1
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Codina P, Zamora E, Bayes-Genis A. Reply to 'The frail patient and the frailing heart'. Eur J Heart Fail 2023; 25:441-442. [PMID: 36789582 DOI: 10.1002/ejhf.2799] [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: 02/06/2023] [Accepted: 02/10/2023] [Indexed: 02/16/2023] Open
Affiliation(s)
- Pau Codina
- Heart Failure Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Spain.,Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain
| | - Elisabet Zamora
- Heart Failure Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Spain.,Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain.,CIBERCV, Instituto de Salud Carlos III, Madrid, Spain
| | - Antoni Bayes-Genis
- Heart Failure Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Spain.,Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain.,CIBERCV, Instituto de Salud Carlos III, Madrid, Spain
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2
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Zamora E, González B, Lupón J, Borrellas A, Domingo M, Santiago‐Vacas E, Cediel G, Codina P, Rivas C, Pulido A, Crespo E, Velayos P, Diaz V, Bayes‐Genis A. Quality of life in patients with heart failure and improved ejection fraction: one-year changes and prognosis. ESC Heart Fail 2022; 9:3804-3813. [PMID: 35916351 PMCID: PMC9773756 DOI: 10.1002/ehf2.14098] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 06/16/2022] [Accepted: 07/20/2022] [Indexed: 01/19/2023] Open
Abstract
AIMS The criteria for patients with heart failure (HF) and improved ejection fraction (HFimpEF) are a baseline left ventricular ejection fraction (LVEF) ≤40%, a ≥10-point increase from baseline LVEF, and a second LVEF measurement >40%. We aimed to (i) assess patients with HF and reduced LVEF (HFrEF) at baseline and compare quality of life (QoL) changes between those that fulfilled and those that did not fulfil the HFimpEF criteria 1 year later and (ii) assess the prognostic role of QoL in patients with HFimpEF. METHODS We reviewed data from a prospective registry of real-world outpatients with HF that were assessed for LVEF and QoL at a first visit to the HF clinic and 1 year later. QoL was evaluated with the Minnesota Living with Heart Failure Questionnaire (MLWHFQ). The primary prognostic endpoint was the composite of all-cause death or HF hospitalization. RESULTS Baseline and 1-year LVEF and MLWFQ scores were available for 1040 patients with an initial LVEF ≤40% (mean age, 65.2 ± 11.7 years; 75.9% men). The main aetiology was ischaemic heart disease (52.9%), and patients were mostly in New York heart Association Classes II (71.1%) and III (21.6%). At baseline, the mean LVEF was 28.5% ± 7.3, and the mean MLWHFQ score was 30.2 ± 19.5. After 1 year, the mean LVEF increased to 38.0% ± 12.2, and the MLWHFQ scores improved to 17.4 ± 16.0. In 361 patients that fulfilled the HFimpEF criteria (34.7%), significant improvements were observed in both LVEF (from 28.7% ± 6.6 to 50.9% ± 7.6, P < 0.001) and QoL (from 32.9 ± 20.6 to 16.9 ± 16.0, P < 0.001). Patients that did not fulfil the HFimpEF criteria also showed significant improvements in LVEF (from 28.4% ± 7.6 to 31.1% ± 7.9, P < 0.001) and QoL (from 28.7 ± 18.8 to 17.6 ± 15.9, P < 0.001). However, the QoL improvement was significantly higher in the HFimpEF group (-16.0 ± 23.8 vs. -11.1 ± 20.3, P = 0.001), despite the worse mean baseline MLWHFQ score, compared with the non-HFimpEF group (P = 0.001). The 1-year QoL was similar between groups (P = 0.50). The 1-year MLWHFQ score was independently associated with outcomes; the hazard ratio for the composite endpoint was 1.02 (95% CI: 1.01-1.03, P = 0.006). In contrast, the QoL improvement (with a cut-off ≥5 points) was not independently associated with the composite outcome. CONCLUSIONS Patients with HFrEF showed improved QoL after 1 year, regardless of whether they met the HFimpEF criteria. The similar 1-year QoL perception between groups suggested that factors other than LVEF influenced QoL perception. The 1-year QoL was superior to the QoL change from baseline for predicting prognosis in patients with HFimpEF.
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Affiliation(s)
- Elisabet Zamora
- Heart Failure Clinic and Cardiology ServiceUniversity Hospital Germans Trias i PujolBarcelonaSpain,Department of MedicineUniversitat Autonoma de BarcelonaBarcelonaSpain,CIBERCVInstituto de Salud Carlos IIIMadridSpain
| | - Beatriz González
- Heart Failure Clinic and Cardiology ServiceUniversity Hospital Germans Trias i PujolBarcelonaSpain
| | - Josep Lupón
- Heart Failure Clinic and Cardiology ServiceUniversity Hospital Germans Trias i PujolBarcelonaSpain,Department of MedicineUniversitat Autonoma de BarcelonaBarcelonaSpain,CIBERCVInstituto de Salud Carlos IIIMadridSpain
| | - Andrea Borrellas
- Heart Failure Clinic and Cardiology ServiceUniversity Hospital Germans Trias i PujolBarcelonaSpain
| | - Mar Domingo
- Heart Failure Clinic and Cardiology ServiceUniversity Hospital Germans Trias i PujolBarcelonaSpain
| | - Evelyn Santiago‐Vacas
- Heart Failure Clinic and Cardiology ServiceUniversity Hospital Germans Trias i PujolBarcelonaSpain
| | - Germán Cediel
