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Jones R, Enogela EM, Zumbro EL, Soukhamneut P, Richardson CR, Buford TW, Jackson EA. Assessment of Frailty Among Older Adults in the Physical Activity Daily Trial. J Appl Gerontol 2024; 43:1428-1437. [PMID: 38655762 DOI: 10.1177/07334648241244690] [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] [Indexed: 04/26/2024] Open
Abstract
Frailty is common among cardiac patients; however, frailty assessment data from patients with peripheral arterial disease (PAD) are limited. The purpose of this observational study was to identify the prevalence and factors related to frailty in addition to unique frailty marker groupings in a cohort of sedentary adults with PAD. We grouped three PAD-relevant frailty characteristics using Fried's frailty phenotype -1) exhaustion, (2) weakness, and (3) slowness-and observed the prevalence of pre-frailty (1-2 characteristics) and frailty (3 characteristics) in the PAD cohort. Of the 106 participants, 34.9% were robust/non-frail, 53.8% were pre-frail, and 2.8% were frail. Exhaustion (33.3%) was the most occurring characteristic followed by weakness (20.0%) and slowness (5.0%). The grouping of weakness + slowness (10.0%) was the most prevalent followed by exhaustion + weakness (8.3%) and exhaustion + slowness (5.0%). Among pre-frail participants, ankle brachial index was correlated with a reduction in gait speed.
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Affiliation(s)
- Raymond Jones
- University of Alabama at Birmingham, Birmingham, AL, USA
| | - Ene M Enogela
- University of Alabama at Birmingham, Birmingham, AL, USA
| | - Emily L Zumbro
- University of Alabama at Birmingham, Birmingham, AL, USA
| | | | | | - Thomas W Buford
- University of Alabama at Birmingham, Birmingham, AL, USA
- Geriatric Research Education and Clinical Center, Birmingham VA Medical Center, Birmingham, AL, USA
| | - Elizabeth A Jackson
- University of Alabama at Birmingham, Birmingham, AL, USA
- Geriatric Research Education and Clinical Center, Birmingham VA Medical Center, Birmingham, AL, USA
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Al-Ani A, Jamil Y, Orkaby AR. Treating Hypercholesterolemia in Older Adults for Primary Prevention of Cardiovascular Events. Drugs Aging 2024; 41:699-712. [PMID: 39126433 DOI: 10.1007/s40266-024-01139-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/22/2024] [Indexed: 08/12/2024]
Abstract
As the population ages, the demographic of adults aged 75 years and older in the U.S. is projected to grow to 45 million by 2050. Hypercholesterolemia is directly linked to atherosclerotic cardiovascular disease (ASCVD), which remains the leading cause of death in older adults. However, primary prevention of ASCVD through lipid-lowering agents remains unclear among older adults owing to limited involvement of older adults in current trials, lack of dedicated trials, and evidence primarily derived from secondary and retrospective analyses. Therefore, this article aims to (1) review key updates from the latest guidelines on treatment of hypercholesterolemia in older adults, (2) highlight limitations of the current ASCVD risk scores in the geriatric population, (3) present outcomes from key studies on the use of lipid-lowering agents and associated side effects, including a brief review of novel agents such as bempedoic acid, although very few adults over age 75 were included in these trial, and (4) finally, highlight upcoming dedicated trials of statins in older adults for the primary prevention of important geriatric outcomes as well as ASCVD.
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Affiliation(s)
- Awsse Al-Ani
- New England GRECC (Geriatric Research, Education, and Clinical Center), VA Boston Healthcare System, Boston, MA, USA
- Division of Aging, Brigham and Women's Hospital, Boston, MA, USA
| | - Yasser Jamil
- Department of Internal Medicine, Yale School of Medicine, Connecticut, USA
| | - Ariela R Orkaby
- New England GRECC (Geriatric Research, Education, and Clinical Center), VA Boston Healthcare System, Boston, MA, USA.
- Division of Aging, Brigham and Women's Hospital, Boston, MA, USA.
- Harvard Medical School, Boston, MA, USA.
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Peixoto C, Choudhri Y, Francoeur S, McCarthy LM, Fung C, Dowlatshahi D, Lemay G, Barry A, Goyal P, Pan J, Bjerre LM, Thompson W. Discontinuation versus continuation of statins: A systematic review. J Am Geriatr Soc 2024. [PMID: 39051828 DOI: 10.1111/jgs.19093] [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: 02/27/2024] [Revised: 05/23/2024] [Accepted: 06/27/2024] [Indexed: 07/27/2024]
Abstract
BACKGROUND Clinicians and patients often face a decision to continue or discontinue statins. We examined the impact of discontinuation of statins compared with continuation on clinical outcomes (all-cause mortality, cardiovascular [CV] mortality, CV events, and quality of life). METHODS We conducted a systematic review. Randomized controlled trials (RCTs), cohort studies, case-control studies, and quasi-randomized studies among people ≥18 years were eligible. We searched MEDLINE, Embase, and Cochrane Central Registry (inception to August 2023). Two independent reviewers performed screening and extracted data. Quality assessment was performed by one author and verified by another. We summarized results narratively, performed meta-analysis for a subset of studies, and used GRADE to assess certainty of evidence. We summarized findings in the subgroup of persons ≥75 years. RESULTS We retrieved 8369 titles/abstracts; 37 reports from 36 studies were eligible. This comprised 35 non-randomized studies (n = 1,708,684) and 1 RCT (n = 381). The 1 RCT was conducted among persons with life expectancy <1 year and showed there is probably no difference in 60-day mortality (risk difference = 3.5%, 90% CI -3.5 to 10.5) for statin discontinuation compared with continuation. Non-randomized studies varied in terms of population and setting, but consistently suggested that statin discontinuation might be associated with a relative increased risk of mortality (hazard ratio (HR) 1.92, 95% CI 1.52 to 2.44, nine studies), CV mortality (HR 1.63, 95% CI 1.27 to 2.10, five reports), and CV events (HR 1.31, 95% CI 1.23 to 1.39, eight reports). Findings in people ≥75 years were consistent with main results. There was a high degree of uncertainty in findings from non-randomized studies due to methodological limitations. CONCLUSIONS Statin discontinuation does not appear to affect short-term mortality near end-of-life based on one RCT. Outside of this population, findings from non-randomized studies consistently suggested statin discontinuation may be associated with worse outcomes, though this is uncertain.
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Affiliation(s)
| | | | | | - Lisa M McCarthy
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
- Institute for Better Health, Trillium Health Partners, Mississauga, Ontario, Canada
- Women's College Research Institute, Toronto, Ontario, Canada
- Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Celeste Fung
- Department of Family Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Dar Dowlatshahi
- Department of Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Geneviève Lemay
- Institut du Savoir Montfort, Ottawa, Ontario, Canada
- Department of Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Arden Barry
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Parag Goyal
- Program for the Care and Study of the Aging Heart, Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Jeffrey Pan
- Department of Anesthesiology, Pharmacology, and Therapeutics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Lise M Bjerre
- Institut du Savoir Montfort, Ottawa, Ontario, Canada
- Department of Family Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Wade Thompson
- Department of Anesthesiology, Pharmacology, and Therapeutics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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Ungar A, Rivasi G, Testa GD, Boureau AS, Mattace-Raso F, Martínez-Sellés M, Bo M, Petrovic M, Werner N, Benetos A. Geriatricians' role in the management of aortic stenosis in frail older patients: a decade later. Eur Geriatr Med 2024:10.1007/s41999-024-01015-9. [PMID: 39037643 DOI: 10.1007/s41999-024-01015-9] [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: 02/04/2024] [Accepted: 06/25/2024] [Indexed: 07/23/2024]
Abstract
INTRODUCTION Increasing evidence supports the implementation of geriatric assessment in the workup of older patients with aortic stenosis (AS). In 2012, an online European survey revealed that geriatricians were rarely involved in the assessment of candidates for transcatheter aortic valve implantation (TAVI). After a "call to action" for early involvement of geriatricians in AS evaluation, the survey was repeated in 2022. Our aim was to investigate whether geriatricians' role changed in the last decade. METHODS Online survey conducted between December 16th, 2021, and December 15th, 2022. All members of the European Geriatric Medicine Society were invited to participate. The survey included 26 questions regarding geriatricians' experience with AS and TAVI. RESULTS Among 193 respondents (79.8% geriatricians), 73 (38%) reported to be involved in AS evaluation at least once a week. During 2 years prior to the survey, 43 (22.3%) had referred > 50% of their patients with severe AS for TAVI. Age influenced TAVI referral in a considerable proportion of respondents (36.8%). TAVI candidates were mainly referred to specialised cardiac centres with multidisciplinary teams (91.8%), including (47.2%) or not including (44.6%) a geriatrician. A total of 38.9% of respondents reported to be part of a multidisciplinary heart team. Geriatricians were less frequently involved (37%) than cardiologists (89.6%) and surgeons (53.4%) in pre-procedural TAVI management. Cardiologists were more frequently involved (85.5%) than geriatricians (33.7%) and surgeons (26.9%) in post-procedural management. CONCLUSIONS Geriatricians' involvement in AS management and multidisciplinary heart teams remains scarce. More efforts should be devoted to implement geriatricians' role in AS decision-making.
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Affiliation(s)
- Andrea Ungar
- Geriatrics and Intensive Care Unit, University of Florence and Azienda Ospedaliero Universitaria Careggi, Florence, Italy.
| | - Giulia Rivasi
- Geriatrics and Intensive Care Unit, University of Florence and Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Giuseppe Dario Testa
- Geriatrics and Intensive Care Unit, University of Florence and Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Anne Sophie Boureau
- Nantes Université, CHU Nantes, Pole de Gérontologie Clinique, 44000, Nantes, France
| | - Francesco Mattace-Raso
- Division of Geriatrics, Department of Internal Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Manuel Martínez-Sellés
- Cardiology Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, CIBERCV, Universidad Europea, Universidad Complutense, Madrid, Spain
| | - Mario Bo
- Section of Geriatric, Department of Medical Sciences, University of Turin, Città della Salute e della Scienza, Molinette, Turin, Italy
| | - Mirko Petrovic
- Section of Geriatrics, Department of Internal Medicine and Paediatrics, Ghent University, Ghent, Belgium
| | - Nikos Werner
- Heart Center Trier, Department of Internal Medicine III, Krankenhaus der Barmherzigen Brüder Trier, Trier, Germany
| | - Athanase Benetos
- Geriatric Department and Federation Hospital-University On Cardiovascular Aging (FHU-CARTAGE), University Hospital of Nancy, Université de Lorraine, Vandoeuvre-Lès-Nancy, France
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Wertman E. Essential New Complexity-Based Themes for Patient-Centered Diagnosis and Treatment of Dementia and Predementia in Older People: Multimorbidity and Multilevel Phenomenology. J Clin Med 2024; 13:4202. [PMID: 39064242 PMCID: PMC11277671 DOI: 10.3390/jcm13144202] [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: 06/10/2024] [Revised: 07/12/2024] [Accepted: 07/13/2024] [Indexed: 07/28/2024] Open
Abstract
Dementia is a highly prevalent condition with devastating clinical and socioeconomic sequela. It is expected to triple in prevalence by 2050. No treatment is currently known to be effective. Symptomatic late-onset dementia and predementia (SLODP) affects 95% of patients with the syndrome. In contrast to trials of pharmacological prevention, no treatment is suggested to remediate or cure these symptomatic patients. SLODP but not young onset dementia is intensely associated with multimorbidity (MUM), including brain-perturbating conditions (BPCs). Recent studies showed that MUM/BPCs have a major role in the pathogenesis of SLODP. Fortunately, most MUM/BPCs are medically treatable, and thus, their treatment may modify and improve SLODP, relieving suffering and reducing its clinical and socioeconomic threats. Regrettably, the complex system features of SLODP impede the diagnosis and treatment of the potentially remediable conditions (PRCs) associated with them, mainly due to failure of pattern recognition and a flawed diagnostic workup. We suggest incorporating two SLODP-specific conceptual themes into the diagnostic workup: MUM/BPC and multilevel phenomenological themes. By doing so, we were able to improve the diagnostic accuracy of SLODP components and optimize detecting and favorably treating PRCs. These revolutionary concepts and their implications for remediability and other parameters are discussed in the paper.
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Affiliation(s)
- Eli Wertman
- Department of Neurology, Hadassah University Hospital, The Hebrew University, Jerusalem 9190500, Israel;
- Section of Neuropsychology, Department of Psychology, The Hebrew University, Jerusalem 9190500, Israel
- Or’ad: Organization for Cognitive and Behavioral Changes in the Elderly, Jerusalem 9458118, Israel
- Merhav Neuropsychogeriatric Clinics, Nehalim 4995000, Israel
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Abdullah G, Akpan A, Phelan MM, Wright HL. New insights into healthy ageing, inflammageing and frailty using metabolomics. FRONTIERS IN AGING 2024; 5:1426436. [PMID: 39044748 PMCID: PMC11263002 DOI: 10.3389/fragi.2024.1426436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/01/2024] [Accepted: 06/24/2024] [Indexed: 07/25/2024]
Abstract
Human ageing is a normal process and does not necessarily result in the development of frailty. A mix of genetic, environmental, dietary, and lifestyle factors can have an impact on ageing, and whether an individual develops frailty. Frailty is defined as the loss of physiological reserve both at the physical and cellular levels, where systemic processes such as oxidative stress and inflammation contribute to physical decline. The newest "omics" technology and systems biology discipline, metabolomics, enables thorough characterisation of small-molecule metabolites in biological systems at a particular time and condition. In a biological system, metabolites-cellular intermediate products of metabolic reactions-reflect the system's final response to genomic, transcriptomic, proteomic, epigenetic, or environmental alterations. As a relatively newer technique to characterise metabolites and biomarkers in ageing and illness, metabolomics has gained popularity and has a wide range of applications. We will give a comprehensive summary of what is currently known about metabolomics in studies of ageing, with a focus on biomarkers for frailty. Metabolites related to amino acids, lipids, carbohydrates, and redox metabolism may function as biomarkers of ageing and/or frailty development, based on data obtained from human studies. However, there is a complexity that underpins biological ageing, due to both genetic and environmental factors that play a role in orchestrating the ageing process. Therefore, there is a critical need to identify pathways that contribute to functional decline in people with frailty.
