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Stein EJ, Neill C, Nair S, Terry JG, Carr JJ, Fearon WF, Elmariah S, Kim JB, Kapadia S, Kumbhani DJ, Gillam L, Whisenant B, Quader N, Zajarias A, Welt FG, Bavry AA, Coylewright M, Piana R, Mallugari RR, Vatterott A, Jackson N, Huang S, Lindman BR. Associations of Sarcopenia and Body Composition Measures With Mortality After Transcatheter Aortic Valve Replacement. Circ Cardiovasc Interv 2024; 17:e013298. [PMID: 38235547 DOI: 10.1161/circinterventions.123.013298] [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: 05/24/2023] [Accepted: 11/08/2023] [Indexed: 01/19/2024]
Abstract
BACKGROUND Frailty associates with worse outcomes after transcatheter aortic valve replacement (TAVR). Sarcopenia underlies frailty, but the association between a comprehensive assessment of sarcopenia-muscle mass, strength, and performance-and outcomes after TAVR has not been examined. METHODS From a multicenter prospective registry of patients with symptomatic severe aortic stenosis undergoing TAVR, 445 who had a preprocedure computed tomography and clinical assessment of frailty were included. Cross-sectional muscle (psoas and paraspinal) areas were measured on computed tomography and indexed to height. Gait speed and handgrip strength were obtained, and patients were dichotomized into fast versus slow; strong versus weak; and normal versus low muscle mass. As measures of body composition, cross-sectional fat (subcutaneous and visceral) was measured and indexed to height. RESULTS The frequency of patients who were slow, weak, and had low muscle mass was 56%, 59%, and 42%, respectively. Among the 3 components of sarcopenia, only slower gait speed (muscle performance) was independently associated with increased post-TAVR mortality (adjusted hazard ratio, 1.12 per 0.1 m/s decrease [95% CI, 1.04-1.21]; P=0.004; adjusted hazard ratio, 1.38 per 1 SD decrease [95% CI, 1.11-1.72]; P=0.004). Meeting multiple sarcopenia criteria was not associated with higher mortality risk than fewer. Lower indexed visceral fat area (adjusted hazard ratio, 1.48 per 1 SD decrease [95% CI, 1.15-1.89]; P=0.002) was associated with mortality but indexed subcutaneous fat was not. Death occurred in 169 (38%) patients. CONCLUSIONS Among patients with symptomatic severe aortic stenosis and comprehensive sarcopenia and body composition phenotyping, gait speed was the only sarcopenia measure associated with post-TAVR mortality. Lower visceral fat was also associated with increased risk pointing to an obesity paradox also observed in other patient populations. These findings reinforce the clinical utility of gait speed as a measure of risk and a potential target for adjunctive interventions alongside TAVR to optimize clinical outcomes.
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Affiliation(s)
- Elliot J Stein
- Department of Medicine (E.J.S., C.N.), Vanderbilt University Medical Center, Nashville, TN
| | - Colin Neill
- Department of Medicine (E.J.S., C.N.), Vanderbilt University Medical Center, Nashville, TN
| | - Sangeeta Nair
- Department of Radiology (S.N., J.G.T., J.J.C.), Vanderbilt University Medical Center, Nashville, TN
| | - J Greg Terry
- Department of Radiology (S.N., J.G.T., J.J.C.), Vanderbilt University Medical Center, Nashville, TN
| | - J Jeffrey Carr
- Department of Radiology (S.N., J.G.T., J.J.C.), Vanderbilt University Medical Center, Nashville, TN
| | - William F Fearon
- Department of Medicine, Division of Cardiology, Stanford Medical Center, Palo Alto, CA (W.F.F., J.B.K.)
| | - Sammy Elmariah
- Department of Medicine, Division of Cardiology, University of California San Francisco (S.E.)
| | - Juyong B Kim
- Department of Medicine, Division of Cardiology, Stanford Medical Center, Palo Alto, CA (W.F.F., J.B.K.)
| | - Samir Kapadia
- Department of Medicine, Division of Cardiology, Cleveland Clinic Foundation, OH (S.K.)
| | - Dharam J Kumbhani
- Department of Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas (D.J.K., A.A.B.)
| | - Linda Gillam
- Department of Cardiovascular Medicine, Morristown Medical Center, NJ (L.G.)
| | - Brian Whisenant
- Department of Medicine, Division of Cardiology, Intermountain Heart Institute, Murray, UT (B.W.)
| | - Nishath Quader
- Department of Medicine, Division of Cardiology, Barnes-Jewish Hospital, St. Louis, MO (N.Q., A.Z., A.V.)
| | - Alan Zajarias
- Department of Medicine, Division of Cardiology, Barnes-Jewish Hospital, St. Louis, MO (N.Q., A.Z., A.V.)
| | - Frederick G Welt
- Department of Medicine, Division of Cardiology, University of Utah Hospital, Salt Lake City (F.G.W.)
| | - Anthony A Bavry
- Department of Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas (D.J.K., A.A.B.)
| | - Megan Coylewright
- Department of Cardiovascular Medicine, The Erlanger Heart and Lung Institute, Chattanooga, TN (M.C.)
| | - Robert Piana
- Department of Medicine, Division of Cardiology (R.P., R.R.M., N.J., B.R.L.), Vanderbilt University Medical Center, Nashville, TN
| | - Ravinder R Mallugari
- Department of Medicine, Division of Cardiology (R.P., R.R.M., N.J., B.R.L.), Vanderbilt University Medical Center, Nashville, TN
| | - Anna Vatterott
- Department of Medicine, Division of Cardiology, Barnes-Jewish Hospital, St. Louis, MO (N.Q., A.Z., A.V.)
| | - Natalie Jackson
- Department of Medicine, Division of Cardiology (R.P., R.R.M., N.J., B.R.L.), Vanderbilt University Medical Center, Nashville, TN
- Structural Heart and Valve Center (N.J., S.H., B.R.L.), Vanderbilt University Medical Center, Nashville, TN
| | - Shi Huang
- Structural Heart and Valve Center (N.J., S.H., B.R.L.), Vanderbilt University Medical Center, Nashville, TN
- Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN (S.H.)
| | - Brian R Lindman
- Department of Medicine, Division of Cardiology (R.P., R.R.M., N.J., B.R.L.), Vanderbilt University Medical Center, Nashville, TN
- Structural Heart and Valve Center (N.J., S.H., B.R.L.), Vanderbilt University Medical Center, Nashville, TN
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Wisniewski AM, Young SD, Do-Nguyen CC, Hawkins RB, Romano MP, Teman NR, Ailawadi G. Impact of Frailty in Patients Undergoing Minimally Invasive Mitral Valve Surgery. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2024; 19:64-71. [PMID: 38284330 DOI: 10.1177/15569845231222315] [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] [Indexed: 01/30/2024]
Abstract
OBJECTIVE Psoas muscle size is a reliable marker of sarcopenia and frailty that correlates with adverse outcomes after cardiac surgery. However, its use in mitral and minimally invasive cardiac surgery is lacking. We sought to determine whether frailty, as measured by psoas muscle index, increases surgical risk for minimally invasive mitral valve surgery. METHODS Patients undergoing isolated minimally invasive mitral surgery via right minithoracotomy were identified. Patients who underwent maze, tricuspid intervention, and those who were emergent were excluded. Total psoas muscle area was calculated using the average cross-sectional area at the L3 vertebra on computed tomography scan and indexed to body surface area. Sarcopenia was defined as <25th gender-specific percentile. Patients were stratified by sarcopenia status and outcomes compared. RESULTS Of 287 total patients, 192 patients met inclusion criteria. Sarcopenic patients were 6 years older (66 vs 60 years, P = 0.01), had lower preoperative albumin levels (4.0 vs 4.3 g/dL, P < 0.001), and had higher Society of Thoracic Surgeons risk of morbidity/mortality (13.1% vs 9.0%, P = 0.003). Operative major morbidity or mortality was 6.4% versus 5.5% (P = 0.824), while the 1-year mortality rate was 2.1% versus 0% (P = 0.08). After risk adjustment, psoas index did not predict operative morbidity or mortality. However, sarcopenia was associated with higher odds of readmission (odds ratio = 0.74, P = 0.02). CONCLUSIONS Contrary to other cardiac operations, for patients undergoing isolated minimally invasive mitral valve surgery, sarcopenia was not associated with increased perioperative risk except for higher readmission rates. Minimally invasive surgical approaches should be strongly considered as the approach of choice in frail patients.