- Heart Failure Clinic and Cardiology ServiceUniversity Hospital Germans Trias i PujolBarcelonaSpain
| | - Pau Codina
- Heart Failure Clinic and Cardiology ServiceUniversity Hospital Germans Trias i PujolBarcelonaSpain,Department of MedicineUniversitat Autonoma de BarcelonaBarcelonaSpain
| | - Carmen Rivas
- Heart Failure Clinic and Cardiology ServiceUniversity Hospital Germans Trias i PujolBarcelonaSpain
| | - Ana Pulido
- Heart Failure Clinic and Cardiology ServiceUniversity Hospital Germans Trias i PujolBarcelonaSpain
| | - Eva Crespo
- Heart Failure Clinic and Cardiology ServiceUniversity Hospital Germans Trias i PujolBarcelonaSpain
| | - Patricia Velayos
- Heart Failure Clinic and Cardiology ServiceUniversity Hospital Germans Trias i PujolBarcelonaSpain
| | - Violeta Diaz
- Heart Failure Clinic and Cardiology ServiceUniversity Hospital Germans Trias i PujolBarcelonaSpain
| | - Antoni Bayes‐Genis
- Heart Failure Clinic and Cardiology ServiceUniversity Hospital Germans Trias i PujolBarcelonaSpain,Department of MedicineUniversitat Autonoma de BarcelonaBarcelonaSpain,CIBERCVInstituto de Salud Carlos IIIMadridSpain
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3
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Herrero-Torrus M, Badosa N, Roqueta C, Ruiz-Bustillo S, Solé-González E, Belarte-Tornero LC, Valdivielso-Moré S, Vázquez O, Farré N. Randomized Controlled Trial Comparing a Multidisciplinary Intervention by a Geriatrician and a Cardiologist to Usual Care after a Heart Failure Hospitalization in Older Patients: The SENECOR Study. J Clin Med 2022; 11:jcm11071932. [PMID: 35407540 PMCID: PMC8999953 DOI: 10.3390/jcm11071932] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 03/25/2022] [Accepted: 03/28/2022] [Indexed: 12/16/2022] Open
Abstract
Background: The prognosis of older patients after a heart failure (HF) hospitalization is poor. Methods: In this randomized trial, we consecutively assigned 150 patients 75 years old or older with a recent heart failure hospitalization to follow-up by a cardiologist (control) or follow-up by a cardiologist and a geriatrician (intervention). The primary outcome was all-cause hospitalization at a one-year follow-up. Results: All-cause hospitalization occurred in 47 of 75 patients (62.7%) in the intervention group and in 58 of 75 patients (77.3%) in the control group (hazard ratio, 0.67; 95% confidence interval, 0.46 to 0.99; p = 0.046). The number of patients with at least one HF hospitalization was similar in both groups (34.7% in the intervention group vs. 40% in the control group, p = 0.5). There were a total of 236 hospitalizations during the study period. The main reasons for hospitalization were heart failure (38.1%) and infection (14.8%). Mortality was 24.7%. Heart failure was the leading cause of mortality (54.1% of all deaths), without differences between groups. Conclusions: A follow-up by a cardiologist and geriatrician in older patients after an HF hospitalization was superior to a cardiologist’s follow-up in reducing all-cause hospitalization in older patients. (Funded by Beca Primitivo de la Vega, Fundación MAPFRE. ClinicalTrials.gov number, NCT03555318).
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Affiliation(s)
- Marta Herrero-Torrus
- Geriatrics Department, Hospital del Mar, 08003 Barcelona, Spain; (M.H.-T.); (C.R.); (O.V.)
| | - Neus Badosa
- Heart Failure Unit, Cardiology Department, Hospital del Mar, 08003 Barcelona, Spain; (N.B.); (S.R.-B.); (E.S.-G.); (L.C.B.-T.); (S.V.-M.)
- Biomedical Research Group on Heart Disease, Hospital del Mar Medical Research Group (IMIM), 08003 Barcelona, Spain
| | - Cristina Roqueta
- Geriatrics Department, Hospital del Mar, 08003 Barcelona, Spain; (M.H.-T.); (C.R.); (O.V.)
- Department of Medicine, Universitat Autónoma de Barcelona, 08193 Barcelona, Spain
| | - Sonia Ruiz-Bustillo
- Heart Failure Unit, Cardiology Department, Hospital del Mar, 08003 Barcelona, Spain; (N.B.); (S.R.-B.); (E.S.-G.); (L.C.B.-T.); (S.V.-M.)
- Biomedical Research Group on Heart Disease, Hospital del Mar Medical Research Group (IMIM), 08003 Barcelona, Spain
- Department of Experimental and Health Sciences, Universitat Pompeu Fabra, 08002 Barcelona, Spain
| | - Eduard Solé-González
- Heart Failure Unit, Cardiology Department, Hospital del Mar, 08003 Barcelona, Spain; (N.B.); (S.R.-B.); (E.S.-G.); (L.C.B.-T.); (S.V.-M.)
| | - Laia C. Belarte-Tornero
- Heart Failure Unit, Cardiology Department, Hospital del Mar, 08003 Barcelona, Spain; (N.B.); (S.R.-B.); (E.S.-G.); (L.C.B.-T.); (S.V.-M.)
- Biomedical Research Group on Heart Disease, Hospital del Mar Medical Research Group (IMIM), 08003 Barcelona, Spain
| | - Sandra Valdivielso-Moré
- Heart Failure Unit, Cardiology Department, Hospital del Mar, 08003 Barcelona, Spain; (N.B.); (S.R.-B.); (E.S.-G.); (L.C.B.-T.); (S.V.-M.)
- Biomedical Research Group on Heart Disease, Hospital del Mar Medical Research Group (IMIM), 08003 Barcelona, Spain
| | - Olga Vázquez
- Geriatrics Department, Hospital del Mar, 08003 Barcelona, Spain; (M.H.-T.); (C.R.); (O.V.)
| | - Núria Farré
- Heart Failure Unit, Cardiology Department, Hospital del Mar, 08003 Barcelona, Spain; (N.B.); (S.R.-B.); (E.S.-G.); (L.C.B.-T.); (S.V.-M.)