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Affiliation(s)
- Genna Abdullah
- Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Asangaedem Akpan
- Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, United Kingdom
- Division of Internal Medicine, University of Western Australia, Bunbury, WA, Australia
- Faculty of Health Sciences, Curtis University, Bunbury, WA, Australia
- Department of Geriatric Medicine, Bunbury Regional Hospital, Bunbury, WA, Australia
| | - Marie M. Phelan
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, United Kingdom
- High Field NMR Facility, Liverpool Shared Research Facilities University of Liverpool, Liverpool, United Kingdom
| | - Helen L. Wright
- Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, United Kingdom
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Williams-Farrelly MM, Ferraro KF. Early Origins of Frailty: Do Later-Life Social Relationships Alter Trajectories of Decline? J Aging Health 2024; 36:275-285. [PMID: 37358912 PMCID: PMC10749989 DOI: 10.1177/08982643231185426] [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] [Indexed: 06/27/2023]
Abstract
Objectives: Social relationships are widely regarded as salubrious, but do they mediate the influence of childhood experiences on frailty in later life? Drawing from cumulative inequality theory, we assess the influence of childhood experiences and adult relationships on frailty trajectories. Methods: We analyzed data from the Health and Retirement Study to examine the influence of six domains of childhood experiences and social relationships on frailty trajectories over 8 years. Mediation analyses were completed with structural equation models. Results: Risky adolescent behavior, chronic disease, and impairments during childhood are associated directly with higher risk of initial frailty, but not over time. More social roles and higher social support mediate the relationship between childhood experiences and frailty, and the effect of more social roles continues over time. Discussion: This study provides compelling evidence that supportive social relationships mediate the risk and severity of frailty in later life associated with noxious childhood experiences.
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Affiliation(s)
- Monica M. Williams-Farrelly
- Department of General Internal Medicine and Geriatrics, Indiana University School of Medicine, Indianapolis, IN, USA
- Indiana University Center for Aging Research, Indianapolis, IN, USA
- Regenstrief Institute, Inc., Indianapolis, IN, USA
| | - Kenneth F. Ferraro
- Department of Sociology, Purdue University, West Lafayette, IN, USA
- Center on Aging and the Life Course, Purdue University, West Lafayette, IN, USA
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8
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Wong JJ, Wang LYT, Hasegawa K, Ho KW, Huang Z, Teo LLY, Tan JWC, Kasahara K, Tan RS, Ge J, Koh AS. Current frailty knowledge, awareness, and practices among physicians following the 2022 European consensus document on Frailty in Cardiology. EUROPEAN HEART JOURNAL OPEN 2024; 4:oeae025. [PMID: 38659665 PMCID: PMC11042574 DOI: 10.1093/ehjopen/oeae025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 03/15/2024] [Accepted: 03/24/2024] [Indexed: 04/26/2024]
Abstract
Aims Aging-related cardiovascular disease and frailty burdens are anticipated to rise with global aging. In response to directions from major cardiovascular societies, we investigated frailty knowledge, awareness, and practices among cardiologists as key stakeholders in this emerging paradigm a year after the European Frailty in Cardiology consensus document was published. Methods and results We launched a prospective multinational web-based survey via social networks to broad cardiology communities representing multiple World Health Organization regions, including Western Pacific and Southeast Asia regions. Overall, 578 respondents [38.2% female; ages 35-49 years (55.2%) and 50-64 years (34.4%)] across subspecialties, including interventionists (43.3%), general cardiologists (30.6%), and heart failure specialists (HFSs) (10.9%), were surveyed. Nearly half had read the consensus document (38.9%). Non-interventionists had better perceived knowledge of frailty assessment instruments (fully or vaguely aware, 57.2% vs. 45%, adj. P = 0.0002), exercise programmes (well aware, 12.9% vs. 6.0%, adj. P = 0.001), and engaged more in multidisciplinary team care (frequently or occasionally, 52.6% vs. 41%, adj. P = 0.002) than interventionists. Heart failure specialists more often addressed pre-procedural frailty (frequently or occasionally, 43.5% vs. 28.2%, P = 0.004) and polypharmacy (frequently or occasionally, 85.5% vs. 71%, adj. P = 0.014) and had consistently better composite knowledge (39.3% vs. 21.6%, adj. P = 0.001) and practice responses (21% vs. 11.1%, adj. P = 0.018) than non-HFSs. Respondents with better knowledge responses also had better frailty practices (40.3% vs. 3.6%, adj. P < 0.001). Conclusion Distinct response differences suggest that future strategies strengthening frailty principles should address practices peculiar to subspecialties, such as pre-procedural frailty strategies for interventionists and rehabilitation interventions for HFSs.
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Affiliation(s)
- Jie Jun Wong
- Department of Cardiology, National Heart Center Singapore, 5 Hospital Drive, 169609 Singapore, Singapore
| | - Laureen Yi-Ting Wang
- Division of Cardiology, Alexandra Hospital, National University Health System, Singapore, Singapore
| | - Koji Hasegawa
- Division of Translational Research, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Kay Woon Ho
- Department of Cardiology, National Heart Center Singapore, 5 Hospital Drive, 169609 Singapore, Singapore
- Duke-NUS Medical School, 8 College Road, 169857 Singapore, Singapore
| | - Zijuan Huang
- Department of Cardiology, National Heart Center Singapore, 5 Hospital Drive, 169609 Singapore, Singapore
- Duke-NUS Medical School, 8 College Road, 169857 Singapore, Singapore
| | - Louis L Y Teo
- Department of Cardiology, National Heart Center Singapore, 5 Hospital Drive, 169609 Singapore, Singapore
- Duke-NUS Medical School, 8 College Road, 169857 Singapore, Singapore
| | - Jack Wei Chieh Tan
- Department of Cardiology, National Heart Center Singapore, 5 Hospital Drive, 169609 Singapore, Singapore
- Duke-NUS Medical School, 8 College Road, 169857 Singapore, Singapore
| | - Kazuyuki Kasahara
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Ru-San Tan
- Department of Cardiology, National Heart Center Singapore, 5 Hospital Drive, 169609 Singapore, Singapore
- Duke-NUS Medical School, 8 College Road, 169857 Singapore, Singapore
| | - Junbo Ge
- Department of Cardiology of Zhongshan Hospital, Fudan University, Shanghai, China
| | - Angela S Koh
- Department of Cardiology, National Heart Center Singapore, 5 Hospital Drive, 169609 Singapore, Singapore
- Duke-NUS Medical School, 8 College Road, 169857 Singapore, Singapore
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Wang L, Zhang X, Liu X. Association between the frailty index and readmission risk in hospitalised elderly Chinese patients: a retrospective cohort study. BMJ Open 2024; 14:e076861. [PMID: 38417955 PMCID: PMC10900421 DOI: 10.1136/bmjopen-2023-076861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 01/16/2024] [Indexed: 03/01/2024] Open
Abstract
OBJECTIVES Frailty is a common and important concern of the ageing population. This study examined the association between the frailty index and negative outcomes of hospitalised elderly Chinese patients. DESIGN Retrospective cohort study. SETTING Geriatrics Department of Peking University First Hospital. PARTICIPANTS 470 hospitalised elderly patients. MAIN OUTCOMES AND MEASURES Frailty was measured using a 30-item deficit-accumulation frailty index. The outcomes were the hospitalisation duration and readmission. RESULTS The frailty index was available for 470 patients: 72 (15.32%) were categorised as robust, 272 (57.87%) as prefrail and 126 (26.81%) as frail. The frail group had a longer hospital stay than the robust and prefrail groups. After adjustment for age, sex and cause of hospitalisation at baseline, frailty remained a strong independent risk factor for all-cause readmission and cardiocerebrovascular disease readmission (HR 2.41, 95% CI 1.49 to 3.91, p<0.001; HR 4.92, 95% CI 1.47 to 6.31, p<0.001, respectively). CONCLUSIONS The frailty index predicted a longer length of stay and higher all-cause and cardiocerebrovascular disease readmission risk in hospitalised elderly patients.
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Affiliation(s)
- Lina Wang
- Geriatric Department, Peking University First Hospital, Beijing, China
| | - Xiaolin Zhang
- Geriatric Department, Peking University First Hospital, Beijing, China
| | - Xinmin Liu
- Geriatric Department, Peking University First Hospital, Beijing, China
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Sciacchitano S, Carola V, Nicolais G, Sciacchitano S, Napoli C, Mancini R, Rocco M, Coluzzi F. To Be Frail or Not to Be Frail: This Is the Question-A Critical Narrative Review of Frailty. J Clin Med 2024; 13:721. [PMID: 38337415 PMCID: PMC10856357 DOI: 10.3390/jcm13030721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 01/07/2024] [Accepted: 01/22/2024] [Indexed: 02/12/2024] Open
Abstract
Many factors have contributed to rendering frailty an emerging, relevant, and very popular concept. First, many pandemics that have affected humanity in history, including COVID-19, most recently, have had more severe effects on frail people compared to non-frail ones. Second, the increase in human life expectancy observed in many developed countries, including Italy has led to a rise in the percentage of the older population that is more likely to be frail, which is why frailty is much a more common concern among geriatricians compared to other the various health-care professionals. Third, the stratification of people according to the occurrence and the degree of frailty allows healthcare decision makers to adequately plan for the allocation of available human professional and economic resources. Since frailty is considered to be fully preventable, there are relevant consequences in terms of potential benefits both in terms of the clinical outcome and healthcare costs. Frailty is becoming a popular, pervasive, and almost omnipresent concept in many different contexts, including clinical medicine, physical health, lifestyle behavior, mental health, health policy, and socio-economic planning sciences. The emergence of the new "science of frailty" has been recently acknowledged. However, there is still debate on the exact definition of frailty, the pathogenic mechanisms involved, the most appropriate method to assess frailty, and consequently, who should be considered frail. This narrative review aims to analyze frailty from many different aspects and points of view, with a special focus on the proposed pathogenic mechanisms, the various factors that have been considered in the assessment of frailty, and the emerging role of biomarkers in the early recognition of frailty, particularly on the role of mitochondria. According to the extensive literature on this topic, it is clear that frailty is a very complex syndrome, involving many different domains and affecting multiple physiological systems. Therefore, its management should be directed towards a comprehensive and multifaceted holistic approach and a personalized intervention strategy to slow down its progression or even to completely reverse the course of this condition.
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Affiliation(s)
- Salvatore Sciacchitano
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, 00189 Rome, Italy;
- Unit of Anaesthesia, Intensive Care and Pain Medicine, Sant’Andrea University Hospital, 00189 Rome, Italy; (M.R.); (F.C.)
- Department of Life Sciences, Health and Health Professions, Link Campus University, 00165 Rome, Italy
| | - Valeria Carola
- Department of Dynamic and Clinical Psychology and Health Studies, Sapienza University of Rome, 00189 Rome, Italy; (V.C.); (G.N.)
| | - Giampaolo Nicolais
- Department of Dynamic and Clinical Psychology and Health Studies, Sapienza University of Rome, 00189 Rome, Italy; (V.C.); (G.N.)
| | - Simona Sciacchitano
- Department of Psychiatry, La Princesa University Hospital, 28006 Madrid, Spain;
| | - Christian Napoli
- Department of Surgical and Medical Science and Translational Medicine, Sapienza University of Rome, 00189 Rome, Italy;
| | - Rita Mancini
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, 00189 Rome, Italy;
| | - Monica Rocco
- Unit of Anaesthesia, Intensive Care and Pain Medicine, Sant’Andrea University Hospital, 00189 Rome, Italy; (M.R.); (F.C.)
- Department of Surgical and Medical Science and Translational Medicine, Sapienza University of Rome, 00189 Rome, Italy;
| | - Flaminia Coluzzi
- Unit of Anaesthesia, Intensive Care and Pain Medicine, Sant’Andrea University Hospital, 00189 Rome, Italy; (M.R.); (F.C.)
- Department Medical and Surgical Sciences and Biotechnologies, Sapienza University of Rome, Polo Pontino, 04100 Latina, Italy
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Rivasi G, Ceolin L, Turrin G, Tortu’ V, D’Andria MF, Testa GD, Montali S, Tonarelli F, Brunetti E, Bo M, Romero-Ortuno R, Mossello E, Ungar A. Prevalence and correlates of frailty in older hypertensive outpatients according to different tools: the HYPER-FRAIL pilot study. J Hypertens 2024; 42:86-94. [PMID: 37698894 PMCID: PMC10713004 DOI: 10.1097/hjh.0000000000003559] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 07/15/2023] [Accepted: 08/23/2023] [Indexed: 09/13/2023]
Abstract
OBJECTIVES To date, few studies have investigated frailty in hypertensive individuals. This study aimed at identifying the prevalence of frailty in a sample of hypertensive older outpatients using six different identification tools. Clinical correlates of frailty and agreement between different frailty definitions were also investigated. METHODS The HYPER-FRAIL pilot study recruited hypertensive patients aged at least 75 years from two geriatric outpatient clinics of Careggi Hospital, Florence, Italy. Four frailty scales [Fried Frailty Phenotype, Frailty Index, Clinical Frailty Scale (CFS), Frailty Postal Score] and two physical performance tests [Short Physical Performance Battery (SPPB) and usual gait speed] were applied. The Cohen's kappa coefficient was calculated to assess agreement between measures. Multiple logistic regression was used to identify clinical features independently associated with frailty. RESULTS Among 121 participants (mean age 81, 60% women), frailty prevalence varied between 33 and 50% according to the tool used. Moderate agreement was observed between Fried Frailty Phenotype, Frailty Index and SPPB, and between Frailty Index and CFS. Agreement was minimal or weak between the remaining measures (K < 0.60). Use of walking aids and depressive symptoms were independently associated with frailty, regardless of the definition used. Frailty correlates also included dementia, disability and comorbidity burden, but not office and 24-h blood pressure values. CONCLUSION Frailty is highly prevalent among older hypertensive outpatients, but agreement between different frailty tools was moderate-to-weak. Longitudinal studies are needed to assess the prognostic role of different frailty tools and their clinical utility in the choice of antihypertensive treatment.