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Affiliation(s)
- Alex M Wisniewski
- Division of Cardiac Surgery, Department of Surgery, University of Virginia, Charlottesville, VA, USA
| | - Steven D Young
- Division of Cardiac Surgery, Department of Surgery, University of Virginia, Charlottesville, VA, USA
| | - Chi Chi Do-Nguyen
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Robert B Hawkins
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Matthew P Romano
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Nicholas R Teman
- Division of Cardiac Surgery, Department of Surgery, University of Virginia, Charlottesville, VA, USA
| | - Gorav Ailawadi
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, MI, USA
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Esposito A, Foffa I, Bastiani L, Vecoli C, Rizza A, Storti S, De Caterina AR, Mazzone A, Berti S. A Novel Frailty Score Based on Laboratory Parameters (FIMS Score) for the Management of Older Patients with Severe Aortic Stenosis. J Clin Med 2023; 12:5927. [PMID: 37762867 PMCID: PMC10531860 DOI: 10.3390/jcm12185927] [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: 06/30/2023] [Revised: 08/04/2023] [Accepted: 09/10/2023] [Indexed: 09/29/2023] Open
Abstract
This study aimed to develop a novel score based on common laboratory parameters able to identify frail and sarcopenic patients as well as predict mortality in elderly patients with severe aortic stenosis (AS) for tailored clinical decision-making. A total of 109 patients (83 ± 5 years; females, 68%) with AS underwent a multidisciplinary pre-operative assessment and finalized a "frailty-based management" for the AS interventional treatment. Laboratory parameters of statistically significant differences between sarcopenic and non-sarcopenic individuals were tested in the structural equation model (SEM) to build a Frailty Inflammation Malnutrition and Sarcopenia score (FIMS score). Mortality at 20 months of follow-up was considered an outcome. FIMS score, in particular, the cut-off value ≥ 1.28 was able to identify "frail" and "early frail" patients and predict mortality with a sensitivity of 83.3% and 82.6%, respectively (p = 0.001) and was an independent determinant associated with a higher risk of mortality (HR 5.382; p-value = 0.002). The FIMS score, easily achievable and usable in clinical practice, was able to identify frail and sarcopenic patients as well as predict their adverse clinical outcomes. This score could provide appropriate guidance during decision-making regarding elderly patients with severe AS.
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Affiliation(s)
- Augusto Esposito
- Cardiology Unit, Ospedale del Cuore, Fondazione Toscana “G. Monasterio”, 54100 Massa, Italy; (A.R.); (A.R.D.C.); (S.B.)
| | - Ilenia Foffa
- Institute of Clinical Physiology, National Research Council, Via Aurelia Sud, 54100 Massa, Italy; (I.F.); (L.B.); (C.V.)
- Fondazione Toscana Gabriele Monasterio, Via Aurelia Sud, 54100 Massa, Italy; (S.S.); (A.M.)
| | - Luca Bastiani
- Institute of Clinical Physiology, National Research Council, Via Aurelia Sud, 54100 Massa, Italy; (I.F.); (L.B.); (C.V.)
- Fondazione Toscana Gabriele Monasterio, Via Aurelia Sud, 54100 Massa, Italy; (S.S.); (A.M.)
| | - Cecilia Vecoli
- Institute of Clinical Physiology, National Research Council, Via Aurelia Sud, 54100 Massa, Italy; (I.F.); (L.B.); (C.V.)
- Fondazione Toscana Gabriele Monasterio, Via Aurelia Sud, 54100 Massa, Italy; (S.S.); (A.M.)
| | - Antonio Rizza
- Cardiology Unit, Ospedale del Cuore, Fondazione Toscana “G. Monasterio”, 54100 Massa, Italy; (A.R.); (A.R.D.C.); (S.B.)
| | - Simona Storti
- Fondazione Toscana Gabriele Monasterio, Via Aurelia Sud, 54100 Massa, Italy; (S.S.); (A.M.)
| | - Alberto Ranieri De Caterina
- Cardiology Unit, Ospedale del Cuore, Fondazione Toscana “G. Monasterio”, 54100 Massa, Italy; (A.R.); (A.R.D.C.); (S.B.)
| | - Annamaria Mazzone
- Fondazione Toscana Gabriele Monasterio, Via Aurelia Sud, 54100 Massa, Italy; (S.S.); (A.M.)
| | - Sergio Berti
- Cardiology Unit, Ospedale del Cuore, Fondazione Toscana “G. Monasterio”, 54100 Massa, Italy; (A.R.); (A.R.D.C.); (S.B.)
- Institute of Clinical Physiology, National Research Council, Via Aurelia Sud, 54100 Massa, Italy; (I.F.); (L.B.); (C.V.)
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Contribution of individual and cumulative frailty-related health deficits on cardiac rehabilitation completion. BMC Geriatr 2023; 23:34. [PMID: 36658538 PMCID: PMC9854083 DOI: 10.1186/s12877-022-03624-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Accepted: 11/14/2022] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Despite the high burden of frailty among cardiac rehabilitation (CR) participants, it is unclear which frailty-related deficits are related to program completion. METHODS Data from a single-centre exercise- and education-based CR program were included. A frailty index (FI) based on 25 health deficits was constructed. Logistic regression was used to estimate the odds of CR completion based on the presence of individual FI items. The odds of completion for cumulative deficits related to biomarkers, body composition, quality of life, as well as a composite of traditional and non-traditional cardiovascular risk factor domains were examined. RESULTS A total of 3,756 individuals were included in analyses. Eight of 25 FI variables were positively associated with program completion while 8 others were negatively associated with completion. The variable with the strongest positive association was the food frequency questionnaire score (OR 1.27 (95% CI 1.14, 1.41), whereas the deficit with strongest negative association was a decline in health over the last year (OR 0.74 (95% CI 0.58, 0.93). An increased number of cardiovascular deficits were associated with an increased odds of CR completion (OR per 1 deficit increase 1.16 (95% CI 1.11, 1.22)). A higher number of traditional CR deficits were predictive of CR completion (OR 1.22 (95% CI 1.16, 1.29)), but non-traditional measures predicted non-completion (OR 0.95 (95% CI 0.92, 0.97)). CONCLUSION A greater number of non-traditional cardiovascular deficits was associated with non-completion. These data should be used to implement intervention to patients who are most vulnerable to drop out to maximize retention.