- Biomedical Research Group on Heart Disease, Hospital del Mar Medical Research Group (IMIM), 08003 Barcelona, Spain
- Department of Medicine, Universitat Autónoma de Barcelona, 08193 Barcelona, Spain
- Correspondence:
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4
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Halimi L, Suehs CM, Marin G, Boissin C, Gamez AS, Vachier I, Molinari N, Bourdin A. Health-related quality of life and disease progression in pulmonary arterial hypertension patients: a 3-year study. ERJ Open Res 2021; 7:00617-2020. [PMID: 34435036 PMCID: PMC8381263 DOI: 10.1183/23120541.00617-2020] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 03/27/2021] [Indexed: 11/05/2022] Open
Abstract
Objectives The role of health-related quality of life (HRQoL) and psychological variables in pulmonary arterial hypertension (PAH) progression remains poorly quantified. We aimed to investigate the relationship between disease progression in PAH patients and HRQoL and psychological characteristics. Methods A 3-year longitudinal cohort was initiated. Patients with stable PAH (groups I-IV ineligible for angioplasty/endarterectomy) were included (n=55). Standard clinical variables, including invasive haemodynamic parameters, were prospectively recorded. A battery of questionnaires was used to characterise the psychological status of patients upon study initiation, and HRQoL was quantified using the SF-36 Questionnaire every 3 months for 24 months, and then again at 36 months. Guideline-defined disease progression and progression-free survival were recorded for 36 months. Measurements and main results Psychological distress was highly prevalent at baseline. The Physical Component Summary (PCS) and the Mental Component Summary (MCS) of the HRQoL were poor (PCS=37.13±8.18; MCS=42.42±10.88) but stable over 3 years of follow-up. Among PCS subscales, Physical Functioning (PF) (p=0.012) was identified as being independently associated with disease progression (Cox survival model), along with mean pulmonary arterial pressure (p=0.003) and cardiac output (p=0.005). Depression was the unique independent psychological characteristic associated with PF (p=0.0001). Conclusions PAH patients have poor HRQoL. In addition to already known criteria related to disease severity, the HRQoL PF subscale is independently associated with disease progression in PAH. This may be explained by depression.
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Affiliation(s)
- Laurence Halimi
- Dept of Respiratory Diseases, Université de Montpellier, CHU Montpellier, Montpellier, France
| | - Carey M Suehs
- Dept of Respiratory Diseases, Université de Montpellier, CHU Montpellier, Montpellier, France.,Dept of Medical Information, Université de Montpellier, CHU Montpellier, Montpellier, France
| | - Gregory Marin
- Dept of Medical Information, Université de Montpellier, CHU Montpellier, Montpellier, France
| | - Clement Boissin
- Dept of Respiratory Diseases, Université de Montpellier, CHU Montpellier, Montpellier, France
| | - Anne-Sophie Gamez
- Dept of Respiratory Diseases, Université de Montpellier, CHU Montpellier, Montpellier, France
| | - Isabelle Vachier
- Dept of Respiratory Diseases, Université de Montpellier, CHU Montpellier, Montpellier, France
| | - Nicolas Molinari
- Dept of Medical Information, Université de Montpellier, CHU Montpellier, Montpellier, France.,IMAG, CNRS, Université de Montpellier, CHU Montpellier, Montpellier, France
| | - Arnaud Bourdin
- Dept of Respiratory Diseases, Université de Montpellier, CHU Montpellier, Montpellier, France.,PhyMedExp, Université de Montpellier, CNRS, INSERM 1046, CHU Montpellier, Montpellier, France
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5
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Comín-Colet J, Martín Lorenzo T, González-Domínguez A, Oliva J, Jiménez Merino S. Impact of non-cardiovascular comorbidities on the quality of life of patients with chronic heart failure: a scoping review. Health Qual Life Outcomes 2020; 18:329. [PMID: 33028351 PMCID: PMC7542693 DOI: 10.1186/s12955-020-01566-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 09/16/2020] [Indexed: 02/06/2023] Open
Abstract
PURPOSE To determine the impact of non-cardiovascular comorbidities on the health-related quality of life (HRQoL) of patients with chronic heart failure (CHF). METHODS A scoping review of the scientific literature published between 2009 and 2019 was carried out. Observational studies which assessed the HRQoL of patients with CHF using validated questionnaires and its association with non-cardiovascular comorbidities were included. RESULTS The search identified 1904 studies, of which 21 fulfilled the inclusion criteria to be included for analysis. HRQoL was measured through specific, generic, or both types of questionnaires in 72.2%, 16.7%, and 11.1% of the studies, respectively. The most common comorbidities studied were diabetes mellitus (12 studies), mental and behavioral disorders (8 studies), anemia and/or iron deficiency (7 studies), and respiratory diseases (6 studies). Across studies, 93 possible associations between non-cardiovascular comorbidities and HRQoL were tested, of which 21.5% regarded anemia or iron deficiency, 20.4% mental and behavioral disorders, 20.4% diabetes mellitus, and 14.0% respiratory diseases. Despite the large heterogeneity across studies, all 21 showed that the presence of a non-cardiovascular comorbidity had a negative impact on the HRQoL of patients with CHF. A statistically significant impact on worse HRQoL was found in 84.2% of associations between mental and behavioral disorders and HRQoL (patients with depression had up to 200% worse HRQoL than patients without depression); 73.7% of associations between diabetes mellitus and HRQoL (patients with diabetes mellitus had up to 21.8% worse HRQoL than patients without diabetes mellitus); 75% of associations between anemia and/or iron deficiency and HRQoL (patients with anemia and/or iron deficiency had up to 25.6% worse HRQoL than between patients without anemia and/or iron deficiency); and 61.5% of associations between respiratory diseases and HRQoL (patients with a respiratory disease had up to 21.3% worse HRQoL than patients without a respiratory disease). CONCLUSION The comprehensive management of patients with CHF should include the management of comorbidities which have been associated with a worse HRQoL, with special emphasis on anemia and iron deficiency, mental and behavioral disorders, diabetes mellitus, and respiratory diseases. An adequate control of these comorbidities may have a positive impact on the HRQoL of patients.