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Affiliation(s)
- Giulia Rivasi
- Division of Geriatric and Intensive Care Medicine, Careggi Hospital and University of Florence, Florence
| | - Ludovica Ceolin
- Division of Geriatric and Intensive Care Medicine, Careggi Hospital and University of Florence, Florence
| | - Giada Turrin
- Division of Geriatric and Intensive Care Medicine, Careggi Hospital and University of Florence, Florence
| | - Virginia Tortu’
- Division of Geriatric and Intensive Care Medicine, Careggi Hospital and University of Florence, Florence
| | - Maria Flora D’Andria
- Division of Geriatric and Intensive Care Medicine, Careggi Hospital and University of Florence, Florence
| | - Giuseppe Dario Testa
- Division of Geriatric and Intensive Care Medicine, Careggi Hospital and University of Florence, Florence
| | - Sara Montali
- Division of Geriatric and Intensive Care Medicine, Careggi Hospital and University of Florence, Florence
| | - Francesco Tonarelli
- Division of Geriatric and Intensive Care Medicine, Careggi Hospital and University of Florence, Florence
| | - Enrico Brunetti
- Section of Geriatrics, Department of Medical Sciences, University of Turin, Città della Salute e della Scienza, Molinette, Turin, Italy
| | - Mario Bo
- Section of Geriatrics, Department of Medical Sciences, University of Turin, Città della Salute e della Scienza, Molinette, Turin, Italy
| | - Roman Romero-Ortuno
- Discipline of Medical Gerontology and Falls and Syncope Unit, Mercer's Institute for Successful Ageing, St. James's Hospital, Dublin, Ireland
| | - Enrico Mossello
- Division of Geriatric and Intensive Care Medicine, Careggi Hospital and University of Florence, Florence
| | - Andrea Ungar
- Division of Geriatric and Intensive Care Medicine, Careggi Hospital and University of Florence, Florence
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12
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Tariq MA, Khalid Z, Malik MK. Pre-existing frailty in the elderly and long-term mortality following percutaneous coronary intervention. J Geriatr Cardiol 2023; 20:832-836. [PMID: 38098464 PMCID: PMC10716609 DOI: 10.26599/1671-5411.2023.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2023] Open
Affiliation(s)
- Muhammad Ali Tariq
- Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Zoha Khalid
- Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan
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Sze S, Pellicori P, Zhang J, Weston J, Clark AL. Which frailty tool best predicts morbidity and mortality in ambulatory patients with heart failure? A prospective study. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2023; 9:731-739. [PMID: 36385564 DOI: 10.1093/ehjqcco/qcac073] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 11/04/2022] [Accepted: 11/15/2022] [Indexed: 11/08/2023]
Abstract
BACKGROUND Frailty is common in patients with heart failure (HF) and is associated with adverse outcome, but it is uncertain how frailty should best be measured. OBJECTIVES To compare the prognostic value of commonly-used frailty tools in ambulatory patients with HF. METHODS AND RESULTS We assessed, simultaneously, three screening tools [clinical frailty scale (CFS); Derby frailty index (DFI); acute frailty network (AFN) frailty criteria), three assessment tools (Fried criteria; Edmonton frailty score (EFS); deficit index (DI)) and three physical tests (handgrip strength, timed get-up-and-go test (TUGT), 5-metre walk test (5MWT)] in consecutive patients with HF attending a routine follow-up visit. 467 patients (67% male, median age = 76 years, median NT-proBNP = 1156 ng/L) were enrolled. During a median follow-up of 554 days, 82 (18%) patients died and 201 (43%) patients were either hospitalised or died. In models corrected for age, Charlson score, haemoglobin, renal function, sodium, NYHA, atrial fibrillation (AF), and body mass index, only log[NT-proBNP] and frailty were independently associated with all-cause death. A base model for predicting mortality at 1 year including NYHA, log[NT-proBNP], sodium and AF, had a C-statistic = 0.75. Amongst screening tools: CFS (C-statistic = 0.84); amongst assessment tools: DI (C-statistic = 0.83) and amongst physical test: 5MWT (C-statistic = 0.80), increased model performance most compared with base model (P <0.05 for all). CONCLUSION Frailty is strongly associated with adverse outcomes in ambulatory patients with HF. When added to a base model for predicting mortality at 1 year including NYHA, NT-proBNP, sodium, and AF, CFS provides comparable prognostic information with assessment tools taking longer to perform.
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Affiliation(s)
- Shirley Sze
- Department of Cardiology, Castle Hill Hospital, Hull York Medical School (at University of Hull), Kingston upon Hull, HU16 5JQ, UK
- Cardiovascular Research Centre, University of Leicester, Glenfield Hospital, Groby Road, Leicester, LE3 9QP, UK
| | - Pierpaolo Pellicori
- Department of Cardiology, Castle Hill Hospital, Hull York Medical School (at University of Hull), Kingston upon Hull, HU16 5JQ, UK
- Robertson Centre for Biostatistics & Clinical Trials, University of Glasgow, Glasgow, G12 8QQ, UK
| | - Jufen Zhang
- Department of Cardiology, Castle Hill Hospital, Hull York Medical School (at University of Hull), Kingston upon Hull, HU16 5JQ, UK
- Faculty of Medical Science, Anglia Ruskin University, Cambridge, CB1 1PT, UK
| | - Joan Weston
- Department of Cardiology, Castle Hill Hospital, Hull York Medical School (at University of Hull), Kingston upon Hull, HU16 5JQ, UK
| | - Andrew L Clark
- Department of Cardiology, Castle Hill Hospital, Hull York Medical School (at University of Hull), Kingston upon Hull, HU16 5JQ, UK
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Barrera Martínez Y, Lebrón Martínez de Velasco C, Fernández Guillén I, Reyes Revuelta M, Canalejo Echeverría A, Muñoz Cobos F. [Functional improvement in frail older adults through the Vivifrail exercise program, during two years of pandemic]. Semergen 2023; 49:102062. [PMID: 37506616 DOI: 10.1016/j.semerg.2023.102062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 06/25/2023] [Accepted: 07/03/2023] [Indexed: 07/30/2023]
Abstract
BACKGROUND AND OBJECTIVE Physical exercise increases functional capacity in older adults, helping to prevent or delay dependence. This study evaluates the impact of a multicomponent physical exercise intervention based on the Vivifrail program, conducted in a primary care center over two years coinciding with the COVID pandemic. SUBJECTS AND METHODS Descriptive longitudinal design with before-after comparison without control group. Participants were older than 65 years old with functional impairment measured by execution test, enrolled in the El Palo Health Center, Málaga. The intervention consists of two weekly group sessions of physical exercise guided by a monitor, according to the Vivifrail program. VARIABLES Barthel Index, Gait Speed, Vivifrail Category, Quality of Life (EuroQol 5-D [EQ-5D]), use of walking aids, number of falls in the previous year. MEASUREMENTS baseline, second (one year) and final (two years). Analysis of the Kruskal-Wallis test, significance level 0.05. RESULTS Twenty patients were evaluated. Between the first and second evaluation, we observed a significant modification in the use of walking aids (p 0.01) and Vivifrail categories: from an initial B category, 50% remained, 25% moved to A, 16.7% to C2 and 8.3% to D (p 0.048). In the analysis of the baseline-final evaluation, we found a statistically significant improvement in quality of life measured by EQ-5D (mean increase of 24 points in today's quality of life measurement, EQ-5D thermometer, with 95% CI (9.6-38.3), p 0.004) and Vivifrail category (n=10) with 60% remaining in category B and 40% moving to D (autonomous) (p<0.0001). There was a trend towards improvement in gait speed, daily walking time, and number of falls, but without reaching statistical significance. CONCLUSIONS Multicomponent physical exercise improves perceived quality of life measured by EQ-5D and leads to a trend towards improvement in functional capacity, mood, and number of falls.
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Affiliation(s)
| | | | | | | | | | - F Muñoz Cobos
- Medicina familiar, Centro de Salud El Palo, Málaga, España
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15
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Ma T, He L, Luo Y, Fu D, Huang J, Zhang G, Cheng X, Bai Y. Frailty, an Independent Risk Factor in Progression Trajectory of Cardiometabolic Multimorbidity: A Prospective Study of UK Biobank. J Gerontol A Biol Sci Med Sci 2023; 78:2127-2135. [PMID: 37170845 DOI: 10.1093/gerona/glad125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Indexed: 05/13/2023] Open
Abstract
BACKGROUND Although frailty was associated with cardiometabolic diseases (CMDs, including coronary heart disease, stroke, and diabetes here), there was no systematic analyses estimating its role in incidence, progression, and prognosis of cardiometabolic multimorbidity (CMM). METHODS We included 351 205 participants without CMDs at baseline in UK Biobank. Occurrences of first CMD, CMM, and death were recorded. We used multistate models to assess transition-specific role of baseline frailty measured by frailty phenotype and frailty index in CMM progression trajectory from no disease to single CMD, CMM, and death. Association between changes in frailty and outcomes was investigated among 17 264 participants. RESULTS Among 351 205 participants (44.0% male, mean age 56.55 years), 8 190 (2.3%) had frail phenotype, and 13 615 (3.9%) were moderate/severe frail according to the frailty index. During median follow-up of 13.11 years, 41 558 participants experienced ≥1 CMD, 4 952 had CMM, and 20 670 died. In multistate models, frail phenotype-related hazard ratios were 1.94 and 2.69 for transitions from no CMD to single disease and death, 1.63 and 1.67 for transitions from single CMD to CMM and death, and 1.57 for transitions from CMM to death (all p < .001). Consistent results were observed for frailty index. Improvement of frailty reduced the risk of CMD progression and death. CONCLUSIONS Frailty is an independent risk factor for all transitions of CMM progression trajectory. Frailty-targeted management is a potential strategy for primary and secondary prevention of CMM beyond chronological age.
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Affiliation(s)
- Tianqi Ma
- Department of Geriatric Medicine, Center of Coronary Circulation, Xiangya Hospital, Central South University, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Lingfang He
- Department of Geriatric Medicine, Center of Coronary Circulation, Xiangya Hospital, Central South University, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yi Luo
- Department of Geriatric Medicine, Center of Coronary Circulation, Xiangya Hospital, Central South University, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Dihan Fu
- Department of Geriatric Medicine, Center of Coronary Circulation, Xiangya Hospital, Central South University, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Jiaqi Huang
- National Clinical Research Center for Metabolic Diseases, Key Laboratory of Diabetes Immunology, Ministry of Education, Changsha, Hunan, China
- Department of Metabolism and Endocrinology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Guogang Zhang
- Department of Cardiovascular Medicine, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Xunjie Cheng
- Department of Geriatric Medicine, Center of Coronary Circulation, Xiangya Hospital, Central South University, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yongping Bai
- Department of Geriatric Medicine, Center of Coronary Circulation, Xiangya Hospital, Central South University, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
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16
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Mirón-Mombiela R, Ruiz-España S, Moratal D, Borrás C. Assessment and risk prediction of frailty using texture-based muscle ultrasound image analysis and machine learning techniques. Mech Ageing Dev 2023; 215:111860. [PMID: 37666473 DOI: 10.1016/j.mad.2023.111860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 08/08/2023] [Accepted: 08/30/2023] [Indexed: 09/06/2023]
Abstract
The purpose of this study was to evaluate texture-based muscle ultrasound image analysis for the assessment and risk prediction of frailty phenotype. This retrospective study of prospectively acquired data included 101 participants who underwent ultrasound scanning of the anterior thigh. Participants were subdivided according to frailty phenotype and were followed up for two years. Primary and secondary outcome measures were death and comorbidity, respectively. Forty-three texture features were computed from the rectus femoris and the vastus intermedius muscles using statistical methods. Model performance was evaluated by computing the area under the receiver operating characteristic curve (AUC) while outcome prediction was evaluated using regression analysis. Models developed achieved a moderate to good AUC (0.67 ≤ AUC ≤ 0.79) for categorizing frailty. The stepwise multiple logistic regression analysis demonstrated that they correctly classified 70-87% of the cases. The models were associated with increased comorbidity (0.01 ≤ p ≤ 0.18) and were predictive of death for pre-frail and frail participants (0.001 ≤ p ≤ 0.016). In conclusion, texture analysis can be useful to identify frailty and assess risk prediction (i.e. mortality) using texture features extracted from muscle ultrasound images in combination with a machine learning approach.
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Affiliation(s)
- Rebeca Mirón-Mombiela
- Department of Physiology, Universitat de València/INCLIVA, Avda. Blasco Ibáñez, 15, 46010 Valencia, Spain; Hospital General Universitario de Valencia (HGUV), Valencia, Spain; Herlev og Gentofte Hospital, Herlev, Denmark.
| | - Silvia Ruiz-España
- Center for Biomaterials and Tissue Engineering, Universitat Politècnica de València, Camí de Vera s/n, 46022 Valencia, Spain.
| | - David Moratal
- Center for Biomaterials and Tissue Engineering, Universitat Politècnica de València, Camí de Vera s/n, 46022 Valencia, Spain.
| | - Consuelo Borrás
- Department of Physiology, Universitat de València/INCLIVA, Avda. Blasco Ibáñez, 15, 46010 Valencia, Spain; INCLIVA Health Research Institute, Av/ de Menéndez y Pelayo, 4, 46010 Valencia, Spain; Center for Biomedical Network Research on Frailty and Healthy Aging (CIBERFES), CIBER-ISCIII, Valencia, Spain.
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17
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Sakyi SA, Tawiah P, Senu E, Ampofo RO, Enimil AK, Amoani B, Anto EO, Opoku S, Effah A, Abban E, Frimpong J, Frimpong E, Bannor LO, Kwayie AA, Naturinda E, Ansah EA, Baidoo BT, Kodzo KE, Ayisi‐Boateng NK. Frailty syndrome and associated factors among patients with hypertension: A cross-sectional study in Kumasi, Ghana. Health Sci Rep 2023; 6:e1664. [PMID: 37900092 PMCID: PMC10600407 DOI: 10.1002/hsr2.1664] [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: 04/23/2023] [Revised: 10/11/2023] [Accepted: 10/16/2023] [Indexed: 10/31/2023] Open
Abstract
Background and Aim Frailty is a condition marked by accumulation of biological deficits and dysfunctions that come with aging and it is correlated with high morbidity and mortality in patients with cardiovascular diseases, particularly hypertension. Hypertension continues to be a leading cause of cardiovascular diseases and premature death globally. However, there is dearth of literature in sub-Saharan Africa on frailty syndrome among hypertensives on medication. This study evaluated frailty syndrome and its associated factors among Ghanaian hypertensives. Methods This cross-sectional study recruited 303 patients with hypertension from the University Hospital, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana. Data on sociodemographic, lifestyle and clinical factors were collected using a well-structured questionnaire. Medication adherence was measured using Adherence in Chronic Disease Scale, and frailty was assessed by Tilburg Frailty Indicator. Statistical analyses were performed using SPSS Version 26.0 and GraphPad prism 8.0. p-value of < 0.05 and 95% confidence interval (CI) were considered statistically significant. Results The prevalence of frailty was 59.7%. The proportion of high, medium and low medication adherence was 23.4%, 64.4% and 12.2%, respectively. Being ≥ 70years (adjusted odds ratio [aOR]: 8.33, 95% CI [3.72-18.67], p < 0.0001), unmarried (aOR: 2.59, 95% CI [1.37-4.89], p = 0.0030), having confirmed hypertension complications (aOR: 3.21, 95% CI [1.36-7.53], p = 0.0080), medium (aOR: 1.99, 95% CI [1.05-3.82], p = 0.0360) and low antihypertensive drug adherence (aOR: 27.69, 95% CI [7.05-108.69], p < 0.0001) were independent predictors of increased odds of developing frailty syndrome. Conclusion Approximately 6 out of 10 Ghanaian adult patients with hypertension experience frailty syndrome. Hypertension complications, older age, being unmarried, and low antihypertensive drug adherence increased the chances of developing frailty syndrome. These should be considered in intervention programmes to prevent frailty among patients with hypertension.