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Sá MP, Erten O, Ramlawi B. Transcatheter Aortic Valve Implantation in Elderly Patients With Aortic Valve Stenosis: The Role of Frailty, Malnutrition, and Sarcopenia. J Am Heart Assoc 2022; 11:e027705. [PMID: 36172936 DOI: 10.1161/jaha.122.027705] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Michel Pompeu Sá
- Department of Cardiothoracic Surgery Lankenau Heart Institute, Lankenau Medical Center, Main Line Health Wynnewood PA.,Department of Cardiothoracic Surgery Lankenau Institute for Medical Research, Main Line Health Wynnewood PA
| | - Ozgun Erten
- Department of Cardiothoracic Surgery Lankenau Heart Institute, Lankenau Medical Center, Main Line Health Wynnewood PA.,Department of Cardiothoracic Surgery Lankenau Institute for Medical Research, Main Line Health Wynnewood PA
| | - Basel Ramlawi
- Department of Cardiothoracic Surgery Lankenau Heart Institute, Lankenau Medical Center, Main Line Health Wynnewood PA.,Department of Cardiothoracic Surgery Lankenau Institute for Medical Research, Main Line Health Wynnewood PA
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Jiang S, Cui J, Zhang LQ, Liu Z, Zhang Y, Shi Y, Cai JP. Role of a Urinary Biomarker in the Common Mechanism of Physical Performance and Cognitive Function. Front Med (Lausanne) 2022; 9:816822. [PMID: 35252255 PMCID: PMC8894651 DOI: 10.3389/fmed.2022.816822] [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: 11/17/2021] [Accepted: 01/26/2022] [Indexed: 11/13/2022] Open
Abstract
IntroductionHealthy aging is described as a process of developing and maintaining intrinsic abilities, including physical and cognitive functions. Although oxidative stress is a common mechanism shared by loss of muscle strength and dementia, its relationship with decreased physical performance and cognitive impairment remains unclear. We aimed to investigate the role of urinary 8-oxo-7, 8-dihydroguanosine (8-oxoGsn), a biomarker of oxidative damage to RNA, in physical and cognitive decline.MethodsThe study followed a cross-sectional design and recruited 40–94-year-old inhabitants of Beijing, China (471 men and 881 women). The physical performance of the participants was assessed using handgrip strength, walking speed, and the repeated chair stand test. The cognitive function was assessed using the Montreal Cognitive Assessment (MoCA) 5-min protocol. Urinary 8-oxoGsn levels were measured for all participants.ResultsParticipants with high urinary 8-oxoGsn levels were more likely to have low grip strength, slow walking speed, poor performance in the repeated chair stand test, and low scores on the MoCA 5-min protocol (odds ratio [OR] 3.43, 95% confidence interval [CI]: 1.52–7.76; OR 1.71, 95% CI: 1.16–2.53; OR 2.06, 95% CI: 0.92–4.63; OR 1.75, 95% CI: 1.18–2.58), after adjusting for age, sex, smoking habits, alcohol consumption, hypertension, diabetes, cerebro-cardiovascular disease, and chronic kidney disease.ConclusionElevated levels of oxidative stress are independently associated with cognitive and physical impairment. Thus, these results can help in the early identification and development of strategies for the prevention and treatment of intrinsic capacity decline.
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Affiliation(s)
- Shan Jiang
- The Key Laboratory of Geriatrics, Beijing Institute of Geriatrics, Beijing Hospital, Beijing, China
- National Center of Gerontology, National Health Commission, Beijing, China
- Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Ju Cui
- The Key Laboratory of Geriatrics, Beijing Institute of Geriatrics, Beijing Hospital, Beijing, China
- National Center of Gerontology, National Health Commission, Beijing, China
- Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Li-Qun Zhang
- The Key Laboratory of Geriatrics, Beijing Institute of Geriatrics, Beijing Hospital, Beijing, China
- National Center of Gerontology, National Health Commission, Beijing, China
- Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Zhen Liu
- The Key Laboratory of Geriatrics, Beijing Institute of Geriatrics, Beijing Hospital, Beijing, China
- National Center of Gerontology, National Health Commission, Beijing, China
- Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Yan Zhang
- The Key Laboratory of Geriatrics, Beijing Institute of Geriatrics, Beijing Hospital, Beijing, China
- National Center of Gerontology, National Health Commission, Beijing, China
- Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Yuan Shi
- Department of Geriatric Medicine, Longtan Community Health Service Center, Beijing, China
| | - Jian-Ping Cai
- The Key Laboratory of Geriatrics, Beijing Institute of Geriatrics, Beijing Hospital, Beijing, China
- National Center of Gerontology, National Health Commission, Beijing, China
- Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
- *Correspondence: Jian-Ping Cai
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Frailty and adverse outcomes in older adults being discharged from the emergency department: A prospective cohort study. CAN J EMERG MED 2021; 22:65-73. [PMID: 31965958 DOI: 10.1017/cem.2019.431] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND A growing number of frail older adults are treated in the emergency department (ED) and discharged home. There is an unmet need to identify older adults that are predisposed to functional decline and repeat ED visits so as to target them with proactive interventions. METHODS A prospective cohort study was conducted in patients 75 years or older who were being discharged from the ED. The objective was to test the value of frailty screening tests, namely 5-meter gait speed and handgrip strength, to predict repeat ED visits at 1 and 6 months and functional decline at 1 month using multivariable logistic regression. RESULTS After excluding 7 patients lost to follow-up, 150 patients were available for analysis. The mean age was 81.1 ± 4.9 years with 51% females, 13% arriving by ambulance, and 67% having at least two comorbid conditions. At ED discharge, 41% of patients were found to have slow gait speed, whereas 23% had weak handgrip strength. After adjustment, only slow gait speed was independently associated with functional decline at 1 month (odds ratio [OR] 1.39 per 0.1 meters/second decrement, 95% confidence interval [CI], 1.12 to 1.72) and repeat ED visits at 6 months (OR 1.20 per 0.1 meters/second decrement, 95% CI, 1.01 to 1.42). CONCLUSIONS Gait speed can be feasibly measured at the time of ED discharge to identify frail older adults at risk for early functional decline and subsequent return to the ED. Conversely, grip strength was not found to be associated with functional decline or ED visits.
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Cardiac Rehabilitation in Frail Older Adults With Cardiovascular Disease: A NEW DIAGNOSTIC AND TREATMENT PARADIGM. J Cardiopulm Rehabil Prev 2021; 40:72-78. [PMID: 31939755 DOI: 10.1097/hcr.0000000000000492] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Older adults with cardiovascular disease (CVD) pose challenges to cardiac rehabilitation (CR) clinicians because their disease is often coupled to physical frailty. Older patients with CVD and frailty may be less likely to tolerate conventional CR exercise training due to multidimensional (ie, strength, mobility, and balance) physical impairments. Furthermore, conventional CR typically emphasizes endurance training without addressing the intrinsic skeletal muscle impairments of frail patients that often manifest as deficits in strength, mobility, and balance, undercutting feasibility and any likely benefits. However, if appropriately modified to meet the needs of frail older adults, CR may be a powerful tool for this challenging population. To best serve frail, older adults with CVD, CR programs can incorporate well-validated strategies to assess frailty and physical function that also fit within the workflows and patient populations of individual programs. Such frailty assessments provide opportunities to identify specific targets (eg, weakness) that need to be addressed before a subsequent aerobic training program can be successfully implemented and sustained. The current review focuses on the use of physical frailty measures in older adults with CVD, with practical considerations for their clinical use in contemporary CR, as well as directions for future research.