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Affiliation(s)
- Josep Comín-Colet
- Community Heart Failure Program, Department of Cardiology, Hospital Universitario de Bellvitge; Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
- University of Barcelona, Barcelona, Spain
| | | | | | - Juan Oliva
- Department of Economic Analysis, University of Castilla-La Mancha, Toledo, Spain
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Natanzon SS, Maor E, Klempfner R, Goldenberg I, Shaviv E, Massalha E, Shlomo N, Goldanov Y, Mazin I. Norton score and clinical outcomes following acute decompensated heart failure hospitalization. J Cardiol 2020; 76:335-341. [DOI: 10.1016/j.jjcc.2020.05.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 04/22/2020] [Accepted: 05/03/2020] [Indexed: 12/11/2022]
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7
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Lemus Barrios GA, Morales Benavidez DC, López Salazar AM, Henao V, González-Robledo G. Evaluación de la fragilidad en la enfermedad cardiovascular: Un reto necesario. REVISTA COLOMBIANA DE CARDIOLOGÍA 2020. [DOI: 10.1016/j.rccar.2019.12.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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8
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Dewan P, Jackson A, Jhund PS, Shen L, Ferreira JP, Petrie MC, Abraham WT, Desai AS, Dickstein K, Køber L, Packer M, Rouleau JL, Solomon SD, Swedberg K, Zile MR, McMurray JJ. The prevalence and importance of frailty in heart failure with reduced ejection fraction – an analysis of
PARADIGM‐HF
and
ATMOSPHERE. Eur J Heart Fail 2020; 22:2123-2133. [DOI: 10.1002/ejhf.1832] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Revised: 02/27/2020] [Accepted: 04/04/2020] [Indexed: 12/20/2022] Open
Affiliation(s)
- Pooja Dewan
- BHF Cardiovascular Research Centre University of Glasgow Glasgow UK
| | - Alice Jackson
- BHF Cardiovascular Research Centre University of Glasgow Glasgow UK
| | - Pardeep S. Jhund
- BHF Cardiovascular Research Centre University of Glasgow Glasgow UK
| | - Li Shen
- BHF Cardiovascular Research Centre University of Glasgow Glasgow UK
| | - João Pedro Ferreira
- National Institute of Health and Medical Research (INSERM) Center for Clinical Multidisciplinary Research 1433, INSERM U1116, University of Lorraine, Regional University Hospital of Nancy, French Clinical Research Infrastructure Network (F‐CRIN) Investigation Network Initiative‐Cardiovascular and Renal Clinical Trialists (INI‐CRCT) Nancy France
| | - Mark C. Petrie
- BHF Cardiovascular Research Centre University of Glasgow Glasgow UK
| | - William T. Abraham
- Division of Cardiovascular Medicine Davis Heart and Lung Research Institute, Ohio State University Columbus OH USA
| | - Akshay S. Desai
- Cardiovascular Medicine Brigham and Women's Hospital Boston MA USA
| | | | - Lars Køber
- Rigshospitalet Copenhagen University Hospital Copenhagen Denmark
| | - Milton Packer
- Baylor Heart and Vascular Institute Baylor University Medical Center Dallas TX USA
| | - Jean L. Rouleau
- Institut de Cardiologie de Montréal Université de Montréal Montréal Canada
| | - Scott D. Solomon
- Cardiovascular Medicine Brigham and Women's Hospital Boston MA USA
| | - Karl Swedberg
- Department of Molecular and Clinical Medicine University of Gothenburg, Gothenburg, Sweden and National Heart
| | - Michael R. Zile
- Medical University of South Carolina and Ralph H. Johnson Veterans Administration Medical Center Charleston SC USA
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9
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Revuelta-López E, Núñez J, Gastelurrutia P, Cediel G, Januzzi JL, Ibrahim NE, Emdin M, VanKimmenade R, Pascual-Figal D, Núñez E, Gommans F, Lupón J, Bayés-Genís A. Neprilysin inhibition, endorphin dynamics, and early symptomatic improvement in heart failure: a pilot study. ESC Heart Fail 2020; 7:559-566. [PMID: 32045114 PMCID: PMC7160502 DOI: 10.1002/ehf2.12607] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 11/26/2019] [Accepted: 12/09/2019] [Indexed: 12/11/2022] Open
Abstract
Aim Sacubitril/valsartan is a first‐in‐class angiotensin receptor‐neprilysin inhibitor developed for the treatment of heart failure with reduced ejection fraction. Its benefits are achieved through the inhibition of neprilysin (NEP) and the specific blockade of the angiotensin receptor AT1. The many peptides metabolized by NEP suggest multifaceted potential consequences of its inhibition. We sought to evaluate the short‐term changes in serum endorphin (EP) values and their relation with patients' physical functioning after initiation of sacubitril/valsartan treatment. Methods and results A total of 105 patients with heart failure with reduced ejection fraction, who were candidates for sacubitril/valsartan treatment, were included in this prospective, observational, multicentre, and international study. In a first visit, and in agreement with current guidelines, treatment with angiotensin‐converting enzyme inhibitors or angiotensin receptor blocker was replaced by sacubitril/valsartan because of clinical indication by the responsible physician. By protocol, patients were reevaluated at 30 days after the start of sacubitril/valsartan. Serum levels of α‐ (α‐EP), γ‐Endorphin (γ‐EP), and soluble NEP (sNEP) were measured using enzyme‐linked immunoassays. New York Heart Association (NYHA) functional class was used as an indicator of patient's functional status. Baseline median levels of circulating α‐EP, γ‐EP, and sNEP were 582 (160–772), 101 (37–287), and 222 pg/mL (124–820), respectively. There was not a significant increase in α‐EP nor γ‐EP serum values after sacubitril/valsartan treatment (P value = 0.194 and 0.102, respectively). There were no significant differences in sNEP values between 30 days and baseline (P value = 0.103). Medians (IQR) of Δα‐EP, Δγ‐EP, and ΔsNEP between 30 days and baseline were 9.3 (−34 − 44), −3.0 (−46.0 − 18.9), and 0 units (−16.4 − 157.0), respectively. In a pre–post sacubitril/valsartan treatment comparison, there was a significant improvement in NYHA class, with 36 (34.3%) patients experiencing improvement by at least one NYHA class category. Δα‐EP and ΔsNEP showed to be significantly associated with NYHA class after 30 days of treatment (P = 0.014 and P < 0.001, respectively). Δα‐EP was linear and significantly associated with NYHA class improvement after 30 days of sacubitril/valsartan treatment. Conclusions These preliminary data suggest that beyond the haemodynamic benefits achieved with sacubitril/valsartan, the altered cleavage of endorphin peptides by NEP inhibition may participate in patients' symptoms improvement.