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Affiliation(s)
- Samuel A. Sakyi
- Department of Molecular MedicineKwame Nkrumah University of Science and TechnologyKumasiGhana
| | - Phyllis Tawiah
- Department of Medicine, School of Medicine and DentistryKwame Nkrumah University of Science and TechnologyKumasiGhana
| | - Ebenezer Senu
- Department of Molecular MedicineKwame Nkrumah University of Science and TechnologyKumasiGhana
| | - Ransford O. Ampofo
- Department of Medical Diagnostics, Faculty of Allied Health SciencesKwame Nkrumah University of Science and TechnologyKumasiGhana
| | - Anthony K. Enimil
- Pediatric Infectious Disease Unit, Child Health DirectorateKomfo Anokye Teaching HospitalKumasiGhana
| | - Benjamin Amoani
- Department of Biomedical ScienceUniversity of Cape CoastCape CoastGhana
| | - Enoch O. Anto
- Department of Medical Diagnostics, Faculty of Allied Health SciencesKwame Nkrumah University of Science and TechnologyKumasiGhana
| | - Stephen Opoku
- Department of Molecular MedicineKwame Nkrumah University of Science and TechnologyKumasiGhana
| | - Alfred Effah
- Department of Molecular MedicineKwame Nkrumah University of Science and TechnologyKumasiGhana
- Department of Medical Diagnostics, Faculty of Allied Health SciencesKwame Nkrumah University of Science and TechnologyKumasiGhana
| | - Elizabeth Abban
- Department of Medical Diagnostics, Faculty of Allied Health SciencesKwame Nkrumah University of Science and TechnologyKumasiGhana
- Department of Medical Laboratory TechnologyGarden City University CollegeKumasiGhana
| | - Joseph Frimpong
- Department of Medical Diagnostics, Faculty of Allied Health SciencesKwame Nkrumah University of Science and TechnologyKumasiGhana
| | - Emmaunel Frimpong
- Department of Medical Diagnostics, Faculty of Allied Health SciencesKwame Nkrumah University of Science and TechnologyKumasiGhana
| | - Lydia Oppong Bannor
- Department of Medical Diagnostics, Faculty of Allied Health SciencesKwame Nkrumah University of Science and TechnologyKumasiGhana
| | - Afia A. Kwayie
- Department of Medical Diagnostics, Faculty of Allied Health SciencesKwame Nkrumah University of Science and TechnologyKumasiGhana
| | - Emmanuel Naturinda
- Department of Medical Diagnostics, Faculty of Allied Health SciencesKwame Nkrumah University of Science and TechnologyKumasiGhana
| | - Eugene A. Ansah
- Department of Medical Diagnostics, Faculty of Allied Health SciencesKwame Nkrumah University of Science and TechnologyKumasiGhana
| | - Bright T. Baidoo
- Department of Medical Diagnostics, Faculty of Allied Health SciencesKwame Nkrumah University of Science and TechnologyKumasiGhana
| | - Kini E. Kodzo
- Department of Medical Diagnostics, Faculty of Allied Health SciencesKwame Nkrumah University of Science and TechnologyKumasiGhana
| | - Nana K. Ayisi‐Boateng
- Department of Medicine, School of Medicine and DentistryKwame Nkrumah University of Science and TechnologyKumasiGhana
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Shafiee A, Bahri RA, Rafiei MA. Frailty among patients undergoing breast reconstruction surgery: A systematic review and meta-analysis. J Plast Reconstr Aesthet Surg 2023; 84:556-566. [PMID: 37422955 DOI: 10.1016/j.bjps.2023.06.040] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 06/09/2023] [Accepted: 06/09/2023] [Indexed: 07/11/2023]
Abstract
BACKGROUND We conducted a systematic review and meta-analysis to evaluate the predictive value of frailty for predicting postsurgical complications in patients undergoing breast reconstruction surgery. METHODS MEDLINE (PubMed), Scopus, Web of Science, and Embase were searched for relevant studies up to September 13, 2022. A systematic review and meta-analysis of studies were performed based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 statement criteria. RESULTS Nine studies were included in this research. The rates of overall complications (odds ratio [OR] 1.52, 95% confidence interval [CI] 1.17-1.97, I2 = 76%; p = 0.002), wound complications (OR 1.87, 95% CI 1.56-2.26, I2 = 16%; p < 0.0001), readmissions (OR 1.94, 95% CI 1.61-2.34, I2 = 15%; p < 0.0001), and reoperations (OR 1.41, 95% CI 1.12-1.77, I2 = 39%; p = 0.003) were significantly greater in frail patients than in nonfrail undergoing breast reconstruction surgery. Furthermore, compared with nonfrail patients, this difference remained significantly higher among prefrail individuals (overall complications: OR 1.27, 95% CI 1.13-1.41, I2 = 67%; p < 0.001, wound complications: OR 1.48, 95% CI 1.33-1.66, I2 = 24%; p < 0.0001, readmission: OR 1.47, 95% CI 1.34-1.61, I2 = 0%; p < 0.0001, reoperation: OR 1.32, 95% CI 1.23-1.42, I2 = 0%; p < 0.0001). We found that frail patients undergoing immediate autologous reconstruction surgery are the most vulnerable to experiencing overall postoperative complications. CONCLUSION Frailty is a strong predictor of postsurgical complications after breast reconstruction surgery in frail and prefrail patients. The most frailty index utilized was the modified five-item frailty index (mFI-5). More research is needed on this topic to assess the utility of frailty in practice, especially in countries other than the United States.
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Wang C, Fang X, Tang Z, Hua Y, Zhang Z, Gu X, Liu B, Yang K, Ji X, Song X. Frailty in relation to the risk of carotid atherosclerosis and cardiovascular events in Chinese community-dwelling older adults: A five-year prospective cohort study. Exp Gerontol 2023; 180:112266. [PMID: 37536575 DOI: 10.1016/j.exger.2023.112266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 07/24/2023] [Accepted: 07/31/2023] [Indexed: 08/05/2023]
Abstract
OBJECTIVE To investigate the frailty, as estimated by accumulated health deficits, in association with the symptomatic carotid atherosclerosis and in relation to five-year cardiovascular (CVD) outcomes. METHODS This is a five-year prospective cohort study. Secondary analysis of data from the Beijing Longitudinal Study on Aging. Community-dwelling people aged 55+ years (n = 1257) have been followed between 2009 and 2014, and having carotid ultrasonography examinations with no CVD events at baseline. Frailty was quantified using the deficit accumulation-based frailty index (FI), constructed from 37 health deficits assessed at baseline. The association between the degree of frailty and carotid atherosclerosis was examined using odds ratios (OR) with multivariate logistic regression analyses. Effects of frailty on the probability of five-year cardiovascular events and mortality were evaluated using Cox proportional hazard ratios (HR). The analyses were adjusted for demographics, baseline carotid atherosclerosis status, and CVD risk factors. RESULTS The FI showed characteristic properties and was independently associated with the major carotid atherosclerosis symptoms, including carotid artery intima-media thickening (the most frail vs. the least frail: OR = 4.39: 1.98-7.82), carotid plaque (OR = 3.41: 1.28-6.54), and carotid plaque stability (OR = 1.19, 95 % CI: 1.01-3.59). Compared with the least frail, the most frail individuals were more likely to develop a cardiovascular event in five years, including myocardial infarction (HR = 3.38, 95 % CI = 1.84-6.19), stroke (HR = 1.26, 95 % CI = 1.00-5.87), CVD death (HR = 6.33, 95 % CI = 1.69-11.02), and all-cause death (HR = 5.95, 95 % CI = 2.74-8.95). CONCLUSION Deficit accumulation was closely associated with carotid atherosclerosis risks and strongly predicted five-year CVD events. The frailty index can be used to help identify older adults at high risks of CVD for improved preventive healthcare.
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Affiliation(s)
- Chunxiu Wang
- Department of Evidence-based Medicine, Xuanwu Hospital, Capital Medical University, China
| | - Xianghua Fang
- Department of Evidence-based Medicine, Xuanwu Hospital, Capital Medical University, China
| | - Zhe Tang
- Department of Evidence-based Medicine, Xuanwu Hospital, Capital Medical University, China
| | - Yang Hua
- Department of Vascular Ultrasonography, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Zhongying Zhang
- Geriatric Department, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Xiang Gu
- Geriatric Department, Youyi Hospital, Capital Medical University, Beijing, China
| | - Beibei Liu
- Department of Vascular Ultrasonography, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Kun Yang
- Department of Evidence-based Medicine, Xuanwu Hospital, Capital Medical University, China
| | - Xunming Ji
- Department of Neurological Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China.
| | - Xiaowei Song
- Health Sciences and Innovation, Surrey Memorial Hospital, Fraser Health Authority, Surrey, BC, Canada.
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Bul M, Shaikh F, McDonagh J, Ferguson C. Frailty and oral anticoagulant prescription in adults with atrial fibrillation: A systematic review. Aging Med (Milton) 2023; 6:195-206. [PMID: 37287671 PMCID: PMC10242262 DOI: 10.1002/agm2.12214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 05/08/2022] [Accepted: 05/12/2022] [Indexed: 11/10/2022] Open
Abstract
Objectives The objectives of this study were to determine the prevalence of frailty in the context of atrial fibrillation (AF); to identify the most commonly used frailty instruments in AF; and to describe the effect of frailty on non-vitamin K oral anticoagulant (NOAC) prescription for stroke prevention in adults with AF. Methods A systematic search of databases, including Medline, Embase, Web of Science, Cochrane Library, Scopus, and CINAHL, was conducted using search terms including "atrial fibrillation," "frailty," and "anticoagulation." A narrative synthesis was undertaken. Results A total of 92 articles were screened, and 12 articles were included. The mean age of the participants (n = 212,111) was 82 years (range = 77-85 years) with 56% of participants identified as frail and 44% identified non-frail. A total of five different frailty instruments were identified: the Frailty Phenotype (FP; n = 5, 42%), the Clinical Frailty Scale (CFS; n = 4, 33%), Cumulative Deficit Model of Frailty (CDM; n = 1, 8%), Edmonton Frail Scale (n = 1, 8%) and the Resident Assessment Instrument - Minimum Data Set (RAI-MDS 2.0; n = 1, 8%). Frailty was identified as an important barrier to anticoagulant therapy with 52% of the frail population anticoagulated vs 67% non-frail. Conclusion Frailty is an important consideration in anticoagulation decision making for stroke prevention in patients with AF. There is scope to improve frailty screening and treatment. Frailty status is an important risk marker and should be considered when evaluating stroke risk alongside congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, prior stroke, transient ischemic attack, or thromboembolism, vascular disease, age 65-74 years, sex category (CHA2DS2-VASc) and Hypertension, Abnormal renal/liver function, Stroke, Bleeding, Labile, Elderly, and Drugs (HAS-BLED) scores.
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Affiliation(s)
- Mary Bul
- Western Sydney UniversityParramattaNew South WalesAustralia
| | - Fahad Shaikh
- Western Sydney UniversityParramattaNew South WalesAustralia
- Western Sydney Nursing and Midwifery Research CentreWestern Sydney Local Health District and Western Sydney University, Blacktown Clinical and Research School, Blacktown HospitalBlacktownNew South WalesAustralia
| | - Julee McDonagh
- School of Nursing and Midwifery/College of Health, Medicine and WellbeingThe University of Newcastle, Central Coast Clinical School, Gosford HospitalGosfordNew South WalesAustralia
| | - Caleb Ferguson
- Western Sydney UniversityParramattaNew South WalesAustralia
- Western Sydney Nursing and Midwifery Research CentreWestern Sydney Local Health District and Western Sydney University, Blacktown Clinical and Research School, Blacktown HospitalBlacktownNew South WalesAustralia
- School of Nursing, Faculty of Science, Medicine and HealthUniversity of WollongongWollongongNew South WalesAustralia
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21
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Mazzone A, Del Turco S, Trianni G, Quadrelli P, Marotta M, Bastiani L, Gasbarri T, D'Agostino A, Mariani M, Basta G, Foffa I, Sbrana S, Vassalle C, Ravani M, Solinas M, Berti S. The Positive Impact of Early Frailty Levels on Mortality in Elderly Patients with Severe Aortic Stenosis Undergoing Transcatheter/Surgical Aortic Valve Replacement. J Cardiovasc Dev Dis 2023; 10:jcdd10050212. [PMID: 37233180 DOI: 10.3390/jcdd10050212] [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: 03/08/2023] [Revised: 05/08/2023] [Accepted: 05/10/2023] [Indexed: 05/27/2023] Open
Abstract
Background: Frailty is highly common in older patients (pts) undergoing transcatheter aortic valve replacement (TAVR), and it is associated with poor outcomes. The selection of patients who can benefit from this procedure is necessary and challenging. The aim of the present study is to evaluate outcomes in older severe aortic valve stenosis (AS) pts, selected by a multidisciplinary approach for surgical, clinical, and geriatric risk and referred to treatment, according to frailty levels. Methods: A total of 109 pts (83 ± 5 years; females, 68%) with AS were classified by Fried's score in pre-frail, early frail, and frail and underwent surgical aortic valve replacement SAVR/TAVR, balloon aortic valvuloplasty, or medical therapy. We evaluated geriatric, clinical, and surgical features and detected periprocedural complications. The outcome was all-cause mortality. Results: Increasing frailty was associated with the worst clinical, surgical, geriatric conditions. By using Kaplan-Meier analysis, the survival rate was higher in pre-frail and TAVR groups (p < 0.001) (median follow-up = 20 months). By using the Cox regression model, frailty (p = 0.004), heart failure (p = 0.007), EF% (p = 0.043), albumin (p = 0.018) were associated with all-cause mortality. Conclusions: According to tailored frailty management, elderly AS pts with early frailty levels seem to be the most suitable candidates for TAVR/SAVR for positive outcomes because advanced frailty would make each treatment futile or palliative.