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Chatterjee S, Shi A, Yoon L, Green SY, Zhang Q, Amarasekara HS, Orozco-Sevilla V, Preventza O, LeMaire SA, Coselli JS. Effect of sarcopenia on survival and spinal cord deficit outcomes after thoracoabdominal aortic aneurysm repair in patients 60 years of age and older. J Thorac Cardiovasc Surg 2021; 165:1985-1996.e3. [PMID: 34147254 DOI: 10.1016/j.jtcvs.2021.05.037] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 04/14/2021] [Accepted: 05/19/2021] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Sarcopenia (core muscle loss) has been used as a surrogate marker of frailty. We investigated whether sarcopenia would adversely affect survival after thoracoabdominal aortic aneurysm repair. METHODS We retrospectively reviewed prospectively collected data from patients aged 60 years or older who underwent thoracoabdominal aortic aneurysm repairs from 2006 to 2016. Imaging was reviewed by 2 radiologists blinded to clinical outcomes. The total psoas index was derived from total psoas muscle cross-sectional area (cm2) at the mid-L4 level, normalized for height (m2). Patients were divided by sex-specific total psoas index values into sarcopenia (lower third) and nonsarcopenia (upper two-thirds) groups. Multivariable modeling identified operative mortality and spinal cord injury predictors. Unadjusted and adjusted survival curves were analyzed. RESULTS Of 392 patients identified, those with sarcopenia (n = 131) were older than nonsarcopenic patients (n = 261) (70.0 years vs 68.0 years; P = .02) and more frequently presented with aortic rupture or required urgent/emergency operations. Operative mortality was comparable (sarcopenia 13.7% vs nonsarcopenia 10.0%; P = .3); sarcopenia was not associated with operative mortality in the multivariable model (odds ratio, 1.40; 95% confidence interval, 0.73-2.77; P = .3). Sarcopenic patients experienced more frequent delayed (13.0% vs 4.6%; P = .005) and persistent (10.7% vs 3.4%; P = .008) paraplegia. Sarcopenia independently predicted delayed paraplegia (odds ratio, 3.17; 95% confidence interval, 1.42-7.08; P = .005) and persistent paraplegia (odds ratio, 3.29; 95% confidence interval, 1.33-8.13; P = .01) in the multivariable model. Adjusted for preoperative/operative covariates, midterm survival was similar for sarcopenic and nonsarcopenic patients (P = .3). CONCLUSIONS Sarcopenia did not influence early mortality or midterm survival after thoracoabdominal aortic aneurysm repair but was associated with greater risk for delayed and persistent paraplegia.
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Affiliation(s)
- Subhasis Chatterjee
- Division of General Surgery, Department of Surgery, Baylor College Medicine, Houston, Tex; Division of Cardiothoracic Surgery, Department of Surgery, Baylor College Medicine, Houston, Tex; CHI St Luke's Health-Baylor St Luke's Medical Center, Houston, Tex; Department of Cardiovascular Surgery, Texas Heart Institute, Houston, Tex.
| | - Ann Shi
- CHI St Luke's Health-Baylor St Luke's Medical Center, Houston, Tex; Department of Radiology, Baylor College Medicine, Houston, Tex
| | - Luke Yoon
- Department of Radiology, Baylor College Medicine, Houston, Tex
| | - Susan Y Green
- Division of Cardiothoracic Surgery, Department of Surgery, Baylor College Medicine, Houston, Tex; Office of Surgical Research, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex
| | - Qianzi Zhang
- Division of Cardiothoracic Surgery, Department of Surgery, Baylor College Medicine, Houston, Tex; CHI St Luke's Health-Baylor St Luke's Medical Center, Houston, Tex
| | - Hiruni S Amarasekara
- Division of Cardiothoracic Surgery, Department of Surgery, Baylor College Medicine, Houston, Tex; Office of Surgical Research, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex
| | - Vicente Orozco-Sevilla
- Division of Cardiothoracic Surgery, Department of Surgery, Baylor College Medicine, Houston, Tex; CHI St Luke's Health-Baylor St Luke's Medical Center, Houston, Tex
| | - Ourania Preventza
- Division of Cardiothoracic Surgery, Department of Surgery, Baylor College Medicine, Houston, Tex; CHI St Luke's Health-Baylor St Luke's Medical Center, Houston, Tex; Department of Cardiovascular Surgery, Texas Heart Institute, Houston, Tex
| | - Scott A LeMaire
- Division of Cardiothoracic Surgery, Department of Surgery, Baylor College Medicine, Houston, Tex; CHI St Luke's Health-Baylor St Luke's Medical Center, Houston, Tex; Department of Cardiovascular Surgery, Texas Heart Institute, Houston, Tex; Office of Surgical Research, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex
| | - Joseph S Coselli
- Division of Cardiothoracic Surgery, Department of Surgery, Baylor College Medicine, Houston, Tex; CHI St Luke's Health-Baylor St Luke's Medical Center, Houston, Tex; Department of Cardiovascular Surgery, Texas Heart Institute, Houston, Tex
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van der Wulp K, van Wely MH, Schoon Y, Vart P, Olde Rikkert MG, Morshuis WJ, van Royen N, Verkroost MW, Gehlmann HR, Van Garsse LA, Kievit PC. Geriatric assessment in the prediction of delirium and long-term survival after transcatheter aortic valve implantation. J Thorac Cardiovasc Surg 2021; 161:2095-2102.e3. [DOI: 10.1016/j.jtcvs.2020.02.076] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 01/07/2020] [Accepted: 02/14/2020] [Indexed: 12/15/2022]
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Jordan N, Gvalda M, Cody R, Galante O, Haywood C, Yates P. Frailty, MRI, and FDG-PET Measures in an Australian Memory Clinic Cohort. Front Med (Lausanne) 2021; 7:578243. [PMID: 33521008 PMCID: PMC7840574 DOI: 10.3389/fmed.2020.578243] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 10/14/2020] [Indexed: 01/30/2023] Open
Abstract
Given that the global population is aging, the number of age-related syndromes, such as frailty, is expected to rise in conjunction. Frailty is characterized by the loss of homeostatic reserve, rendering the individual vulnerable to poor health outcomes. Many biological mechanisms have been proposed to contribute to frailty. However, few studies have assessed the associations between frailty and brain diseases or neuroimaging biomarkers. Aims: The aims of this study were to measure the prevalence of frailty in a memory clinic and to examine associations between frailty and brain changes found on magnetic resonance imaging (MRI) and 18-F deoxyglucose (FDG) positron emission tomography (PET) in memory clinic attendees. Methods: A 54-items Frailty Index was retrospectively assessed for all clinic attendees from 2014. Frailty was defined as FI > 0.25. MR images were analyzed for stroke, cerebral small vessel disease [CSVD, including cerebral microbleeds (CMBs), cortical superficial siderosis (CSS), and white matter hyperintensity (WMH)], and neurodegenerative changes [MRI: mesial temporal atrophy (MTA), FDG-PET: regional hypometabolism], blind to clinical findings. Results: There were 209 clinic attendees in 2014, of whom 121 had MRI performed. The prevalence of frailty (using FI) in the memory clinic in 2014 was 38.3% overall (patients without MRI: 43.2%, patients with MRI 34.7%, p = 0.25). Frailty was associated with presence of deep WMH, increased severity of periventricular WMH, and presence of CSS, but not neurodegeneration markers (MTA atrophy/FDG-PET hypometabolism). Conclusion: The findings support the idea that previously reported associations between frailty and imaging evidence of CSVD in other cohorts are also relevant to the Australian clinic setting. Given that a large proportion of memory clinic attendees are frail, there may be opportunities for interventions to reduce preventable adverse health outcomes, such as falls and fractures, and reduce the prevalence and impact of frailty in this cohort.