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Affiliation(s)
- Elena Revuelta-López
- Heart Failure and Cardiac Regeneration (ICREC) Research Program, Health Science Research Institute Germans Trias i Pujol (IGTP), Badalona, Spain.,Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares, (CIBERCV,), Madrid, Spain
| | - Julio Núñez
- Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares, (CIBERCV,), Madrid, Spain.,Cardiology Department, Hospital Clínico Universitario, Universitat de València, INCLIVA, Valencia, Spain; INCLIVA; Universitat de València, Valencia, Spain
| | - Paloma Gastelurrutia
- Heart Failure and Cardiac Regeneration (ICREC) Research Program, Health Science Research Institute Germans Trias i Pujol (IGTP), Badalona, Spain.,Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares, (CIBERCV,), Madrid, Spain
| | - Germán Cediel
- Cardiology Service and Heart Failure Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - James L Januzzi
- Division of Cardiology, Massachusetts General Hospital and Cardiometabolic Trials, Baim Institute for Clinical Research, Boston, Massachusetts, MA, USA
| | - Nasrien E Ibrahim
- Division of Cardiology, Massachusetts General Hospital and Cardiometabolic Trials, Baim Institute for Clinical Research, Boston, Massachusetts, MA, USA
| | - Michele Emdin
- Institute of Life Sciences, Scuola Superiore Sant'Anna, Fondazione Toscana Gabriele Monasterio, Pisa, Italy; Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Roland VanKimmenade
- Department of Cardiology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Domingo Pascual-Figal
- Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares, (CIBERCV,), Madrid, Spain.,Cardiology Department, Hospital Virgen de la Arrixaca, Universidad de Murcia, Murcia, Spain
| | - Eduardo Núñez
- Cardiology Department, Hospital Clínico Universitario, Universitat de València, INCLIVA, Valencia, Spain; INCLIVA; Universitat de València, Valencia, Spain
| | - Frank Gommans
- Department of Cardiology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Josep Lupón
- Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares, (CIBERCV,), Madrid, Spain.,Cardiology Service and Heart Failure Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Spain.,Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain
| | - Antoni Bayés-Genís
- Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares, (CIBERCV,), Madrid, Spain.,Cardiology Service and Heart Failure Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Spain.,Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain
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10
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Lemos DMP, Saldanha PF, Vieira LF, Azzolin KDO. Nursing taxonomies in hospital discharge planning: a quasi-experimental study. Rev Bras Enferm 2020; 73:e20180896. [DOI: 10.1590/0034-7167-2018-0896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Accepted: 10/18/2019] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Objective: to evaluate the effect of implementation of hospital discharge planning based on the taxonomies of NANDA-International, nursing interventions classification (NIC) and nursing outcomes classification (NOC) for patients with heart failure (HF) or diabetes mellitus (DM). Methods: quasi-experimental quantitative study conducted in a public university hospital located in the state of Rio Grande do Sul, Brazil. Convenience sampling included 28 adult patients hospitalized for HF or DM with the nursing diagnosis Ineffective Health Management (00078), who received the following nursing interventions: Teaching: Disease Process, Teaching: Prescribed Medication and Teaching: Prescribed Diet. Before and after the intervention, the following nursing outcomes were evaluated : Knowledge: Diabetes Management and Knowledge: Heart Failure Management. Results: the score of the nursing outcome Knowledge: Heart Failure Management went from 2.05±0.28 to 2.54±0.30 (P=0.002), and of the nursing outcome Knowledge: Diabetes Management went from 2.61±0.55 to 3.21±0.57 (P=0.000). Conclusion: discharge planning based on the NIC improves the NOC score and may interfere in the health outcomes.
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11
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Yang X, Lupón J, Vidán MT, Ferguson C, Gastelurrutia P, Newton PJ, Macdonald PS, Bueno H, Bayés-Genís A, Woo J, Fung E. Impact of Frailty on Mortality and Hospitalization in Chronic Heart Failure: A Systematic Review and Meta-Analysis. J Am Heart Assoc 2019; 7:e008251. [PMID: 30571603 PMCID: PMC6405567 DOI: 10.1161/jaha.117.008251] [Citation(s) in RCA: 111] [Impact Index Per Article: 22.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background Although frailty has been associated with increased risks for hospitalization and mortality in chronic heart failure, the precise average effect remains uncertain. We performed a systematic review and meta‐analysis to summarize the hazards for mortality and incident hospitalization in patients with heart failure and frailty compared with those without frailty and explored the heterogeneity underlying the effect size estimates. Methods and Results MEDLINE, EMBASE, and Cochrane databases were queried for articles published between January 1966 and March 2018. Predefined selection criteria were used. Hazard ratios (HRs) were pooled for meta‐analyses, and where odds ratios were used previously, original data were recalculated for HR. Overlapping data were consolidated, and only unique data points were used. Study quality and bias were assessed. Eight studies were included for mortality (2645 patients), and 6 studies were included for incident hospitalization (2541 patients) during a median follow‐up of 1.82 and 1.12 years, respectively. Frailty was significantly associated with an increased hazard for mortality (HR, 1.54; 95% confidence interval, 1.34–1.75; P<0.001) and incident hospitalization (HR, 1.56; 95% confidence interval, 1.36–1.78; P<0.001) in chronic heart failure. The Fried phenotype estimated a 16.9% larger effect size than the combined Fried/non‐Fried frailty assessment for the end point of mortality (HR, 1.80; 95% confidence interval, 1.41–2.28; P<0.001), but not for hospitalization (HR, 1.57; 95% confidence interval, 1.30–1.89; P<0.001). Study heterogeneity was found to be low (I2=0%), and high quality of studies was verified by the Newcastle‐Ottawa scale. Conclusions Overall, the presence of frailty in chronic heart failure is associated with an increased hazard for death and hospitalization by ≈1.5‐fold.