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Affiliation(s)
- Annamaria Mazzone
- Diagnostic and Interventional Cardiology Department, Fondazione Toscana Gabriele Monasterio, 54100 Massa, Italy
| | | | - Giuseppe Trianni
- Diagnostic and Interventional Cardiology Department, Fondazione Toscana Gabriele Monasterio, 54100 Massa, Italy
| | - Paola Quadrelli
- Adult Cardiosurgery Department, Fondazione Toscana Gabriele Monasterio, 54100 Massa, Italy
| | - Marco Marotta
- Adult Cardiosurgery Department, Fondazione Toscana Gabriele Monasterio, 54100 Massa, Italy
| | - Luca Bastiani
- CNR Institute of Clinical Physiology, 56124 Pisa, Italy
| | - Tommaso Gasbarri
- Adult Cardiosurgery Department, Fondazione Toscana Gabriele Monasterio, 54100 Massa, Italy
| | - Andreina D'Agostino
- Diagnostic and Interventional Cardiology Department, Fondazione Toscana Gabriele Monasterio, 54100 Massa, Italy
| | - Massimiliano Mariani
- Diagnostic and Interventional Cardiology Department, Fondazione Toscana Gabriele Monasterio, 54100 Massa, Italy
| | | | - Ilenia Foffa
- CNR Institute of Clinical Physiology, 54100 Massa, Italy
| | | | | | - Marcello Ravani
- Diagnostic and Interventional Cardiology Department, Fondazione Toscana Gabriele Monasterio, 54100 Massa, Italy
| | - Marco Solinas
- Adult Cardiosurgery Department, Fondazione Toscana Gabriele Monasterio, 54100 Massa, Italy
| | - Sergio Berti
- Diagnostic and Interventional Cardiology Department, Fondazione Toscana Gabriele Monasterio, 54100 Massa, Italy
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22
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Soto ME, Pérez-Torres I, Rubio-Ruiz ME, Cano-Martínez A, Manzano-Pech L, Guarner-Lans V. Frailty and the Interactions between Skeletal Muscle, Bone, and Adipose Tissue-Impact on Cardiovascular Disease and Possible Therapeutic Measures. Int J Mol Sci 2023; 24:ijms24054534. [PMID: 36901968 PMCID: PMC10003713 DOI: 10.3390/ijms24054534] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 02/18/2023] [Accepted: 02/24/2023] [Indexed: 03/02/2023] Open
Abstract
Frailty is a global health problem that impacts clinical practice. It is complex, having a physical and a cognitive component, and it is the result of many contributing factors. Frail patients have oxidative stress and elevated proinflammatory cytokines. Frailty impairs many systems and results in a reduced physiological reserve and increased vulnerability to stress. It is related to aging and to cardiovascular diseases (CVD). There are few studies on the genetic factors of frailty, but epigenetic clocks determine age and frailty. In contrast, there is genetic overlap of frailty with cardiovascular disease and its risk factors. Frailty is not yet considered a risk factor for CVD. It is accompanied by a loss and/or poor functioning of muscle mass, which depends on fiber protein content, resulting from the balance between protein breakdown and synthesis. Bone fragility is also implied, and there is a crosstalk between adipocytes, myocytes, and bone. The identification and assessment of frailty is difficult, without there being a standard instrument to identify or treat it. Measures to prevent its progression include exercises, as well as supplementing the diet with vitamin D and K, calcium, and testosterone. In conclusion, more research is needed to better understand frailty and to avoid complications in CVD.
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Affiliation(s)
- María Elena Soto
- Department of Endocrinology, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City 14080, Mexico
| | - Israel Pérez-Torres
- Department of Cardiovascular Biomedicine, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City 14080, Mexico
| | - María Esther Rubio-Ruiz
- Department of Physiology, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City 14080, Mexico
| | - Agustina Cano-Martínez
- Department of Physiology, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City 14080, Mexico
| | - Linaloe Manzano-Pech
- Department of Cardiovascular Biomedicine, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City 14080, Mexico
| | - Verónica Guarner-Lans
- Department of Physiology, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City 14080, Mexico
- Correspondence:
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23
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Nguyen DD, Arnold SV. Impact of frailty on disease-specific health status in cardiovascular disease. Heart 2023:heartjnl-2022-321631. [PMID: 36604164 DOI: 10.1136/heartjnl-2022-321631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Accepted: 12/20/2022] [Indexed: 01/07/2023] Open
Abstract
Frailty is a syndrome of older age that reflects an impaired physiological reserve and decreased ability to recover from medical stressors. While the impact of frailty on mortality in cardiovascular disease has been well described, its impact on cardiovascular disease-specific health status-cardiac symptoms, physical functioning and quality of life-has been less well studied. In this review, we summarise the impact of frailty on health status outcomes across different cardiovascular conditions. In heart failure, frail patients have markedly impaired disease-specific health status and are at risk for subsequent health status deteriorations. However, frail patients have similar or even greater health status improvements with interventions for heart failure, such as cardiac rehabilitation or guideline-directed medical therapy. In valvular heart disease, the impact of frailty on disease-specific health status is of even greater concern since management involves physiologically taxing procedures that can worsen health status. Frailty increases the risk of poor health status outcomes after transcatheter aortic valve intervention or surgical aortic valve replacement for aortic stenosis, but there is no evidence that frail patients benefit more from one procedure versus another. In both heart failure and valvular heart disease, health status improvements may reverse frailty, highlighting the overlap between cardiovascular disease and frailty and emphasising that treatment should typically not be withheld based on the presence of frailty alone. Meanwhile, data are limited on the impact of frailty on health status outcomes in the treatment of coronary artery disease, peripheral artery disease and atrial fibrillation, and requires further research.
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Affiliation(s)
- Dan D Nguyen
- Cardiovascular Outcomes Research, Saint Luke's Mid America Heart Institute, Kansas City, Missouri, USA.,Department of Medicine, University of Missouri Kansas City, Kansas City, Missouri, USA
| | - Suzanne V Arnold
- Cardiovascular Outcomes Research, Saint Luke's Mid America Heart Institute, Kansas City, Missouri, USA .,Department of Medicine, University of Missouri Kansas City, Kansas City, Missouri, USA
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24
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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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25
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Lutski M, Weinstein G, Goldbourt U, Tanne D. Peripheral sensory nerve function, type 2 diabetes and frailty among men with cardiovascular disease. J Diabetes Complications 2022; 36:108337. [PMID: 36347066 DOI: 10.1016/j.jdiacomp.2022.108337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 09/21/2022] [Accepted: 10/05/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To investigated the cross-sectional association between peripheral sensory nerve function and frailty among community-dwelling men, and examine whether type 2 diabetes (T2D) modifies this association. METHODS A sample of 349 men [mean age = 77.1 ± 6.4 years; 37 % with T2D] who previously (1990-1998) participated in the Bezafibrate Infarction Prevention (BIP) trial, underwent assessment of frailty and legs vibratory thresholds (LVT), a measure of peripheral sensory nerve function, as part of the BIP Neurocognitive study during 2011-2013. LVT was assessed using a graduated tuning fork and frailty was assessed using the Fried criteria. An ordered logistic regression model was used to assess the link between LVT and degrees of frailty and to test for effect modification by T2D. RESULTS Overall, 117 (33.5 %) of patients were non-frail, 134 (38.4 %) pre-frail, and 98 (28.1 %) frail. A significant interaction between LVT and T2D with regard to frailty was found. Among men with T2D, estimated OR (95%CI) for increasing frailty at the 1st, 2nd, and 3rd as compared to the top LVT quartile were 13.5 (3.4-54.3), 5.9 (1.5-23.5), and 4.4 (1.20-16.0), respectively. Among men without T2D, the estimated ORs for increasing frailty in patients at the 1st, 2nd, and 3rd quartiles compared to the top LVT quartile were 2.8 (1.1-7.4), 1.6 (0.6-4.1), and 2.5 (1.0-6.5), respectively. CONCLUSION Frailty is significantly associated with worsening peripheral sensory nerve function, particularly among men with T2D.
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Affiliation(s)
- Miri Lutski
- The Israel Center for Disease Control, Israel Ministry of Health, Tel Hashomer, Israel; Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Galit Weinstein
- School of Public Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
| | - Uri Goldbourt
- Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - David Tanne
- Stroke and Cognition Institute, Rambam Health Care Campus, Haifa, Israel; Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
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26
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Utility of the Fatigue, Resistance, Ambulation, Illness, and Loss of weight Scale in Older Patients with Cardiovascular Disease. J Am Med Dir Assoc 2022; 23:1971-1976.e2. [PMID: 36137558 DOI: 10.1016/j.jamda.2022.08.006] [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: 04/16/2022] [Revised: 07/09/2022] [Accepted: 08/10/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVES To compare the Fried criteria for frailty diagnosis with the Frailty Screening Index (FSI) and the fatigue, resistance, ambulation, illness, and loss of weight (FRAIL) scale in older patients with cardiovascular disease (CVD). DESIGN We conducted a retrospective 1-year follow-up cohort study of adult inpatients who participated in a cardiac rehabilitation program between June 2016 and September 2018. SETTING AND PARTICIPANTS We included 1472 Japanese patients age 65 years and older with CVD. After excluding 765 patients with incomplete frailty measurements, 707 patients were included in the analysis. METHODS Frailty and physical function were measured before hospital discharge according to each of the 3 definitions. Outcomes were all-cause mortality and physical dysfunction. RESULTS The prevalence of frailty according to the Fried criteria, the FRAIL scale, and the FSI was 213 (30.1%), 181 (25.6%), and 186 (26.3%), respectively. The FSI and the FRAIL scale showed moderate agreement with the Fried criteria [vs FSI: K = 0.52, 95% confidence interval (CI): 0.45-0.59; vs FRAIL scale: K = 0.45, 95% CI: 0.37-0.52; all P < .001]. We found a significant correlation between all-cause mortality and frailty assessed by all of the definitions, even after multivariate adjustment [FSI: hazard ratio (HR): 2.43, 95% CI: 1.30-4.58, P = .006; FRAIL scale: HR: 2.32, 95% CI: 1.21-4.45, P = .011; Fried criteria: HR: 1.99, 95% CI: 1.04-3.82, P = .038). However, the prediction accuracy of the FRAIL scale was higher than that of the FSI and comparable to that of the Fried criteria for physical dysfunction. CONCLUSIONS AND IMPLICATIONS The FSI and the FRAIL scale showed moderate agreement with the Fried criteria regarding frailty diagnostic performance and had comparable prognostic value. However, only the FRAIL scale was as accurate as the Fried criteria in screening for physical dysfunction.
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27
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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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28
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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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29
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Muszalik M, Stępień H, Puto G, Cybulski M, Kurpas D. Implications of the Metabolic Control of Diabetes in Patients with Frailty Syndrome. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10327. [PMID: 36011979 PMCID: PMC9408164 DOI: 10.3390/ijerph191610327] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 08/16/2022] [Accepted: 08/17/2022] [Indexed: 06/15/2023]
Abstract
Introduction: Frailty syndrome occurs more frequently in patients with diabetes than in the general population. The reasons for this more frequent occurrence and the interdependence of the two conditions are not well understood. To date, there is no fully effective method for the diagnosis, prevention, and monitoring of frailty syndrome. This study aimed to assess the degree of metabolic control of diabetes in patients with frailty syndrome and to determine the impact of frailty on the course of diabetes using a retrospective analysis. Materials and Methods: A total of 103 individuals aged 60+ with diabetes were studied. The study population included 65 women (63.1%) and 38 men (36.9%). The mean age was 72.96 years (SD 7.55). The study was conducted in the practice of a general practitioner in Wielkopolska in 2018−2019. The research instrument was the authors’ original medical history questionnaire. The questions of the questionnaire were related to age, education, and sociodemographic situation of the respondents, as well as their dietary habits, health status, and use of stimulants. Other instruments used were: the Mini-Mental State Examination (MMSE), Lawton Scale (IADL—Instrumental Activities of Daily Living), Katz Scale (ADL—Activities of Daily Living), Geriatric Depression Rating Scale (GDS), and SHARE-FI scale (Survey of Health, Aging, and Retirement in Europe). Anthropometric and biochemical tests were performed. Results: In the study, frailty syndrome was diagnosed using the SHARE-FI scale in 26 individuals (25%): 32 (31.1%) were pre-frailty and 45 (43.7%) represented a non-frailty group. Statistical analysis revealed that elevated HbA1c levels were associated with a statistically significant risk of developing frailty syndrome (p = 0.048). In addition, the co-occurrence of diabetes and frailty syndrome was found to be a risk factor for loss of functional capacity or limitation in older adults (p = 0.00) and was associated with the risk of developing depression (p < 0.001) and cognitive impairment (p < 0.001). Conclusions: Concerning metabolic control of diabetes, higher HbA1c levels in the elderly are a predictive factor for the development of frailty syndrome. No statistical significance was found for the other parameters of metabolic control in diabetes. People with frailty syndrome scored significantly higher on the Geriatric Depression Rating Scale and lower on the MMSE cognitive rating scale than the comparison group. This suggests that frailty is a predictive factor for depression and cognitive impairment. Patients with frailty and diabetes have significantly lower scores on the Basic Activities of Daily Living Rating Scale and the Complex Activities of Daily Living Rating Scale, which are associated with loss or limitation of functioning. Frailty syndrome is a predictive factor for loss of functional capacity in the elderly.
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Affiliation(s)
- Marta Muszalik
- Department of Geriatrics, Faculty of Health Sciences, Nicolaus Copernicus University in Torun, Collegium Medicum in Bydgoszcz, 85-094 Bydgoszcz, Poland
| | - Hubert Stępień
- Department of Internal Medicine II, Asklepios Clinic Uckermark, 74-506 Schwedt, Germany
| | - Grażyna Puto
- Department of Clinical Nursing, Institute of Nursing and Midwifery, Faculty of Health Sciences, Jagiellonian University Medical College Cracow, 31-501 Crakow, Poland
| | - Mateusz Cybulski
- Department of Integrated Medical Care, Faculty of Health Sciences, Medical University of Bialystok, 15-096 Białystok, Poland
| | - Donata Kurpas
- Department of Family Medicine, Wroclaw Medical University, 51-141 Wroclaw, Poland
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30
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Chronic Coronary Syndrome in Frail Old Population. LIFE (BASEL, SWITZERLAND) 2022; 12:life12081133. [PMID: 36013312 PMCID: PMC9410393 DOI: 10.3390/life12081133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 07/23/2022] [Accepted: 07/25/2022] [Indexed: 12/30/2022]
Abstract
The demographic trend of aging is associated with an increased prevalence of comorbidities among the elderly. Physical, immunological, emotional and cognitive impairment, in the context of the advanced biological age segment, leads to the maintenance and precipitation of cardiovascular diseases. Thus, more and more data are focused on understanding the pathophysiological mechanisms underlying each fragility phenotype and how they potentiate each other. The implications of inflammation, sarcopenia, vitamin D deficiency and albumin, as dimensions inherent in fragility, in the development and setting of chronic coronary syndromes (CCSs) have proven their patent significance but are still open to research. At the same time, the literature speculates on the interdependent relationship between frailty and CCSs, revealing the role of the first one in the development of the second. In this sense, depression, disabilities, polypharmacy and even cognitive disorders in the elderly with ischemic cardiovascular disease mean a gradual and complex progression of frailty. The battery of tests necessary for the evaluation of the elderly with CCSs requires a permanent update, according to the latest guidelines, but also an individualized approach related to the degree of frailty and the conditions imposed by it. By summation, the knowledge of frailty screening methods, through the use of sensitive and individualized tools, is the foundation of secondary prevention and prognosis in the elderly with CCSs. Moreover, a comprehensive geriatric assessment remains the gold standard of the medical approach of these patients. The management of the frail elderly, with CCSs, brings new challenges, also from the perspective of the treatment particularities. Sometimes the risk–benefit balance is difficult to achieve. Therefore, the holistic, individualized and updated approach of these patients remains a desired objective, by understanding and permanently acquiring knowledge on the complexity of the frailty syndrome.
