12/15/2022]
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153
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Affiliation(s)
- Kelsey M Flint
- Division of Cardiology, Rocky Mountain Regional VA Medical Center, Aurora, CO (K.M.F.)
| | - Daniel E Forman
- Division of Cardiology, Rocky Mountain Regional VA Medical Center, Aurora, CO (K.M.F.).,Cardiac Rehabilitation and GeroFit, VA Pittsburgh Healthcare System, PA (D.E.F.)
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154
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Flint K. Frailty in TOPCAT: a deep dive into the deficit index approach for defining frailty. Eur J Heart Fail 2018; 20:1578-1579. [PMID: 30280454 DOI: 10.1002/ejhf.1316] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 08/24/2018] [Indexed: 11/06/2022] Open
Affiliation(s)
- Kelsey Flint
- Rocky Mountain Regional VA Medical Center, Aurora, CO, USA
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155
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156
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Saito H, Kagiyama N, Nagano N, Matsumoto K, Yoshioka K, Endo Y, Hayashida A, Matsue Y. Social isolation is associated with 90-day rehospitalization due to heart failure. Eur J Cardiovasc Nurs 2018; 18:16-20. [PMID: 30251884 DOI: 10.1177/1474515118800113] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Social isolation has been reported to be associated with decreased quality of life and the onset of organic diseases. The objective of this study was to investigate the prevalence of social isolation in patients with heart failure and whether it is associated with rehospitalization. METHODS AND RESULTS The study included consecutive patients aged ⩾55 years who were hospitalized due to heart failure. Social isolation was assessed using total scores less than 12 on an abbreviated version of the Lubben Social Network Scale. The endpoint was heart failure rehospitalization within 90 days after discharge. Among 148 patients with heart failure (80±8 years old, 51% male), 73 (49%) were socially isolated. The patients with social isolation had similar comorbidities compared with those without social isolation. Heart failure rehospitalization occurred within 90 days for 25 patients and the heart failure rehospitalization rate was significantly higher in the social isolation group ( p=0.036). LASSO (least absolute shrinkage and selection operator) regression confirmed that social isolation was one of the strongest predictors of heart failure rehospitalization, showing larger effects than living alone, being unemployed, and other established risk factors. CONCLUSION Half of the patients with heart failure reported social isolation, which had a strong association with heart failure rehospitalization.
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Affiliation(s)
- Hiroshi Saito
- 1 Department of Rehabilitation, Kameda Medical Center, Japan
| | - Nobuyuki Kagiyama
- 2 Division of Cardiology, Washington University in St Louis, USA.,3 Department of Cardiology, The Sakakibara Heart Institute of Okayama, Japan
| | - Noriko Nagano
- 4 Department of Nursing, The Sakakibara Heart Institute of Okayama, Japan
| | - Kozue Matsumoto
- 4 Department of Nursing, The Sakakibara Heart Institute of Okayama, Japan
| | - Kenji Yoshioka
- 5 Department of Cardiology, Kameda Medical Center, Japan
| | - Yoshiko Endo
- 1 Department of Rehabilitation, Kameda Medical Center, Japan
| | - Akihiro Hayashida
- 3 Department of Cardiology, The Sakakibara Heart Institute of Okayama, Japan
| | - Yuya Matsue
- 5 Department of Cardiology, Kameda Medical Center, Japan.,6 Department of Cardiovascular Medicine, Juntendo University School of Medicine, Japan
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157
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Hornsby WE, Sareini MA, Golbus JR, Willer CJ, McNamara JL, Konerman MC, Hummel SL. Lower Extremity Function Is Independently Associated With Hospitalization Burden in Heart Failure With Preserved Ejection Fraction. J Card Fail 2018; 25:2-9. [PMID: 30219550 DOI: 10.1016/j.cardfail.2018.09.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 07/23/2018] [Accepted: 09/05/2018] [Indexed: 12/15/2022]
Abstract
BACKGROUND Frailty reflects decreased resilience to physiological stressors; its prevalence and prognosis are not fully defined in heart failure with preserved ejection fraction (HFpEF). METHODS The Short Physical Performance Battery (SPPB) was prospectively obtained in 114 outpatients with HFpEF. The SPPB tests gait speed, tandem balance, and timed chair rises, each scored from 0 to 4 points. Severe and mild frailty were respectively defined as an SPPB score ≤6 and 7-9 points. We used risk-adjusted logistic, Poisson, and negative binominal regression, respectively, to assess the relationship between SPPB score and risk of death or all-cause hospitalization, number of hospitalizations, and days hospitalized or dead longer than 6 months. RESULTS Patients were similar to other HFpEF cohorts (age 68 ± 13 years, 58% female, body mass index 36 ± 8 kg/m2, multiple comorbidities). Mean SPPB score was 6.9 ± 3.2, and 80% of patients were at least mildly frail. Over a 6-month period, the SPPB score independently predicted death or all-cause hospitalization (odds ratio 0.81 per point, 95% confidence interval [CI] 0.69-0.94, P = .006), number of hospitalizations (incidence rate ratio 0.92 per point, 95% CI 0.86-0.97, P = .006), and days hospitalized or dead (incidence rate ratio 0.85 per point, 95% CI 0.73-0.99, P = .04). CONCLUSIONS Lower extremity function, as measured by the SPPB, independently predicts hospitalization burden in outpatients with HFpEF. Additional studies are warranted to explore shared mechanisms and treatment implications of frailty in HFpEF.
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Affiliation(s)
- Whitney E Hornsby
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan; Frankel Cardiovascular Center, Michigan Medicine, Ann Arbor, Michigan
| | - Mohamed-Ali Sareini
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan; Frankel Cardiovascular Center, Michigan Medicine, Ann Arbor, Michigan
| | - Jessica R Golbus
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan; Frankel Cardiovascular Center, Michigan Medicine, Ann Arbor, Michigan
| | - Cristen J Willer
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan; Frankel Cardiovascular Center, Michigan Medicine, Ann Arbor, Michigan; Department of Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, Michigan; Department of Human Genetics, University of Michigan, Ann Arbor, Michigan
| | - Jennifer L McNamara
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan; Frankel Cardiovascular Center, Michigan Medicine, Ann Arbor, Michigan
| | - Matthew C Konerman
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan; Frankel Cardiovascular Center, Michigan Medicine, Ann Arbor, Michigan
| | - Scott L Hummel
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan; Frankel Cardiovascular Center, Michigan Medicine, Ann Arbor, Michigan; Ann Arbor Veterans Affairs Health System, Ann Arbor, Michigan.
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Abstract
Frailty is a complex clinical syndrome associated with ageing and chronic illness, resulting from multiple organ impairment; physiological reserves decrease and vulnerability to stressors increase. The role of frailty in cardiovascular disease has become increasingly recognised. Up to 79% of patients with heart failure are frail. Moreover, frailty is associated with a worse quality of life and poor prognosis. This review summarises the available literature on frailty in HF and highlights indications for its management.
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Affiliation(s)
- Cristiana Vitale
- Centre for Clinical and Basic Research, Department of Medical Sciences, IRCCS San Raffaele Pisana Rome, Italy
| | - Ilaria Spoletini
- Centre for Clinical and Basic Research, Department of Medical Sciences, IRCCS San Raffaele Pisana Rome, Italy
| | - Giuseppe Mc Rosano
- Centre for Clinical and Basic Research, Department of Medical Sciences, IRCCS San Raffaele Pisana Rome, Italy
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