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Affiliation(s)
- Nan Jordan
- Department of Geriatric Medicine, Austin Health, Heidelberg, VIC, Australia
| | - Matthew Gvalda
- Department of Geriatric Medicine, Austin Health, Heidelberg, VIC, Australia
| | - Ross Cody
- Department of Geriatric Medicine, Austin Health, Heidelberg, VIC, Australia.,Department of Geriatric Medicine, Austin Health, Heidelberg, VIC, Australia
| | - Olivia Galante
- Department of Geriatric Medicine, Austin Health, Heidelberg, VIC, Australia
| | - Cilla Haywood
- Department of Geriatric Medicine, Austin Health, Heidelberg, VIC, Australia
| | - Paul Yates
- Department of Geriatric Medicine, Austin Health, Heidelberg, VIC, Australia.,Department of Medicine, Eastern Health, Box Hill, VIC, Australia.,Department of Medicine, University of Melbourne, Heidelberg, VIC, Australia
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12
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Ahisar Y, Thanassoulis G, Huang KN, Ohayon SM, Afilalo J. Intersecting Genetics of Frailty and Cardiovascular Disease. J Nutr Health Aging 2021; 25:1023-1027. [PMID: 34545923 DOI: 10.1007/s12603-021-1673-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES To determine the genetic correlates of physical frailty and sarcopenia, focusing on single nucleotide polymorphisms (SNPs) in genome-wide association studies (GWAS), and to explore the genetic overlap of frailty with cardiovascular disease (CVD) and its risk factors. METHODS PubMed was systematically searched for GWAS studies investigating the association between SNPs and objective measures of physical frailty or sarcopenia. SNPs were retained if they were associated with one of the phenotypes of interest by a p-value of 5.0x10-8 or less. RESULTS Ten studies were included, with a total of 237 SNPs in 181 genes being associated with physical frailty or sarcopenia; as measured by handgrip strength or lean (muscle) mass. These genes were cross-referenced in the GWAS Catalog, and many of them were found to be associated with CVD or metabolic syndrome. CONCLUSIONS Evidence from GWAS has shown that frailty is associated with common genetic polymorphisms. Many of these polymorphisms have been implicated in CVD, supporting the hypothesis of a shared pathophysiology between these entities. Future studies are eagerly anticipated to map out the mechanistic links and discover therapeutic targets and novel biomarkers for frailty.
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Affiliation(s)
- Y Ahisar
- Jonathan Afilalo, MD, MSc, FACC, FRCPC, Associate Professor, McGill University, Director, Geriatric Cardiology Fellowship Program, Jewish General Hospital, 3755 Cote Ste Catherine Rd, E-222, Montreal, QC H3T 1E2, Phone: (514) 340-7540 | Fax: (514) 340-7534,
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13
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Borregaard B, Dahl JS, Lauck SB, Ryg J, Berg SK, Ekholm O, Hendriks JM, Riber LPS, Norekvål TM, Møller JE. Association between frailty and self-reported health following heart valve surgery. IJC HEART & VASCULATURE 2020; 31:100671. [PMID: 33235899 PMCID: PMC7670239 DOI: 10.1016/j.ijcha.2020.100671] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 09/26/2020] [Accepted: 10/26/2020] [Indexed: 12/13/2022]
Abstract
Background Knowledge about the association between frailty and self-reported health among patients undergoing heart valve surgery remains sparse. Thus, the objectives were to I) describe changes in self-reported health at different time points according to frailty status, and to II) investigate the association between frailty status at discharge and poor self-reported health four weeks after discharge among patients undergoing heart valve surgery. Methods In a prospective cohort study, consecutive patients undergoing heart valve surgery, including transapical/transaortic valve procedures were included. Frailty was measured using the Fried score, and self-reported health using the Kansas City Cardiomyopathy Questionnaire (KCCQ) and the EuroQoL-5 Dimensions 5-Levels Health Status Questionnaire (EQ-5D-5L).To investigate the association between frailty and self-reported health, multivariable logistic regression models were used. Analyses were adjusted for sex, age, surgical risk evaluation (EuroScore) and procedure and presented as odds ratios (OR) with 95% confidence intervals (CI). Results Frailty was assessed at discharge in 288 patients (median age 71, 69% men); 51 patients (18%) were frail. In the multivariable analyses, frailty at discharge remained significantly associated with poor self-reported health at four weeks, OR (95% CI): EQ-5D-5L Index 3.38 (1.51-7.52), VAS 2.41 (1.13-5.14), and KCCQ 2.84 (1.35-5.97). Conclusion Frailty is present at discharge in 18% of patients undergoing heart valve surgery, and being frail is associated with poor self-reported health at four weeks of follow-up. This supports a clinical need to address the unique risk of frail patients among heart valve teams broadly, and not only to measure frailty as a marker of operative risk.
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Affiliation(s)
- Britt Borregaard
- Department of Cardiology, Odense University Hospital, Denmark.,Department of Cardiothoracic and Vascular Surgery, Odense University Hospital, Denmark.,University of Southern Denmark, Denmark
| | - Jordi S Dahl
- Department of Cardiology, Odense University Hospital, Denmark.,University of Southern Denmark, Denmark
| | - Sandra B Lauck
- Centre for Heart Valve Innovation, St. Paul's Hospital, Canada.,University of British Columbia, Canada
| | - Jesper Ryg
- University of Southern Denmark, Denmark.,Department of Geriatric Medicine, Odense University Hospital, Denmark
| | - Selina K Berg
- Department of Clinical Medicine, University of Copenhagen, Denmark.,The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Denmark
| | | | - Jeroen M Hendriks
- Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, Royal Adelaide Hospital, Australia.,College of Nursing and Health Sciences, Flinders University, Australia.,Department of Health, Medicine and Caring Sciences, Linköping University, Sweden
| | - Lars P S Riber
- Department of Cardiothoracic and Vascular Surgery, Odense University Hospital, Denmark.,University of Southern Denmark, Denmark
| | - Tone M Norekvål
- Department of Heart Disease, Haukeland University Hospital, Norway.,Department of Clinical Science, University of Bergen, Norway.,Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Norway
| | - Jacob E Møller
- Department of Cardiology, Odense University Hospital, Denmark.,University of Southern Denmark, Denmark.,The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Denmark
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14
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Sareh S, Ugarte R, Dobaria V, Hadaya J, Sirody J, McCallum JC, de Virgilio C, Benharash P. Impact of Frailty on Clinical and Financial Outcomes Following Minor Lower Extremity Amputation: A Nationwide Analysis. Am Surg 2020; 86:1312-1317. [PMID: 33103459 DOI: 10.1177/0003134820964230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Frailty has been shown to portend worse outcomes in surgical patients. Our goal was to identify the impact of frailty on outcomes and resource utilization among patients undergoing minor lower extremity amputation in the United States. Using the Nationwide Readmission Database, we identified all adults undergoing a minor amputation between 2010 and 2015, and assessed 90-day outcomes, including readmission, reamputation, mortality, and cumulative hospitalization costs. Frailty was defined by International Classification of Diseases codes consistent with the ten frailty clusters as defined by the Johns Hopkins Adjusted Clinical Group System. Multivariable regression models were developed for risk adjustment. An estimated 302 798 patients (mean age = 61.8 years) were identified, of which 15.2% were categorized as Frail. Before adjustment, frailty was associated with increased rates of readmission (44% vs. 36%, P < .001) and in-hospital mortality (4% vs. 2%, P < .001). Frailty was also associated with increased cumulative costs of care ($39 417 vs. $27 244, P < .001). After risk adjustment, frailty remained an independent predictor of readmission (Adjusted odds ratio [AOR] 1.18, CI 1.14-1.23), in-hospital mortality (AOR 1.48, CI 1.34-1.65), and incremental costs (+$7 646, CI $6927-$8365). Frailty is an independent marker of worse outcomes following minor foot amputation, and may be utilized to direct quality improvement efforts.