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Iacovelli F, Desario P, Cafaro A, Pignatelli A, Alemanni R, Montesanti R, Bortone AS, De Cillis E, De Palo M, Bardi L, Martinelli GL, Tesorio T, Cassese M, Contegiacomo G. The hemodynamic performance of balloon-expandable aortic bioprostheses in the elderly: a comparison between rapid deployment and transcatheter implantation. Hellenic J Cardiol 2022; 68:9-16. [PMID: 35863727 DOI: 10.1016/j.hjc.2022.07.006] [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: 03/13/2022] [Revised: 07/01/2022] [Accepted: 07/11/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Surgical aortic valve replacement with a rapid deployment valve (RDV) is a relatively recent treatment option. Aim of this study was to compare the hemodynamic performance of balloon-expandable (BE)-RDVs and BE-transcatheter heart valves (THVs) in a high surgical risk and frail-elderly population. METHODS BE-THVs and BE-RDVs were respectively implanted in 138 and 47 patients, all older than 75 years and with a Canadian Study of Health and Aging category of 5 or above. Echocardiographic assessment was performed at discharge and at six months. RESULTS At discharge, transprosthetic pressure gradients and indexed effective orifice area (iEOA) were similar in both cohorts. At six-month follow-up, BE-RDV showed lower peak (14.69 vs 20.86 mmHg; p <0.001) and mean (7.82 vs 11.83 mmHg; p <0.001) gradients, as well as larger iEOA (1.05 vs 0.84 cm2/m2; p <0.001). Similar findings were also shown considering only small sized valves. Moderate-to-severe paravalvular leakage was more prevalent in BE-THVs at discharge (14.49 vs 0.00%; p=0.032) and, considering exclusively small prostheses, at six months too (57.69 vs 15.00%; p=0.014). Nevertheless, BE-THVs determined amelioration in left ventricular ejection fraction (53.79 vs 60.14%; p <0.001), pulmonary artery systolic pressure (35.81 vs 33.15 mmHg; p=0.042) and tricuspid regurgitation severity (40.58 vs 19.57%; p=0.031) from discharge to mid-term follow-up. CONCLUSIONS BE-RDVs showed better hemodynamic performance, especially when implanted in small annulus. Despite their worse baseline conditions, transcatheter patients still exhibited a greater improvement of their echocardiographic profile at mid-term follow-up.
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Affiliation(s)
- Fortunato Iacovelli
- Division of University Cardiology, Cardiothoracic Department, Policlinico University Hospital, Piazza Giulio Cesare 11, 70124 Bari, Italy; Division of Cardiology, "SS. Annunziata" Hospital, Via Francesco Bruno 1, 74121 Taranto, Italy.
| | - Paolo Desario
- Division of University Cardiology, Cardiothoracic Department, Policlinico University Hospital, Piazza Giulio Cesare 11, 70124 Bari, Italy.
| | - Alessandro Cafaro
- Division of Cardiology, "V. Fazzi" Hospital, Piazza Filippo Muratore, 73100 Lecce, Italy.
| | - Antonio Pignatelli
- Interventional Cardiology Service, "Anthea" Clinic, GVM Care & Research, Via Camillo Rosalba 35/37, 70124 Bari, Italy.
| | - Rossella Alemanni
- Division of Heart Surgery, Emergency and Critical Care Department, "Casa Sollievo della Sofferenza" Research Hospital, Viale Cappuccini, 71013 San Giovanni Rotondo, Italy.
| | - Rosamaria Montesanti
- Division of Heart Surgery, Emergency and Critical Care Department, "Casa Sollievo della Sofferenza" Research Hospital, Viale Cappuccini, 71013 San Giovanni Rotondo, Italy.
| | - Alessandro Santo Bortone
- Division of University Heart Surgery, Cardiothoracic Department, Policlinico University Hospital, Piazza Giulio Cesare 11, 70124 Bari, Italy.
| | - Emanuela De Cillis
- Division of University Heart Surgery, Cardiothoracic Department, Policlinico University Hospital, Piazza Giulio Cesare 11, 70124 Bari, Italy.
| | - Micaela De Palo
- Division of University Heart Surgery, Cardiothoracic Department, Policlinico University Hospital, Piazza Giulio Cesare 11, 70124 Bari, Italy.
| | - Luca Bardi
- Division of Cardiology, Department of Advanced Biomedical Sciences, University of Naples "Federico II", Via Sergio Pansini 5, 80131 Naples, Italy.
| | - Gian Luca Martinelli
- Division of Heart Surgery, Cardiovascular Department, "MultiMedica" Research Hospital, Via Milanese 300, 20099 Sesto San Giovanni, Italy.
| | - Tullio Tesorio
- Interventional Cardiology Service, "Montevergine" Clinic, Via Mario Malzoni, 83013 Mercogliano, Italy.
| | - Mauro Cassese
- Division of Heart Surgery, Emergency and Critical Care Department, "Casa Sollievo della Sofferenza" Research Hospital, Viale Cappuccini, 71013 San Giovanni Rotondo, Italy.
| | - Gaetano Contegiacomo
- Interventional Cardiology Service, "Anthea" Clinic, GVM Care & Research, Via Camillo Rosalba 35/37, 70124 Bari, Italy.
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Impact of activities of daily living on percutaneous coronary intervention and acute and long-term mortality in patients with acute myocardial infarction: Yamagata AMI registry. J Cardiol 2022; 80:313-318. [DOI: 10.1016/j.jjcc.2022.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 04/27/2022] [Accepted: 04/28/2022] [Indexed: 11/24/2022]
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Exploring the Relationship between Frailty, Functional Status, Polypharmacy, and Quality of Life in Elderly and Middle-Aged Patients with Cardiovascular Diseases: A One-Year Follow-Up Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19042286. [PMID: 35206472 PMCID: PMC8871852 DOI: 10.3390/ijerph19042286] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Revised: 02/05/2022] [Accepted: 02/14/2022] [Indexed: 02/04/2023]
Abstract
The association between frailty, disability in activities of daily living (ADL), polypharmacy, and quality of life (QoL) in middle-aged patients with cardiovascular disease (CVD) is little investigated. This study sought (a) to explore this association comparatively in elderly and middle-aged hospitalized patients with CVD and (b) to determine which domains of ADL and QoL might improve the frailty prediction. A one-year follow-up study including 90 elderly (≥65 years old) and 89 middle-aged patients (40-65 years old) was conducted. At baseline, frailty assessment was performed based on the Fried criteria; Barthel Index (BI) and Duke Activity Status Index (DASI) were used for ADL, and European Quality of Life-5 dimensions (EQ-5D) for QoL. At follow-up, data were collected via telephone. At baseline, 79 patients (51 elderly and 28 middle-aged) were frail. The CVD frail patients showed functional dependency and a poor QoL compared to the non-frail (p < 0.001) and within each subgroup at follow-up. Mobility was found to predict frailty in both elderly (OR = 2.34) (C.I. (1.03-5.29)) and middle-aged patients (OR = 2.58) (C.I. (1.15-5.78)). The ADL assessment and self-reported QoL may help to identify an aggravation or an advanced frailty condition in hospitalized elderly and middle-aged CVD patients.
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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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Hirashiki A, Shimizu A, Suzuki N, Nomoto K, Kokubo M, Hashimoto K, Sato K, Kondo I, Murohara T, Arai H. Composite Biomarkers for Assessing Frailty Status in Stable Older Adults With Cardiovascular Disease. Circ Rep 2022; 4:123-130. [PMID: 35342841 PMCID: PMC8901249 DOI: 10.1253/circrep.cr-21-0143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 01/13/2022] [Accepted: 01/19/2022] [Indexed: 11/16/2022] Open
Abstract
Background:
The relationship between frailty status and laboratory measurements in cardiovascular disease (CVD) remains unclear. We investigated which laboratory measurements indicated frailty in stable older CVD patients. Methods and Results:
One-hundred thirty-eight stable older CVD patients were evaluated by laboratory measurements, with frailty assessed using the Kihon Checklist (KCL). Laboratory measurements were compared between frail and non-frail groups. Across the entire cohort, mean age was 81.7 years, mean left ventricular ejection fraction was 57.8%, and mean plasma B-type natriuretic peptide was 182 pg/mL. KCL scores were used to divide patients into non-frail (n=43; KCL <8) and frail (n=95; KCL ≥8) groups. Serum iron was significantly lower in the frail than non-frail group (mean [±SD] 61.2±30.3 vs. 89.5±26.1 μg/dL, respectively; P<0.001). Blood urea nitrogen (BUN; 27.3±16.5 vs. 19.7±8.2 mg/dL; P=0.013) and C-reactive protein (CRP; 1.05±1.99 vs. 0.15±0.21 mg/dL; P=0.004) were significantly higher in the frail than non-frail group. Multivariate analysis revealed that serum iron, CRP, and BUN were significant independent predictors of frailty (β=−0.069, 0.917, and 0.086, respectively). Conclusions:
Frailty status was significantly associated with iron, CRP, and BUN in stable older CVD patients. Composite biomarkers (inflammation, iron deficiency, and renal perfusion) may be useful for assessing frailty in these patients.
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Affiliation(s)
- Akihiro Hirashiki
- Department of Cardiology, National Center for Geriatrics and Gerontology
| | - Atsuya Shimizu
- Department of Cardiology, National Center for Geriatrics and Gerontology
| | - Noriyuki Suzuki
- Department of Cardiology, National Center for Geriatrics and Gerontology
| | - Kenichiro Nomoto
- Department of Cardiology, National Center for Geriatrics and Gerontology
| | - Manabu Kokubo
- Department of Cardiology, National Center for Geriatrics and Gerontology
| | - Kakeru Hashimoto
- Department of Rehabilitation, National Center for Geriatrics and Gerontology
| | - Kenji Sato
- Department of Rehabilitation, National Center for Geriatrics and Gerontology
| | - Izumi Kondo
- Department of Rehabilitation, National Center for Geriatrics and Gerontology
| | - Toyoaki Murohara
- Department of Cardiology, Nagoya University Graduate School of Medicine
| | - Hidenori Arai
- Department of Geriatric Medicine, National Center for Geriatrics and Gerontology
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Scherrenberg M, Marinus N, Giallauria F, Falter M, Kemps H, Wilhelm M, Prescott E, Vigorito C, De Kluiver E, Cipriano G, Dendale P, Hansen D. The need for long-term personalized management of frail CVD patients by rehabilitation and telemonitoring: a framework. Trends Cardiovasc Med 2022:S1050-1738(22)00023-8. [PMID: 35121082 DOI: 10.1016/j.tcm.2022.01.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 01/24/2022] [Accepted: 01/29/2022] [Indexed: 10/19/2022]
Abstract
Due to advances in cardiovascular medicine and preventive cardiology, patients benefit from a better prognosis, even in case of significant disease burden such as acute and chronic coronary syndromes, advanced valvular heart disease and chronic heart failure. These advances have allowed CVD patients to increase their life expectancy, but on the other hand also experience aging-related syndromes such as frailty. Despite being underrecognized, frailty is a critical, common, and co-existent condition among older CVD patients, leading to exercise intolerance and compromised adherence to cardiovascular rehabilitation. Moreover, frail patients need a different approach for CR and are at very high risk for adverse events, but yet are underrepresented in conventional CR. Fortunately, recent advances have been made in technology, allowing remote monitoring, coaching and supervision of CVD patients in secondary prevention programs with promising benefits. Similarly, we hypothesized that such programs should also be implemented to treat frailty in CVD patients. However, considering frail patients' particular needs and challenges, telerehabilitation interventions should thus be appropriately adapted. Our purpose is to provide, for the first time and based on expert opinions, a framework of how such a cardiac telerehabilitation program could be developed and implemented to manage a prevention and rehabilitation program for CVD patients with frailty.
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Affiliation(s)
- Martijn Scherrenberg
- Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium; UHasselt, Faculty of Medicine and Life Sciences, Diepenbeek, Belgium; Faculty of Medicine and Health Sciences, Antwerp University, Belgium
| | - Nastasia Marinus
- UHasselt, Faculty of Rehabilitation Sciences, BIOMED-REVAL, Hasselt, Belgium
| | | | - Maarten Falter
- Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium; UHasselt, Faculty of Medicine and Life Sciences, Diepenbeek, Belgium; Faculty of Medicine, Department of Cardiology, KULeuven, Herestraat 49, 3000, Leuven, Belgium
| | - Hareld Kemps
- Department of Cardiology, Máxima Medical Center, The Netherlands; Department of Industrial Design, Technical University Eindhoven, The Netherlands
| | - Matthias Wilhelm
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Eva Prescott
- Department of Cardiology, Bispebjerg University Hospital, University of Copenhagen, Copenhagen, NW, Denmark
| | - Carlo Vigorito
- Department of Translational Medical Sciences, Federico II University of Naples
| | | | | | - Paul Dendale
- Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium; UHasselt, Faculty of Medicine and Life Sciences, Diepenbeek, Belgium
| | - Dominique Hansen
- Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium; UHasselt, Faculty of Rehabilitation Sciences, BIOMED-REVAL, Hasselt, Belgium.
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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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Mone P, Gambardella J, Lombardi A, Pansini A, De Gennaro S, Leo AL, Famiglietti M, Marro A, Morgante M, Frullone S, De Luca A, Santulli G. Correlation of physical and cognitive impairment in diabetic and hypertensive frail older adults. Cardiovasc Diabetol 2022; 21:10. [PMID: 35045834 PMCID: PMC8772197 DOI: 10.1186/s12933-021-01442-z] [Citation(s) in RCA: 40] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 12/30/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Diabetes and hypertension are common in older adults and represent established risk factors for frailty. Frailty is a multidimensional condition due to reserve loss and susceptibility to stressors with a high risk of death, hospitalizations, functional and cognitive impairment. Comorbidities such as diabetes and hypertension play a key role in increasing the risk of mortality, hospitalization, and disability. Moreover, frail patients with diabetes and hypertension are known to have an increased risk of cognitive and physical impairment. Nevertheless, no study assessed the correlation between physical and cognitive impairment in frail older adults with diabetes and hypertension. METHODS We evaluated consecutive frail older patients with diabetes and hypertension who presented at ASL (local health unit of the Italian Ministry of Health) Avellino, Italy, from March 2021 to October 2021. The inclusion criteria were: a previous diagnosis of diabetes and hypertension with no evidence of secondary causes; age > 65 years; a frailty status; Montreal Cognitive Assessment (MoCA) score < 26. RESULTS 179 patients successfully completed the study. We found a strong and significant correlation between MoCA score and 5-m gait speed test (r: 0.877; p < 0.001). To further verify our results, we performed a linear multivariate analysis adjusting for potential confounding factors, with MoCA score as dependent variable, which confirmed the significant association with glycemia (p < 0.001). CONCLUSIONS This is the first study showing a significant correlation between 5-m gait speed test and MoCA score in frail diabetic and hypertensive older adults.