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Affiliation(s)
- Xiaobo Yang
- 1 Department of Medicine and Therapeutics Faculty of Medicine The Chinese University of Hong Kong Hong Kong, SAR.,2 Laboratory for Heart Failure and Circulation Research Li Ka Shing Institute of Health Sciences Prince of Wales Hospital Hong Kong, SAR
| | - Josep Lupón
- 3 Cardiology Department Hospital Universitari Germans Trias i Pujol Badalona Spain.,4 Department of Medicine Universitat Autonòma de Barcelona Spain.,5 CIBERCV Instituto de Salud Carlos III Madrid Spain
| | - Maria T Vidán
- 6 Department of Geriatrics Instituto de Investigación IiSGM and CIBERFES Hospital General Universitario Gregorio Marañón Madrid Spain.,7 Universidad Complutense de Madrid Spain
| | - Caleb Ferguson
- 8 Western Sydney Nursing and Midwifery Research Centre Western Sydney University and Western Sydney Local Health District Sydney Australia
| | - Paloma Gastelurrutia
- 5 CIBERCV Instituto de Salud Carlos III Madrid Spain.,9 Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol Badalona Spain
| | - Phillip J Newton
- 8 Western Sydney Nursing and Midwifery Research Centre Western Sydney University and Western Sydney Local Health District Sydney Australia
| | - Peter S Macdonald
- 10 Heart and Lung Transplant Unit St Vincent's Hospital University of New South Wales Sydney Australia.,11 Transplantation Research Laboratory Victor Chang Cardiac Research Institute Sydney Australia
| | - Héctor Bueno
- 7 Universidad Complutense de Madrid Spain.,12 Centro Nacional de Investigaciones Cardiovasculares Madrid Spain.,13 Instituto de Investigación i+12 and Cardiology Department Hospital Universitario 12 de Octubre Madrid Spain
| | - Antoni Bayés-Genís
- 3 Cardiology Department Hospital Universitari Germans Trias i Pujol Badalona Spain.,4 Department of Medicine Universitat Autonòma de Barcelona Spain.,5 CIBERCV Instituto de Salud Carlos III Madrid Spain
| | - Jean Woo
- 1 Department of Medicine and Therapeutics Faculty of Medicine The Chinese University of Hong Kong Hong Kong, SAR.,14 CUHK Jockey Club Institute of Ageing The Chinese University of Hong Kong Hong Kong, SAR
| | - Erik Fung
- 1 Department of Medicine and Therapeutics Faculty of Medicine The Chinese University of Hong Kong Hong Kong, SAR.,2 Laboratory for Heart Failure and Circulation Research Li Ka Shing Institute of Health Sciences Prince of Wales Hospital Hong Kong, SAR.,15 School of Public Health Imperial College London London United Kingdom.,16 CARE Programme Lui Che Woo Institute of Innovative Medicine Faculty of Medicine The Chinese University of Hong Kong Hong Kong, SAR.,17 Gerald Choa Cardiac Research Centre Faculty of Medicine The Chinese University of Hong Kong Hong Kong, SAR
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12
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Impact of inpatient cardiac rehabilitation on Barthel Index score and prognosis in patients with acute decompensated heart failure. Int J Cardiol 2019; 293:125-130. [DOI: 10.1016/j.ijcard.2019.06.071] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 06/23/2019] [Accepted: 06/26/2019] [Indexed: 01/09/2023]
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13
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Fung E, Hui E, Yang X, Lui LT, Cheng KF, Li Q, Fan Y, Sahota DS, Ma BHM, Lee JSW, Lee APW, Woo J. Heart Failure and Frailty in the Community-Living Elderly Population: What the UFO Study Will Tell Us. Front Physiol 2018; 9:347. [PMID: 29740330 PMCID: PMC5928128 DOI: 10.3389/fphys.2018.00347] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2017] [Accepted: 03/20/2018] [Indexed: 12/11/2022] Open
Abstract
Heart failure and frailty are clinical syndromes that present with overlapping phenotypic characteristics. Importantly, their co-presence is associated with increased mortality and morbidity. While mechanical and electrical device therapies for heart failure are vital for select patients with advanced stage disease, the majority of patients and especially those with undiagnosed heart failure would benefit from early disease detection and prompt initiation of guideline-directed medical therapies. In this article, we review the problematic interactions between heart failure and frailty, introduce a focused cardiac screening program for community-living elderly initiated by a mobile communication device app leading to the Undiagnosed heart Failure in frail Older individuals (UFO) study, and discuss how the knowledge of pre-frailty and frailty status could be exploited for the detection of previously undiagnosed heart failure or advanced cardiac disease. The widespread use of mobile devices coupled with increasing availability of novel, effective medical and minimally invasive therapies have incentivized new approaches to heart failure case finding and disease management.
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Affiliation(s)
- Erik Fung
- Department of Medicine and Therapeutics, Faculty of Medicine, Chinese University of Hong Kong, Sha Tin, Hong Kong
- Laboratory for Heart Failure and Circulation Research, Li Ka Shing Institute of Health Sciences, Prince of Wales Hospital, Sha Tin, Hong Kong
- Faculty of Medicine, Gerald Choa Cardiac Research Centre, Chinese University of Hong Kong, Sha Tin, Hong Kong
| | - Elsie Hui
- Department of Medicine and Therapeutics, Faculty of Medicine, Chinese University of Hong Kong, Sha Tin, Hong Kong
- Department of Medicine and Geriatrics, Shatin Hospital, Sha Tin, Hong Kong
| | - Xiaobo Yang
- Department of Medicine and Therapeutics, Faculty of Medicine, Chinese University of Hong Kong, Sha Tin, Hong Kong
- Laboratory for Heart Failure and Circulation Research, Li Ka Shing Institute of Health Sciences, Prince of Wales Hospital, Sha Tin, Hong Kong
- PhD Programme in Medical Sciences, Division of Medical Sciences, Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Leong T. Lui
- Department of Medicine and Therapeutics, Faculty of Medicine, Chinese University of Hong Kong, Sha Tin, Hong Kong
- Laboratory for Heart Failure and Circulation Research, Li Ka Shing Institute of Health Sciences, Prince of Wales Hospital, Sha Tin, Hong Kong
| | - King F. Cheng
- Department of Medicine and Therapeutics, Faculty of Medicine, Chinese University of Hong Kong, Sha Tin, Hong Kong
- Laboratory for Heart Failure and Circulation Research, Li Ka Shing Institute of Health Sciences, Prince of Wales Hospital, Sha Tin, Hong Kong
| | - Qi Li
- Department of Medicine and Therapeutics, Faculty of Medicine, Chinese University of Hong Kong, Sha Tin, Hong Kong