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Affiliation(s)
- Sohail Sareh
- Cardiovascular Outcomes Research Laboratories, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.,Los Angeles County Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Ramsey Ugarte
- Los Angeles County Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Vishal Dobaria
- Cardiovascular Outcomes Research Laboratories, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Joseph Hadaya
- Cardiovascular Outcomes Research Laboratories, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Joseph Sirody
- Los Angeles County Harbor-UCLA Medical Center, Torrance, CA, USA
| | - John C McCallum
- Los Angeles County Harbor-UCLA Medical Center, Torrance, CA, USA
| | | | - Peyman Benharash
- Cardiovascular Outcomes Research Laboratories, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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Using the Concept of Frailty to Understand Variability in Health Outcomes Among Individuals with Systemic Lupus Erythematosus. CURRENT TREATMENT OPTIONS IN RHEUMATOLOGY 2020. [DOI: 10.1007/s40674-020-00150-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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16
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Wleklik M, Uchmanowicz I, Jankowska EA, Vitale C, Lisiak M, Drozd M, Pobrotyn P, Tkaczyszyn M, Lee C. Multidimensional Approach to Frailty. Front Psychol 2020; 11:564. [PMID: 32273868 PMCID: PMC7115252 DOI: 10.3389/fpsyg.2020.00564] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 03/10/2020] [Indexed: 12/18/2022] Open
Abstract
The concept of frailty syndrome (FS) was first described in the scientific literature three decades ago. For a very long time, we understood it as a geriatric problem, recently becoming one of the dominant concepts in cardiology. It identifies symptoms of FS in one in 10 elderly people. It is estimated that in Europe, 17% of elderly people have FS. The changes in FS resemble and often overlap with changes associated with the physiological aging process of the body. Although there are numerous scientific reports confirming that FS is age correlated, it is not an unavoidable part of the aging process and does not apply only to the elderly. FS is a reversible clinical condition. To maximize benefits of frailty-reversing activities for patient with frailty, identification of its determinants appears to be fundamental. Many of the determinants of the FS have already been known: reduction in physical activity, malnutrition, sarcopenia, polypharmacy, depressive symptom, cognitive disorders, and lack of social support. This review shows that insight into FS determinants is the starting point for building both the comprehensive definition of FS and the adoption of the assessment method of FS, and then successful clinical management.
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Affiliation(s)
- Marta Wleklik
- Faculty of Health Sciences, Wrocław Medical University, Wrocław, Poland
| | | | - Ewa A. Jankowska
- Centre for Heart Diseases, Faculty of Health Sciences, Wrocław Medical University, Wrocław, Poland
| | - Cristiana Vitale
- Centre for Clinical and Basic Research, IRCCS San Raffaele Pisana, Rome, Italy
| | - Magdalena Lisiak
- Faculty of Health Sciences, Wrocław Medical University, Wrocław, Poland
| | - Marcin Drozd
- Centre for Heart Diseases, Faculty of Health Sciences, Wrocław Medical University, Wrocław, Poland
| | | | - Michał Tkaczyszyn
- Centre for Heart Diseases, Faculty of Health Sciences, Wrocław Medical University, Wrocław, Poland
| | - Christopher Lee
- William F. Conell School of Nursing, Boston College, Newton, MA, United States
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Sezgin D, Liew A, O'Donovan MR, O'Caoimh R. Pre-frailty as a multi-dimensional construct: A systematic review of definitions in the scientific literature. Geriatr Nurs 2020; 41:139-146. [DOI: 10.1016/j.gerinurse.2019.08.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 08/08/2019] [Accepted: 08/12/2019] [Indexed: 12/12/2022]
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18
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Romero-Ortuno R, Scarlett S, O’Halloran AM, Kenny RA. Is phenotypical prefrailty all the same? A longitudinal investigation of two prefrailty subtypes in TILDA. Age Ageing 2019; 49:39-45. [PMID: 31711148 DOI: 10.1093/ageing/afz129] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Fried's frailty phenotype is defined by five criteria: exhaustion, unexplained weight loss, weakness, slowness and low physical activity. Prefrailty (PF) meets one or two criteria. PF is of interest as a target for preventative interventions, but it is not known if it is a homogenous syndrome. OBJECTIVE to compare the longitudinal trajectories of two PF groups: one defined by exhaustion and/or unexplained weight loss (PF1) and one defined by one or two of the following: weakness, slowness, low physical activity (PF2). DESIGN AND SETTING population-based longitudinal study of ageing. SUBJECTS One-thousand four-hundred seventy-six PF participants aged ≥50 years from wave 1 of the study (2010), followed 2-yearly over four longitudinal waves (2012, 2014, 2016, 2018). METHODS generalised estimating equations (GEEs) were used to assess the effect of PF type across waves to predict cumulative mortality and disability in basic activities of daily living (ADL) and independent ADL (IADL), adjusting for baseline characteristics (age, sex, education, living alone, self-rated health, comorbidity, body mass index). RESULTS in wave 1, there were 503 PF1 and 973 PF2 participants. By wave 5, 38 (7.6%) PF1 and 145 (14.9%) PF2 participants had died. In PF1 participants, mean numbers of ADL and IADL disabilities both increased from 0.1 to 0.2 from wave 1 to wave 5, whilst in PF2 increases were from 0.2 to 0.5. Adjusted GEE models suggested significantly divergent trajectories of IADL disability by wave 2, ADL disability by wave 3 and mortality by wave 3. CONCLUSION PF may not be a homogenous biological syndrome.