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Affiliation(s)
- Pasquale Mone
- grid.251993.50000000121791997Department of Medicine, Einstein Institute for Aging Research, Einstein-Mount Sinai Diabetes Research Center (ES-DRC), The Fleischer Institute for Diabetes and Metabolism (FIDAM), Albert Einstein College of Medicine, New York, NY USA ,grid.9841.40000 0001 2200 8888Department of Mental and Physical Health and Preventive Medicine, University of Campania “Luigi Vanvitelli”, Naples, Italy ,Division of Internal Medicine, Sant’Angelo Dei Lombardi Hospital, ASL (Local Health Unit), Avellino, Italy
| | - Jessica Gambardella
- grid.251993.50000000121791997Department of Medicine, Einstein Institute for Aging Research, Einstein-Mount Sinai Diabetes Research Center (ES-DRC), The Fleischer Institute for Diabetes and Metabolism (FIDAM), Albert Einstein College of Medicine, New York, NY USA ,grid.4691.a0000 0001 0790 385XInternational Translational Research and Medical Education (ITME) Consortium, Department of Advanced Biomedical Sciences, “Federico II” University, Naples, Italy
| | - Angela Lombardi
- grid.251993.50000000121791997Department of Medicine, Einstein Institute for Aging Research, Einstein-Mount Sinai Diabetes Research Center (ES-DRC), The Fleischer Institute for Diabetes and Metabolism (FIDAM), Albert Einstein College of Medicine, New York, NY USA
| | - Antonella Pansini
- Elderly Assistance and Home Care, ASL (Local Health Unit), Avellino, Italy
| | - Stefano De Gennaro
- Division of Internal Medicine, Sant’Angelo Dei Lombardi Hospital, ASL (Local Health Unit), Avellino, Italy
| | - Anna Luisa Leo
- Division of Internal Medicine, Sant’Angelo Dei Lombardi Hospital, ASL (Local Health Unit), Avellino, Italy
| | - Michele Famiglietti
- Division of Internal Medicine, Sant’Angelo Dei Lombardi Hospital, ASL (Local Health Unit), Avellino, Italy
| | - Anna Marro
- Elderly Assistance and Home Care, ASL (Local Health Unit), Avellino, Italy
| | - Maria Morgante
- Elderly Assistance and Home Care, ASL (Local Health Unit), Avellino, Italy
| | - Salvatore Frullone
- Division of Internal Medicine, Sant’Angelo Dei Lombardi Hospital, ASL (Local Health Unit), Avellino, Italy
| | - Antonio De Luca
- grid.9841.40000 0001 2200 8888Department of Mental and Physical Health and Preventive Medicine, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Gaetano Santulli
- grid.251993.50000000121791997Department of Medicine, Einstein Institute for Aging Research, Einstein-Mount Sinai Diabetes Research Center (ES-DRC), The Fleischer Institute for Diabetes and Metabolism (FIDAM), Albert Einstein College of Medicine, New York, NY USA ,grid.4691.a0000 0001 0790 385XInternational Translational Research and Medical Education (ITME) Consortium, Department of Advanced Biomedical Sciences, “Federico II” University, Naples, Italy ,grid.251993.50000000121791997Department of Molecular Pharmacology, Institute for Neuroimmunology and Inflammation (INI), Wilf Family Cardiovascular Research Institute, Albert Einstein College of Medicine, New York, NY USA
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Arnold SV, Zhao Y, Leon MB, Sathananthan J, Alu M, Thourani VH, Smith CR, Mack MJ, Cohen DJ. Impact of Frailty and Prefrailty on Outcomes of Transcatheter or Surgical Aortic Valve Replacement. Circ Cardiovasc Interv 2022; 15:e011375. [PMID: 35041454 DOI: 10.1161/circinterventions.121.011375] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Randomized trials have shown short- and mid-term benefits with transcatheter versus surgical aortic valve replacement (TAVR versus SAVR) for patients at intermediate or low-risk for surgery. Frailty and prefrailty could explain some of this benefit due to an impaired ability to recover fully from a major surgical procedure. METHODS We examined 2-year outcomes (survival and Kansas City Cardiomyopathy Questionnaire [KCCQ] scores) among patients at intermediate or low surgical risk treated with transfemoral-TAVR or SAVR within the PARTNER (Placement of Aortic Transcatheter Valves) 2A trial, SAPIEN 3 intermediate-risk registry, and PARTNER 3 trial. Frailty was examined as a continuous variable based on grip strength, gait speed, serum albumin, and activities of daily living. We tested the interaction of frailty markers by treatment (TAVR versus SAVR) in proportional hazards regression models (survival) and piecewise linear regression models (KCCQ), adjusting for patient demographic and clinical factors. RESULTS Among the 3025 patients in the analytic cohort (2003 TAVR, 1022 SAVR; mean age 79.3 years, 61.6% men), 799 (26.4%) were nonfrail, 2041 (67.5%) were prefrail (1-2 frailty markers), and 185 (6.1%) were frail (3-4 frailty markers). Increasing frailty (none versus prefrail versus frail) was associated with higher 2-year mortality (5.5% versus 11.1% versus 22.8%; log-rank P<0.001) and worse 2-year health status among survivors (KCCQ scores adjusted for baseline: 84.8 versus 79.6 versus 77.4, P<0.001). In multivariable models, there were no significant interactions between frailty markers and treatment group for either survival (interaction P=0.39) or health status (interaction P>0.47 for all time points). CONCLUSIONS In a cohort of older patients with severe aortic stenosis who were at low or intermediate surgical risk, increasing frailty markers were associated with worse 2-year mortality and greater health status impairment after either TAVR or SAVR, but there were no significant interactions between type of valve replacement and frailty with respect to either outcome.
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Affiliation(s)
- Suzanne V Arnold
- Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City, MO (S.V.A.)
| | - Yanglu Zhao
- Edwards Lifesciences, Inc, Irvine, CA (Y.Z.)
| | - Martin B Leon
- Cardiovascular Research Foundation, NY (M.B.L., M.A., D.J.C.).,Columbia-Presbyterian Hospital University Medical Center, NY (M.B.L., M.A., C.R.S.)
| | - Janar Sathananthan
- St Paul's Hospital, University of British Columbia, Vancouver, Canada (J.S.)
| | - Maria Alu
- Cardiovascular Research Foundation, NY (M.B.L., M.A., D.J.C.).,Columbia-Presbyterian Hospital University Medical Center, NY (M.B.L., M.A., C.R.S.)
| | | | - Craig R Smith
- Columbia-Presbyterian Hospital University Medical Center, NY (M.B.L., M.A., C.R.S.)
| | | | - David J Cohen
- Cardiovascular Research Foundation, NY (M.B.L., M.A., D.J.C.).,St. Francis Hospital, Roslyn, NY (D.J.C.)
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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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Cheng HW, Liu CY, Chen YS, Shih CC, Chen WY, Chiou AF. Assessment of preoperative frailty and identification of patients at risk for postoperative delirium in cardiac intensive care units: a prospective observational study. Eur J Cardiovasc Nurs 2021; 20:745-751. [PMID: 34472606 DOI: 10.1093/eurjcn/zvab076] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 05/24/2021] [Accepted: 08/17/2021] [Indexed: 01/09/2023]
Abstract
BACKGROUND Postoperative delirium (POD) is a common complication that may occur from 24 to 72 h after cardiac surgery. Frailty is a chronic syndrome that leads to a decline in physiological reserve and to disability. The associations between frailty and POD are unclear. AIMS To investigate associations between POD and frailty in patients undergoing cardiac surgery and to analyse predictors of POD. METHODS AND RESULTS Convenience sampling was used to recruit 152 patients who underwent cardiac surgery in two medical centres in northern Taiwan. Preoperative frailty in these patients was evaluated using Fried's frailty phenotype. Delirium in patients was assessed from postoperative day 1 to day 5 using the confusion assessment method for intensive care units. A total of 152 patients who underwent cardiac surgery included 68 (44.74%) prefrail patients and 21 (13.81%) patients with frailty after the surgery. Ten patients (6.58%) developed delirium after cardiac surgery. The occurrence of delirium peaked at postoperative day 2, and the average duration of delirium was 3 days. A case-control comparison revealed a significant correlation between preoperative frailty and POD. Significant predictors of POD in patients undergoing cardiac surgery included the European System for Cardiac Operative Risk Evaluation II, preoperative arrhythmia, and preoperative anxiety and depression. CONCLUSION Preoperative frailty was correlated with POD. Preoperative arrhythmia, anxiety, and depression are predictors of POD. Nurses should perform preoperative assessments of surgical risk and physiological and psychological conditions of patients undergoing cardiac surgery and monitor the occurrence of POD.
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Affiliation(s)
- Hsiao-Wei Cheng
- Department of Nursing, National Taiwan University Hospital, No.7, Chung Shan South Road, Zhongzheng Dist., Taipei 100, Taiwan
| | - Chieh-Yu Liu
- Biostatistical Consultant Lab, Department of Health Care Management, National Taipei University of Nursing and Health Sciences, No.365, Ming-te Road, Peitou District, Taipei 112, Taiwan
| | - Yih-Sharng Chen
- Department of Surgery, Cardiovascular Surgery & Ped Cardiovascular Surgery, National Taiwan University Hospital, and College of Medicine, National Taiwan University, No.7, Chung Shan South Road, Zhongzheng Dist., Taipei 100, Taiwan
| | - Chun-Che Shih
- Taipei Heart Institute, Taipei Medical University, No. 250 Wu-Hsing St. Taipei 110, Taiwan.,Division of Cardiovascular Surgery, Department of Surgery, Wan Fang Hospital, Taipei Medical University, No. 111, Sec.3, Xinglong Rd., Wenshan Dist., Taipei 116, Taiwan.,Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, No. 250 Wu-Hsing St. Taipei 110, Taiwan.,Institute of Clinical Medicine, Department of Surgery, School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, No. 155, Sec. 2, Li-Nong St., Taipei 112, Taiwan
| | - Wei-Yi Chen
- Department of Nursing, Taipei Veterans General Hospital, No. 201, Sec. 2, Shipai Rd., Beitou District, Taipei 112, Taiwan
| | - Ai-Fu Chiou
- College of Nursing, Institute of Clinical Nursing, National Yang Ming Chiao Tung University, No. 155, Sec. 2, Li-Nong St., Taipei 112, Taiwan
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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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Jain NS, Vuong LN, Hickman LB, Chin P, Hill EJR, Buck D, Festekjian JH. Using the modified frailty index to predict negative outcomes in free-flap breast reconstruction: A National Surgical Quality Improvement Project-based study. Microsurgery 2021; 41:709-715. [PMID: 34533855 DOI: 10.1002/micr.30810] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 07/21/2021] [Accepted: 08/27/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND Post-mastectomy free-flap breast reconstruction is becoming increasingly common in the United States. However, predicting which patients may suffer complications remains challenging. We sought to apply the validated modified frailty index (mFI) to free-flap breast reconstruction in breast cancer patients and determine its utility in predicting negative outcomes. METHODS We conducted a retrospective study using National Surgical Quality Improvement Project (NSQIP). All patients who had a CPT code of 19364, indicative of free tissue transfer for breast cancer reconstruction, were included. Data on preoperative characteristics and postoperative outcomes were collected. Patients were separated based on the number of mFI factors present into three categories: 0, 1, and > 2 factors. Preoperative demographics, clinical status, and other comorbidities were also studied. Negative outcomes were compared using multivariate logistic regression. RESULTS 11,852 patients (mean age 50.9 ± 9.5) were found; 24.2% had complications, comparable to previous literature. mFI is predictive of all types of negative outcomes. 22.5% of all patients with 0 mFI, 27.7% of patients with 1 mFI and 34.2% of patients with at least two mFI had a negative outcome. The most common factors contributing to the mFI were history of hypertension (24.8%) and diabetes (6.1%). mFI was found to be an isolated risk factor for negative outcomes, along with steroid use, American Society of Anesthesiology (ASA) classification, body mass index, and immediate, and bilateral operations. CONCLUSIONS This NSQIP-based study for patients undergoing free flap breast reconstruction shows that the mFI holds predictive value regarding negative outcomes. This provides more information to properly counsel patients before free flap breast reconstruction surgery.
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Affiliation(s)
- Nirbhay S Jain
- Division of Plastic and Reconstructive Surgery, University of California, Los Angeles, Los Angeles, California, USA
| | - Linh N Vuong
- Divison of Plastic and Reconstructive Surgery, Department of Surgery, Washington University in St. Louis, St. Louis, Missouri, USA
| | - L Brian Hickman
- Department of Neurology, University of California, Los Angeles, Los Angeles, California, USA
| | - Patrick Chin
- Division of Plastic and Reconstructive Surgery, University of California, Los Angeles, Los Angeles, California, USA
| | - Elspeth J R Hill
- Divison of Plastic and Reconstructive Surgery, Department of Surgery, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Donald Buck
- Plastic and Reconstructive Surgery, St. Louis, Missouri, USA
| | - Jaco H Festekjian
- Division of Plastic and Reconstructive Surgery, University of California, Los Angeles, Los Angeles, California, USA
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Frailty Assessment in Heart Failure and Ventricular Assist Device Populations: A Review from the United States. Heart Lung 2021; 50:941-952. [PMID: 34433112 DOI: 10.1016/j.hrtlng.2021.07.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 07/28/2021] [Accepted: 07/29/2021] [Indexed: 01/30/2023]
Abstract
IMPORTANCE Post-operative risk is increased with frail individuals undergoing cardiac surgery. Yet, there is no consensus for frailty assessment prior to durable left ventricular assist device (dLVAD) evaluation. OBJECTIVE The objectives of this integrative review were to describe frailty measures, examine psychometrics of measures used, and identify variables related to frailty in heart failure with reduced ejection fraction (HFrEF) and dLVAD populations. DESIGN, SETTING, PARTICIPANTS PubMed, CINAHL, and Embase databases were searched for terms related to frailty, HFrEF and dLVAD that met inclusion criteria. RESULTS Fourteen articles met inclusion criteria. Frailty was inconsistently defined. The Fried Phenotype Criteria was the most widely used approach to measurement. Validity was reported in all articles. Variables related to frailty included readmissions, higher mortality and increased adverse events. CONCLUSION There was variability in frailty definition and frailty measurement across studies. Further research in HFrEF and dLVAD populations is needed for frailty evaluation.
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Solomon J, Moss E, Morin JF, Langlois Y, Cecere R, de Varennes B, Lachapelle K, Piazza N, Martucci G, Bendayan M, Piankova P, Hayman V, Ouimet MC, Rudski LG, Afilalo J. The Essential Frailty Toolset in Older Adults Undergoing Coronary Artery Bypass Surgery. J Am Heart Assoc 2021; 10:e020219. [PMID: 34315236 PMCID: PMC8475706 DOI: 10.1161/jaha.120.020219] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Background The Essential Frailty Toolset (EFT) was shown to be easy to use and predictive of adverse events in patients undergoing aortic valve replacement procedures. The objective of this study was to evaluate the EFT in patients undergoing coronary artery bypass grafting procedures. Methods and Results The McGill Frailty Registry prospectively included patients ≥60 years of age undergoing urgent or elective isolated coronary artery bypass grafting between 2011 and 2018 at 2 hospitals. The preoperative EFT was scored 0 to 5 points as a function of timed chair rises, Mini-Mental Status Examination, serum albumin, and hemoglobin. The primary outcome was all-cause mortality assessed by Cox proportional hazards regression. The cohort consisted of 500 patients with a mean age of 71.4 ± 6.4 years, of which 27% presented with acute coronary syndromes requiring urgent surgery. The mean EFT was 1.3 ± 1.1 points, 132 (26%) were nonfrail, 298 (60%) were prefrail, and 70 (14%) were frail. Over a median follow-up of 4.0 years, 78 deaths were observed. In nonfrail, prefrail, and frail patients, survival at 1 year was 98%, 95%, and 91%, and at 5 years was 89%, 83%, and 63% (P<0.001). After adjustment, each incremental EFT point was associated with a hazard ratio of 1.28 (95% CI, 1.05-1.56) and frail patients had a 3-fold increase in all-cause mortality. Conclusions The EFT is a pragmatic and highly prognostic tool to assess frailty and guide decisions for coronary artery bypass grafting in older adults. Furthermore, the EFT may be actionable through targeted interventions such as cardiac rehabilitation and nutritional optimization.