- Laboratory for Heart Failure and Circulation Research, Li Ka Shing Institute of Health Sciences, Prince of Wales Hospital, Sha Tin, Hong Kong
- PhD Programme in Medical Sciences, Division of Medical Sciences, Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Yiting Fan
- Department of Medicine and Therapeutics, Faculty of Medicine, Chinese University of Hong Kong, Sha Tin, Hong Kong
- PhD Programme in Medical Sciences, Division of Medical Sciences, Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Daljit S. Sahota
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Chinese University of Hong Kong, Sha Tin, Hong Kong
| | - Bosco H. M. Ma
- Department of Medicine and Therapeutics, Faculty of Medicine, Chinese University of Hong Kong, Sha Tin, Hong Kong
- Department of Medicine and Geriatrics, Shatin Hospital, Sha Tin, Hong Kong
| | - Jenny S. W. Lee
- Department of Medicine and Therapeutics, Faculty of Medicine, Chinese University of Hong Kong, Sha Tin, Hong Kong
- Department of Medicine, Alice Ho Miu Ling Nethersole Hospital and Tai Po Hospital, Tai Po, Hong Kong
| | - Alex P. W. Lee
- Department of Medicine and Therapeutics, Faculty of Medicine, Chinese University of Hong Kong, Sha Tin, Hong Kong
| | - Jean Woo
- Department of Medicine and Therapeutics, Faculty of Medicine, Chinese University of Hong Kong, Sha Tin, Hong Kong
- CUHK Jockey Club Institute of Ageing, Chinese University of Hong Kong, Sha Tin, Hong Kong
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14
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Gastelurrutia P, Lupón J, Moliner P, Yang X, Cediel G, de Antonio M, Domingo M, Altimir S, González B, Rodríguez M, Rivas C, Díaz V, Fung E, Zamora E, Santesmases J, Núñez J, Woo J, Bayes-Genis A. Comorbidities, Fragility, and Quality of Life in Heart Failure Patients With Midrange Ejection Fraction. Mayo Clin Proc Innov Qual Outcomes 2018; 2:176-185. [PMID: 30225447 PMCID: PMC6124320 DOI: 10.1016/j.mayocpiqo.2018.02.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Objective To assess the effects of comorbidities, fragility, and quality of life (QOL) on long-term prognosis in ambulatory patients with heart failure (HF) with midrange left ventricular ejection fraction (HFmrEF), an unexplored area. Patients and Methods Consecutive patients prospectively evaluated at an HF clinic between August 1, 2001, and December 31, 2015, were retrospectively analyzed on the basis of left ventricular ejection fraction category. We compared patients with HFmrEF (n=185) to those with reduced (HFrEF; n=1058) and preserved (HFpEF; n=162) ejection fraction. Fragility was defined as 1 or more abnormal evaluations on 4 standardized geriatric scales (Barthel Index, Older Americans Resources and Services scale, Pfeiffer Test, and abbreviated-Geriatric Depression Scale). The QOL was assessed with the Minnesota Living with Heart Failure Questionnaire. A comorbidity score (0-7) was constructed. All-cause death, HF-related hospitalization, and the composite end point of both were assessed. Results Comorbidities and QOL scores were similar in HFmrEF (2.41±1.5 and 30.1±18.3, respectively) and HFrEF (2.30±1.4 and 30.8±18.5, respectively) and were higher in HFpEF (3.02±1.5, P<.001, and 36.5±20.7, P=.003, respectively). No statistically significant differences in fragility between HFmrEF (48.6%) and HFrEF (41.9%) (P=.09) nor HFpEF (54.3%) (P=.29) were found. In univariate analysis, the association of comorbidities, QOL, and fragility with the 3 end points was higher for HFmrEF than for HFrEF and HFpEF. In multivariate analysis, comorbidities were independently associated with the 3 end points (P≤.001), and fragility was independently associated with all-cause death and the composite end point (P<.001) in HFmrEF. Conclusion Comorbidities and fragility are independent predictors of outcomes in ambulatory patients with HFmrHF and should be considered in the routine clinical assessment of HFmrEF.
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Key Words
- GDS, Geriatric Depression Scale
- HF, heart failure
- HFmrEF, heart failure and mildly reduced ejection fraction
- HFpEF, heart failure and preserved left ventricular ejection fraction
- HFrEF, heart failure and reduced left ventricular ejection fraction
- LVEF, left ventricular ejection fraction
- MLHFQ, Minnesota Living with Heart Failure Questionnaire
- NYHA, New York Heart Association
- OARS, Older Americans Resources and Services
- QOL, quality of life
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Affiliation(s)
- Paloma Gastelurrutia
- ICREC Research Program, Germans Trias i Pujol Research Institute in Health Sciences, Badalona, Spain.,Cardiology Department, University Hospital Germans Trias i Pujol, Badalona, Spain
| | - Josep Lupón
- Cardiology Department, University Hospital Germans Trias i Pujol, Badalona, Spain.,Department of Medicine, UAB, Barcelona, Spain.,CIBER Cardiovascular, Health Institute Carlos III, Madrid, Spain
| | - Pedro Moliner
- Cardiology Department, University Hospital Germans Trias i Pujol, Badalona, Spain
| | - Xiaobo Yang
- The Chinese University of Hong Kong, Hong Kong SAR, China
| | - German Cediel
- Cardiology Department, University Hospital Germans Trias i Pujol, Badalona, Spain
| | - Marta de Antonio
- Cardiology Department, University Hospital Germans Trias i Pujol, Badalona, Spain.,CIBER Cardiovascular, Health Institute Carlos III, Madrid, Spain
| | - Mar Domingo
- Cardiology Department, University Hospital Germans Trias i Pujol, Badalona, Spain
| | - Salvador Altimir
- Cardiology Department, University Hospital Germans Trias i Pujol, Badalona, Spain
| | - Beatriz González
- Cardiology Department, University Hospital Germans Trias i Pujol, Badalona, Spain
| | - Margarita Rodríguez
- Cardiology Department, University Hospital Germans Trias i Pujol, Badalona, Spain
| | - Carmen Rivas
- Cardiology Department, University Hospital Germans Trias i Pujol, Badalona, Spain
| | - Violeta Díaz
- Cardiology Department, University Hospital Germans Trias i Pujol, Badalona, Spain
| | - Erik Fung
- The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Elisabet Zamora
- Cardiology Department, University Hospital Germans Trias i Pujol, Badalona, Spain.,Department of Medicine, UAB, Barcelona, Spain.,CIBER Cardiovascular, Health Institute Carlos III, Madrid, Spain
| | - Javier Santesmases
- Cardiology Department, University Hospital Germans Trias i Pujol, Badalona, Spain
| | - Julio Núñez
- CIBER Cardiovascular, Health Institute Carlos III, Madrid, Spain.,Clinic University Hospital, INCLIVA, Department of Medicine, University of València, València, Spain
| | - Jean Woo
- The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Antoni Bayes-Genis