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Affiliation(s)
- Roman Romero-Ortuno
- Discipline of Medical Gerontology, School of Medicine, Trinity College Dublin, Dublin, Ireland
- The Irish Longitudinal Study on Ageing (TILDA), Trinity College Dublin, Dublin, Ireland
| | - Siobhan Scarlett
- The Irish Longitudinal Study on Ageing (TILDA), Trinity College Dublin, Dublin, Ireland
| | - Aisling M O’Halloran
- The Irish Longitudinal Study on Ageing (TILDA), Trinity College Dublin, Dublin, Ireland
| | - Rose Anne Kenny
- Discipline of Medical Gerontology, School of Medicine, Trinity College Dublin, Dublin, Ireland
- The Irish Longitudinal Study on Ageing (TILDA), Trinity College Dublin, Dublin, Ireland
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20
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Association Between Cardiac Rehabilitation and Frailty. Can J Cardiol 2019; 36:482-489. [PMID: 31837892 DOI: 10.1016/j.cjca.2019.08.032] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 08/05/2019] [Accepted: 08/16/2019] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Cardiac rehabilitation is a mainstay treatment for patients experiencing an adverse cardiovascular event. Heart disease is important in frailty, but the impact of cardiac rehabilitation on frailty is unclear. METHODS Patients were referred to a 12-week group-based exercise and education cardiac rehabilitation program performed twice weekly. Frailty was measured with the use of a 25-item accumulation of deficits frailty index (range 0-1; higher values indicate greater frailty) at cardiac rehabilitation admission and completion. Patients were categorized by the degree of frailty in 0.1 increments. RESULTS Of the 4004 patients who enrolled, 2322 (58.0%) completed cardiac rehabilitation with complete data at admission and completion. There were 414 (17.8%), 642 (27.6%), 690 (29.7%), 401 (17.3%), and 175 (7.5%) patients with admission frailty levels of < 0.20, 0.20-0.30, 0.30-0.40, 0.40-0.50, and > 0.50, respectively. Frailty levels improved from cardiac rehabilitation admission (mean 0.34 [95% CI 0.32-0.35]) to completion (0.26 [0.25-0.28]) for those who completed the program (P < 0.001). After adjusting for age, sex, and number of exercise sessions attended, frailty improved in all frailty groups by mean differences of 0.03 (0.02-0.03), 0.05 (0.05-0.06), 0.08 (0.08-0.09), 0.10 (0.09-0.11), and 0.11 (0.10-0.13) in the < 0.20, 0.20-0.30, 0.30-0.40, 0.40-0.50, and > 0.50 frailty groups, respectively. The minimal improvement in frailty scores (≥ 0.03 reduction) was achieved by 48%, 65%, 72%, 76%, and 79% of patients in the the 5 frailty groups, respectively. CONCLUSIONS Although higher frailty levels were associated with cardiac rehabilitation drop-out, finishing the program was related to improving frailty levels, especially in patients who were the frailest.
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21
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Age-related deficit accumulation and the diseases of ageing. Mech Ageing Dev 2019; 180:107-116. [DOI: 10.1016/j.mad.2019.04.005] [Citation(s) in RCA: 82] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 04/10/2019] [Accepted: 04/15/2019] [Indexed: 12/25/2022]
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Drudi LM, Ades M, Landry T, Gill HL, Grenon SM, Steinmetz OK, Afilalo J. Scoping review of frailty in vascular surgery. J Vasc Surg 2019; 69:1989-1998.e2. [DOI: 10.1016/j.jvs.2018.10.053] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 10/10/2018] [Indexed: 12/21/2022]
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Sezgin D, O’Donovan M, Cornally N, Liew A, O’Caoimh R. Defining frailty for healthcare practice and research: A qualitative systematic review with thematic analysis. Int J Nurs Stud 2019; 92:16-26. [DOI: 10.1016/j.ijnurstu.2018.12.014] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 12/13/2018] [Accepted: 12/17/2018] [Indexed: 12/22/2022]
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24
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Gibson JA, Crowe S. Frailty in Critical Care: Examining Implications for Clinical Practices. Crit Care Nurse 2018; 38:29-35. [PMID: 29858193 DOI: 10.4037/ccn2018336] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Frailty is an aging-related, multisystem clinical state characterized by loss of physiological reserves and diminished capacity to withstand exposure to stressors. Frailty increases the risk of serious adverse outcomes, compared with that of nonfrail people of the same age. Adverse outcomes can be severe and may include procedural complications, delirium, significant functional decline and disability, prolonged hospital length of stay, extended recovery periods, and death. As older adults make up a continually growing proportion of hospitalized patients, critical care nurses need to understand how to recognize frailty and be familiar with related clinical practice implications. Such knowledge underpins effective organization and delivery of care strategies aimed at minimizing harm and maximizing positive outcomes for frail older adults. Drawing from recent literature, this article explores frailty and critical illness by discussing 2 dominant models of the concept. Using a clinical case study, links between frailty and critical care nursing practices are highlighted and clinical considerations are explored.
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Affiliation(s)
- Jennifer A Gibson
- Jennifer A. Gibson is a doctoral candidate at the University of British Columbia and a patient care manager in the Heart Centre at St Paul's Hospital in Vancouver, Canada. .,Sarah Crowe is a clinical nurse specialist in critical care at Fraser Health Authority in Surrey, Canada.
| | - Sarah Crowe
- Jennifer A. Gibson is a doctoral candidate at the University of British Columbia and a patient care manager in the Heart Centre at St Paul's Hospital in Vancouver, Canada.,Sarah Crowe is a clinical nurse specialist in critical care at Fraser Health Authority in Surrey, Canada
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Goldfarb M, Lauck S, Webb JG, Asgar AW, Perrault LP, Piazza N, Martucci G, Lachapelle K, Noiseux N, Kim DH, Popma JJ, Lefèvre T, Labinaz M, Lamy A, Peterson MD, Arora RC, Morais JA, Morin JF, Rudski LG, Afilalo J. Malnutrition and Mortality in Frail and Non-Frail Older Adults Undergoing Aortic Valve Replacement. Circulation 2018; 138:2202-2211. [DOI: 10.1161/circulationaha.118.033887] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
- Michael Goldfarb
- Azrieli Heart Centre (M.G., L.G.R., J.A.), Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Sandra Lauck
- Centre for Heart Valve Innovation, St Paul’s Hospital, University of Vancouver, British Columbia, Canada (S.L., J.G.W.)
| | - John G. Webb
- Centre for Heart Valve Innovation, St Paul’s Hospital, University of Vancouver, British Columbia, Canada (S.L., J.G.W.)
| | - Anita W. Asgar
- Division of Cardiology (A.W.A.), Institut de Cardiologie de Montréal, Université de Montréal, Quebec, Canada
| | - Louis P. Perrault
- Division of Cardiac Surgery (L.P.P.), Institut de Cardiologie de Montréal, Université de Montréal, Quebec, Canada
| | - Nicolo Piazza
- Division of Cardiology (N.P., G.M.), McGill University Health Centre, Montreal, Quebec, Canada
| | - Giuseppe Martucci
- Division of Cardiology (N.P., G.M.), McGill University Health Centre, Montreal, Quebec, Canada
| | - Kevin Lachapelle
- Division of Cardiac Surgery (K.L.), McGill University Health Centre, Montreal, Quebec, Canada
| | - Nicolas Noiseux
- Division of Cardiac Surgery, Centre Hospitalier de l’Université de Montréal, Centre de Recherche du CHUM, Montreal, Quebec, Canada (N.N.)
| | - Dae H. Kim
- Division of Gerontology (D.H.K.), Beth Israel Deaconess Medical Center, Harvard University, Boston, MA
| | - Jeffrey J. Popma
- Division of Cardiology (J.J.P.), Beth Israel Deaconess Medical Center, Harvard University, Boston, MA
| | - Thierry Lefèvre
- Division of Cardiology, Institut Cardiovasculaire Paris Sud, Hôpital Privé Jacques Cartier, Massy, France (T.L.)
| | - Marino Labinaz
- Division of Cardiology, University of Ottawa Heart Institute, Ontario, Canada (M.L.)
| | - Andre Lamy
- Division of Cardiac Surgery, Hamilton Health Sciences, Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada (A.L.)
| | - Mark D. Peterson
- Division of Cardiac Surgery, St Michael’s Hospital, University of Toronto, Ontario, Canada (M.D.P.)