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Affiliation(s)
- Joshua Solomon
- Centre for Clinical Epidemiology Lady Davis Institute for Medical ResearchJewish General Hospital Montreal QC Canada
| | - Emmanuel Moss
- Division of Cardiac Surgery Jewish General HospitalMcGill University Montreal QC Canada
| | - Jean-Francois Morin
- Division of Cardiac Surgery Jewish General HospitalMcGill University Montreal QC Canada
| | - Yves Langlois
- Division of Cardiac Surgery Jewish General HospitalMcGill University Montreal QC Canada
| | - Renzo Cecere
- Division of Cardiac Surgery McGill University Health Centre Montreal QC Canada
| | - Benoit de Varennes
- Division of Cardiac Surgery McGill University Health Centre Montreal QC Canada
| | - Kevin Lachapelle
- Division of Cardiac Surgery McGill University Health Centre Montreal QC Canada
| | - Nicolo Piazza
- Division of Cardiology McGill University Health Centre Montreal QC Canada
| | - Giuseppe Martucci
- Division of Cardiology McGill University Health Centre Montreal QC Canada
| | - Melissa Bendayan
- Centre for Clinical Epidemiology Lady Davis Institute for Medical ResearchJewish General Hospital Montreal QC Canada
| | - Palina Piankova
- Centre for Clinical Epidemiology Lady Davis Institute for Medical ResearchJewish General Hospital Montreal QC Canada
| | - Victoria Hayman
- Centre for Clinical Epidemiology Lady Davis Institute for Medical ResearchJewish General Hospital Montreal QC Canada
| | | | - Lawrence G Rudski
- Division of Cardiology Jewish General HospitalMcGill University Montreal QC Canada
| | - Jonathan Afilalo
- Centre for Clinical Epidemiology Lady Davis Institute for Medical ResearchJewish General Hospital Montreal QC Canada.,Research InstituteMcGill University Health Centre Montreal QC Canada.,Division of Cardiology Jewish General HospitalMcGill University Montreal QC Canada
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Laddu DR, Ozemek C, Sabbahi A, Severin R, Phillips SA, Arena R. Prioritizing movement to address the frailty phenotype in heart failure. Prog Cardiovasc Dis 2021; 67:26-32. [PMID: 33556427 PMCID: PMC8342629 DOI: 10.1016/j.pcad.2021.01.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 01/29/2021] [Indexed: 12/12/2022]
Abstract
Frailty is a highly prevalent multisystem syndrome in older adults with heart failure (HF) and is associated with poor clinical prognosis and increased complexity of care. While frailty is neither disease nor age specific, it is a clinical manifestation of aging-related processes that reflects a reduced physiological ability to tolerate and recover from stress associated with aging, disease, or therapy. Within this context, physical frailty, which is distinctly oriented to physical functional domains (e.g., muscle weakness, slowness, and low activity), has been recognized as a critical vital sign in older persons with HF. Identification and routine assessment of physical frailty, using objective physical performance measures, may guide the course of patient-centered treatment plans that maximize the likelihood of improving clinical outcomes in older HF patients. Exercise-based rehabilitation is a primary therapy to improve cardiovascular health in patients with HF; however, the limited evidence supporting the effectiveness of exercise tailored to older and frail HF patients underscores the current gaps in management of their care. Interdisciplinary exercise interventions designed with consideration of physical frailty as a therapeutic target may be an important strategy to counteract functional deficits characteristic of frailty and HF, and to improve patient-centered outcomes in this population. The purpose of this current review is to provide a better understanding of physical frailty and its relation to management of care in older patients with HF. Implications of movement-based interventions, including exercise and physical rehabilitation, to prevent or reverse physical frailty and improve clinical outcomes will further be discussed.
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Affiliation(s)
- Deepika R Laddu
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, United States of America; Healthy Living for Pandemic Event Protection (HL - PIVOT) Network, Chicago, IL, USA.
| | - Cemal Ozemek
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, United States of America; Integrative Physiology Laboratory, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, United States of America
| | - Ahmad Sabbahi
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, United States of America; Healthy Living for Pandemic Event Protection (HL - PIVOT) Network, Chicago, IL, USA
| | - Richard Severin
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, United States of America; Integrative Physiology Laboratory, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, United States of America; Healthy Living for Pandemic Event Protection (HL - PIVOT) Network, Chicago, IL, USA
| | - Shane A Phillips
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, United States of America; Integrative Physiology Laboratory, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, United States of America; Healthy Living for Pandemic Event Protection (HL - PIVOT) Network, Chicago, IL, USA
| | - Ross Arena
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, United States of America; Healthy Living for Pandemic Event Protection (HL - PIVOT) Network, Chicago, IL, USA
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Abstract
BACKGROUND Frailty may increase the risk of complications and mortality in patients undergoing cardiac surgery. Few studies on frailty and its associated factors have been conducted in these patients. OBJECTIVE The aim of this study was to explore frailty and related factors in patients undergoing cardiac surgery. METHODS A total of 154 patients undergoing cardiac surgery in northern Taiwan were recruited using a longitudinal study design and interviewed using structured questionnaires assessing physical activity, anxiety and depression, and social support before surgery and at 1 month and 3 months after surgery. RESULTS The prevalence of frailty in patients undergoing cardiac surgery was 16.2%, 20.5%, and 16.6% before surgery and at 1 month and 3 months after surgery, respectively. Frail and prefrail patients undergoing cardiac surgery were more likely to be unemployed, have gout, have a higher New York Heart Association class, have preoperative dysrhythmia, undergo cardiopulmonary bypass, have a lower functional ability, have a higher European System for Cardiac Operative Risk Evaluation score, have a longer anesthesia time, have longer endotracheal tube and extracorporeal circulation times, have longer intensive care unit and hospital stays, have lower hemoglobin and albumin levels, have higher anxiety and depression levels, and have lower Mini-Mental State Examination scores. The significant predictors of prefrailty and frailty included unemployment, the presence of gout, higher New York Heart Association classes, less independence in activities of daily living, lower hemoglobin levels, and higher levels of depression. CONCLUSIONS Frailty was associated with patients' functional status, perioperative conditions and psychosocial factors. Preoperative assessments of frailty and appropriate interventions are needed to improve frailty in patients undergoing cardiac surgery.
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Wang Y, Han HR, Yang W, Zhang H, Zhang J, Ruan H, Tang N, Ren J, Sun X, Li C, Han L. Associations between risk factors for cardiovascular diseases and frailty among community-dwelling older adults in Lanzhou, China. Int J Nurs Sci 2021; 8:168-174. [PMID: 33997130 PMCID: PMC8105554 DOI: 10.1016/j.ijnss.2021.03.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 02/09/2021] [Accepted: 03/08/2021] [Indexed: 11/27/2022] Open
Abstract
Objectives To examine the relationship between cardiovascular disease risk factors and frailty in a sample of older Chinese adults. Methods A total of 458 community-dwelling older adults (≥65 years) in Lanzhou, Gansu Province of China participated in a cross-sectional survey. Their status was evaluated in terms of frailty phenotype (unintentional weight loss, exhaustion, low activity levels, slowness and weakness). Participants were categorized as not frail, prefrail or frail. Cardiovascular disease risk factors that were assessed included: blood pressure, body mass index, waist circumference, blood glucose, total cholesterol, triglycerides, low-density lipoproteins and high-density lipoproteins. Results Individuals with obesity had an increased risk of prefrailty (OR: 2.26; 95% CI: 1.05, 4.84). Hypertension was inversely associated with frailty among the participants (OR: 0.31; 95% CI: 0.11, 0.87) after adjusting for covariates. Conclusions The findings suggest that much more attention should be paid to weight control of the elderly in the community for preventing them from transition to prefrailty or frailty. Active prevention and control of cardiovascular diseases among the community-dwelling elder are still of great importance.
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Affiliation(s)
- Yanhong Wang
- School of Nursing, Lanzhou University, Lanzhou, China
| | - Hae-Ra Han
- School of Nursing, Johns Hopkins University, Maryland, USA
| | - Wei Yang
- Gastroenterology Department, The First Hospital of Lanzhou University, Lanzhou, China
| | | | - Jing Zhang
- School of Nursing, Lanzhou University, Lanzhou, China
| | - Haihui Ruan
- School of Nursing, Lanzhou University, Lanzhou, China
| | - Nan Tang
- School of Nursing, Lanzhou University, Lanzhou, China
| | - Jingjing Ren
- School of Nursing, Lanzhou University, Lanzhou, China
| | - Xia Sun
- Community Health Services Center of Tuanjiexincun, Lanzhou, China
| | - Chunrong Li
- Community Health Services Center of Jiaojiawan, Lanzhou, China
| | - Lin Han
- School of Nursing, Lanzhou University, Lanzhou, China
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Soangra R, Lockhart T. Smartphone-Based Prediction Model for Postoperative Cardiac Surgery Outcomes Using Preoperative Gait and Posture Measures. SENSORS 2021; 21:s21051704. [PMID: 33801240 PMCID: PMC7958120 DOI: 10.3390/s21051704] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 02/16/2021] [Accepted: 02/23/2021] [Indexed: 11/16/2022]
Abstract
Gait speed assessment increases the predictive value of mortality and morbidity following older adults' cardiac surgery. The purpose of this study was to improve clinical assessment and prediction of mortality and morbidity among older patients undergoing cardiac surgery through the identification of the relationships between preoperative gait and postural stability characteristics utilizing a noninvasive-wearable mobile phone device and postoperative cardiac surgical outcomes. This research was a prospective study of ambulatory patients aged over 70 years undergoing non-emergent cardiac surgery. Sixteen older adults with cardiovascular disease (Age 76.1 ± 3.6 years) scheduled for cardiac surgery within the next 24 h were recruited for this study. As per the Society of Thoracic Surgeons (STS) recommendation guidelines, eight of the cardiovascular disease (CVD) patients were classified as frail (prone to adverse outcomes with gait speed ≤0.833 m/s) and the remaining eight patients as non-frail (gait speed >0.833 m/s). Treating physicians and patients were blinded to gait and posture assessment results not to influence the decision to proceed with surgery or postoperative management. Follow-ups regarding patient outcomes were continued until patients were discharged or transferred from the hospital, at which time data regarding outcomes were extracted from the records. In the preoperative setting, patients performed the 5-m walk and stand still for 30 s in the clinic while wearing a mobile phone with a customized app "Lockhart Monitor" available at iOS App Store. Systematic evaluations of different gait and posture measures identified a subset of smartphone measures most sensitive to differences in two groups (frail versus non-frail) with adverse postoperative outcomes (morbidity/mortality). A regression model based on these smartphone measures tested positive on five CVD patients. Thus, clinical settings can readily utilize mobile technology, and the proposed regression model can predict adverse postoperative outcomes such as morbidity or mortality events.
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Affiliation(s)
- Rahul Soangra
- Crean College of Health and Behavioral Sciences, Chapman University, Orange, CA 92866, USA;
- Fowler School of Engineering, Chapman University, Orange, CA 92866, USA
| | - Thurmon Lockhart
- School of Biological and Health Systems Engineering, Arizona State University, Tempe, AZ 85287, USA
- Correspondence: ; Tel.: +1-540-257-3058
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Figgins E, Pieruccini-Faria F, Speechley M, Montero-Odasso M. Potentially modifiable risk factors for slow gait in community-dwelling older adults: A systematic review. Ageing Res Rev 2021; 66:101253. [PMID: 33429086 DOI: 10.1016/j.arr.2020.101253] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 12/21/2020] [Accepted: 12/29/2020] [Indexed: 01/06/2023]
Abstract
PURPOSE Slow gait speed in older adults is associated with increased risk for falls and fractures, functional dependence, multimorbidity, and even mortality. The risk of these adverse outcomes can be reduced by intervening on potentially modifiable risk factors. The purpose of this systematic review was to identify potentially modifiable risk factors associated with slow gait speed and clinically meaningful gait speed decline in older community-dwelling adults. METHODS Literature searches were conducted in MEDLINE, EMBASE, and CINAHL, Google Scholar, and in the bibliographies of retrieved articles. RESULTS Forty studies met the inclusion criteria for qualitative review. Study designs were cross-sectional and longitudinal. Operational definitions of 'slow gait' and 'meaningful gait speed decline' were variable and based on sample distributions (e.g. quartiles), external criteria (e.g. < 0.8 m/s), and dynamic changes over time (e.g. ≥ 0.05 m/s decline per year). Twenty-six potentially modifiable risk factors were assessed in at least two studies. The risk factors most commonly investigated and that showed significant associations with slow gait and/or meaningful gait speed decline include physical activity, education, body mass index-obesity, pain, and depression/depressive symptoms. CONCLUSION Our results suggest that there are modifiable targets to maintain gait speed that are amenable to potential treatment.
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Affiliation(s)
- Erica Figgins
- Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, The University of Western Ontario, Kresge Building, Room K201, London, ON, N6A 5C1, Canada; Gait and Brain Laboratory, Parkwood Institute, Lawson Health Research Institute, London, ON, Canada.
| | - Frederico Pieruccini-Faria
- Gait and Brain Laboratory, Parkwood Institute, Lawson Health Research Institute, London, ON, Canada; Division of Geriatric Medicine, Department of Medicine, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, ON, N6C 0A7, Canada.
| | - Mark Speechley
- Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, The University of Western Ontario, Kresge Building, Room K201, London, ON, N6A 5C1, Canada; Gait and Brain Laboratory, Parkwood Institute, Lawson Health Research Institute, London, ON, Canada; Schulich Interfaculty Program in Public Health, The University of Western Ontario, London, ON, N6G 2M1, Canada.
| | - Manuel Montero-Odasso
- Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, The University of Western Ontario, Kresge Building, Room K201, London, ON, N6A 5C1, Canada; Gait and Brain Laboratory, Parkwood Institute, Lawson Health Research Institute, London, ON, Canada; Division of Geriatric Medicine, Department of Medicine, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, ON, N6C 0A7, Canada.
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