- ICREC Research Program, Germans Trias i Pujol Research Institute in Health Sciences, Badalona, Spain.,Cardiology Department, University Hospital Germans Trias i Pujol, Badalona, Spain.,Department of Medicine, UAB, Barcelona, Spain.,CIBER Cardiovascular, Health Institute Carlos III, Madrid, Spain
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15
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McDonagh J, Martin L, Ferguson C, Jha SR, Macdonald PS, Davidson PM, Newton PJ. Frailty assessment instruments in heart failure: A systematic review. Eur J Cardiovasc Nurs 2017; 17:23-35. [DOI: 10.1177/1474515117708888] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background: Frailty is an independent predictor of mortality across many conditions. Reported rates of frailty in heart failure range from 15% to 74%. There are several instruments available to assess frailty; however, to date there has been no consensus on the most appropriate instrument for use in individuals with heart failure. Aims: To identify how frailty is assessed in individuals with heart failure and to elucidate which domains of frailty are most frequently assessed. Methods: Key electronic databases were searched (MEDLINE, COCHRANE Central and CINAHL) to identify studies that assessed frailty in individuals with heart failure using a formal frailty instrument. Results: Twenty studies published in 24 articles were included, for which a total of seven unique frailty instruments were identified. The most commonly used instrument was the Frailty Phenotype ( n= 11), with the majority of studies using a modified version of the Frailty Phenotype ( n= 8). The second most commonly used instrument identified was the Comprehensive Geriatric Assessment ( n= 4). Conclusion: There is an increasing interest in the assessment of frailty, but, to date, there is no frailty instrument validated specifically in the heart failure population.
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Affiliation(s)
- Julee McDonagh
- Centre for Cardiovascular and Chronic Care, Faculty of Health, University of Technology, Sydney, Australia
| | - Lily Martin
- Centre for Cardiovascular and Chronic Care, Faculty of Health, University of Technology, Sydney, Australia
| | - Caleb Ferguson
- Centre for Cardiovascular and Chronic Care, Faculty of Health, University of Technology, Sydney, Australia
| | - Sunita R Jha
- Centre for Cardiovascular and Chronic Care, Faculty of Health, University of Technology, Sydney, Australia
| | - Peter S Macdonald
- Heart and Lung Transplant Clinic, St Vincent’s Hospital, Sydney, Australia
- Victor Chang Cardiac Research Institute, Sydney, Australia
| | | | - Phillip J Newton
- Centre for Cardiovascular and Chronic Care, Faculty of Health, University of Technology, Sydney, Australia
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16
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Takahashi K, Saito M, Inaba S, Morofuji T, Aisu H, Sumimoto T, Ogimoto A, Ikeda S, Higaki J. Contribution of the long-term care insurance certificate for predicting 1-year all-cause readmission compared with validated risk scores in elderly patients with heart failure. Open Heart 2016; 3:e000501. [PMID: 27933194 PMCID: PMC5133414 DOI: 10.1136/openhrt-2016-000501] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Revised: 10/19/2016] [Accepted: 11/01/2016] [Indexed: 01/08/2023] Open
Abstract
Objectives Readmission is a common and serious problem associated with heart failure (HF). Unfortunately, conventional risk models have limited predictive value for predicting readmission. The recipients of long-term care insurance (LTCI) are frail and have mental and physical impairments. We hypothesised that adjustment of the conventional risk score with an LTCI certificate enables a more accurate appreciation of readmission for HF. Methods We investigated 452 patients with HF who were followed up for 1 year to determine all-cause readmission. We obtained their clinical and socioeconomic data, including LTCI. The three clinical risk scores used in our evaluation were Keenan (2008), Krumholz (2000) and Charlson (1994). We used net reclassification improvement (NRI) to assess the incremental benefit. Results Patients with LTCI were significantly older, and had a higher prevalence of cerebrovascular disease and dementia than those without LTCI. One-year all-cause readmission (n=193, 43%) was significantly associated with all risk scores, receiving LTCI and the category of LTCI. Receiving LTCI was associated with readmission independent of all risk scores (HR, 1.59 to 1.63; all p<0.01). Adding LTCI to all risk scores led to a significantly improved reclassification, which was observed in the subgroup of patients with HF with preserved ejection fraction (≥50%) but not in the subgroup with reduced ejection fraction (<50%). Conclusions Possession of an LTCI certificate was independently associated with 1-year all-cause readmission after adjusting for validated clinical risk scores in patients with HF. Adding LTCI status significantly improved the model performance for readmission risk, particularly in patients with HF and preserved ejection fraction.
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Affiliation(s)
- Kayo Takahashi
- Kitaishikai Hospital, Ozu, Japan; Ehime University Graduate School of Medicine, Toon, Japan
| | | | | | | | - Hiroe Aisu
- Kitaishikai Hospital, Ozu, Japan; Ehime University Graduate School of Medicine, Toon, Japan
| | | | | | - Shuntaro Ikeda
- Ehime University Graduate School of Medicine , Toon , Japan
| | - Jitsuo Higaki
- Ehime University Graduate School of Medicine , Toon , Japan
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17
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Effects of non-sporting and sporting qigong on frailty and quality of life among breast cancer patients receiving chemotherapy. Eur J Oncol Nurs 2016; 21:257-65. [DOI: 10.1016/j.ejon.2015.10.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Revised: 09/16/2015] [Accepted: 10/30/2015] [Indexed: 11/18/2022]
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18
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Gastelurrutia P, Lupón J, Altimir S, de Antonio M, González B, Cabanes R, Rodríguez M, Urrutia A, Domingo M, Zamora E, Díez C, Coll R, Bayes-Genis A. Fragility is a key determinant of survival in heart failure patients. Int J Cardiol 2014; 175:62-6. [DOI: 10.1016/j.ijcard.2014.04.237] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Accepted: 04/22/2014] [Indexed: 10/25/2022]
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