| | - Rakesh C. Arora
- Section of Cardiac Surgery, Max Rady College of Medicine, Rady Faculty of Health Science, University of Manitoba, Winnipeg, Canada (R.C.A.)
| | - José A. Morais
- Division of Geriatric Medicine (J.A.M.), McGill University Health Centre, Montreal, Quebec, Canada
| | - Jean-Francois Morin
- Division of Cardiac Surgery (J.-F.M.), Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Lawrence G. Rudski
- Azrieli Heart Centre (M.G., L.G.R., J.A.), Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Jonathan Afilalo
- Azrieli Heart Centre (M.G., L.G.R., J.A.), Jewish General Hospital, McGill University, Montreal, Quebec, Canada
- Centre for Clinical Epidemiology, Lady Davis Institute for Medical Research (J.A.), Jewish General Hospital, McGill University, Montreal, Quebec, Canada
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Mullie L, Obrand A, Bendayan M, Trnkus A, Ouimet M, Moss E, Chen‐Tournoux A, Rudski LG, Afilalo J. Phase Angle as a Biomarker for Frailty and Postoperative Mortality: The BICS Study. J Am Heart Assoc 2018; 7:e008721. [PMID: 30371163 PMCID: PMC6201414 DOI: 10.1161/jaha.118.008721] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 07/02/2018] [Indexed: 01/19/2023]
Abstract
Background Phase angle (PA) is a bioimpedance measurement that is determined lean body mass and hydration status. Patients with low PA values are more likely to be frail, sarcopenic, or malnourished. Previous work has shown that low PA predicts adverse outcomes after cardiac surgery, but the effect of PA on survival has not previously been assessed in this setting. Methods and Results The BICS (Bioimpedance in Cardiac Surgery) study recruited 277 patients undergoing major cardiac surgery at 2 university-affiliated hospitals in Montreal, QC, Canada. Bioimpedance measurements as well as frailty and nutritional assessments were performed preoperatively. The primary outcome was all-cause mortality. Secondary outcomes were 30-day mortality, postoperative morbidity, and hospital length of stay. There were 10 deaths at 1 month of follow-up and 16 deaths at 12 months of follow-up. PA was associated with age, sex, body mass index, comorbidities, and frailty, as measured by the Short Physical Performance Battery and Fried scales. After adjusting for Society of Thoracic Surgeons-predicted mortality, lower PA was associated with higher mortality at 1 month (adjusted odds ratio, 3.57 per 1° decrease in PA ; 95% confidence interval, 1.35-9.47) and at 12 months (adjusted odds ratio, 3.03 per 1° decrease in PA ; 95% confidence interval, 1.30-7.09), a higher risk of overall morbidity (adjusted hazard ratio, 2.51 per 1° decrease in PA ; 95% confidence interval, 1.32-4.75), and a longer hospital length of stay (adjusted β, 4.8 days per 1° decrease in PA ; 95% confidence interval, 1.3-8.2 days). Conclusions Low PA is associated with frailty and is predictive of mortality, morbidity, and length of stay after major cardiac surgery. Further work is needed to determine the responsiveness of PA to interventions aimed at reversing frailty.
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Affiliation(s)
- Louis Mullie
- Centre for Clinical EpidemiologyLady Davis InstituteMcGill UniversityMontrealQuebecCanada
- Division of Internal MedicineMcGill UniversityMontrealQuebecCanada
| | - Alexandrine Obrand
- Centre for Clinical EpidemiologyLady Davis InstituteMcGill UniversityMontrealQuebecCanada
- School of EngineeringMassachusetts Institute of TechnologyCambridgeMA
| | - Melissa Bendayan
- Centre for Clinical EpidemiologyLady Davis InstituteMcGill UniversityMontrealQuebecCanada
- Division of Experimental MedicineFaculty of MedicineMcGill UniversityMontrealQuebecCanada
| | - Amanda Trnkus
- Centre for Clinical EpidemiologyLady Davis InstituteMcGill UniversityMontrealQuebecCanada
| | - Marie‐Claude Ouimet
- Centre for Innovative MedicineMcGill University Health CentreMcGill UniversityMontrealQuebecCanada
| | - Emmanuel Moss
- Division of Cardiac SurgeryJewish General HospitalMcGill UniversityMontrealQuebecCanada
| | | | - Lawrence G. Rudski
- Centre for Clinical EpidemiologyLady Davis InstituteMcGill UniversityMontrealQuebecCanada
- Division of CardiologyJewish General HospitalMcGill UniversityMontrealQuebecCanada
| | - Jonathan Afilalo
- Centre for Clinical EpidemiologyLady Davis InstituteMcGill UniversityMontrealQuebecCanada
- Division of Experimental MedicineFaculty of MedicineMcGill UniversityMontrealQuebecCanada
- Division of CardiologyJewish General HospitalMcGill UniversityMontrealQuebecCanada
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Liguori I, Russo G, Aran L, Bulli G, Curcio F, Della-Morte D, Gargiulo G, Testa G, Cacciatore F, Bonaduce D, Abete P. Sarcopenia: assessment of disease burden and strategies to improve outcomes. Clin Interv Aging 2018; 13:913-927. [PMID: 29785098 PMCID: PMC5957062 DOI: 10.2147/cia.s149232] [Citation(s) in RCA: 170] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Life expectancy is increasing worldwide, with a resultant increase in the elderly population. Aging is characterized by the progressive loss of skeletal muscle mass and strength - a phenomenon called sarcopenia. Sarcopenia has a complex multifactorial pathogenesis, which involves not only age-related changes in neuromuscular function, muscle protein turnover, and hormone levels and sensitivity, but also a chronic pro-inflammatory state, oxidative stress, and behavioral factors - in particular, nutritional status and degree of physical activity. According to the operational definition by the European Working Group on Sarcopenia in Older People (EWGSOP), the diagnosis of sarcopenia requires the presence of both low muscle mass and low muscle function, which can be defined by low muscle strength or low physical performance. Moreover, biomarkers of sarcopenia have been identified for its early detection and for a detailed identification of the main pathophysiological mechanisms involved in its development. Because sarcopenia is associated with important adverse health outcomes, such as frailty, hospitalization, and mortality, several therapeutic strategies have been identified that involve exercise training, nutritional supplementation, hormonal therapies, and novel strategies and are still under investigation. At the present time, only physical exercise has showed a positive effect in managing and preventing sarcopenia and its adverse health outcomes. Thus, further well-designed and well-conducted studies on sarcopenia are needed.
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Affiliation(s)
- Ilaria Liguori
- Department of Translational Medical Sciences, University of Naples "Federico II", Naples, Italy
| | - Gennaro Russo
- Department of Translational Medical Sciences, University of Naples "Federico II", Naples, Italy
| | - Luisa Aran
- Department of Translational Medical Sciences, University of Naples "Federico II", Naples, Italy
| | - Giulia Bulli
- Department of Translational Medical Sciences, University of Naples "Federico II", Naples, Italy
| | - Francesco Curcio
- Department of Translational Medical Sciences, University of Naples "Federico II", Naples, Italy
| | - David Della-Morte
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy.,Department of Human Sciences and Quality of Life Promotion, San Raffaele Roma Open University, Rome, Italy
| | - Gaetano Gargiulo
- Division of Internal Medicine, AOU San Giovanni di Dio e Ruggi di Aragona, Salerno, Italy
| | - Gianluca Testa
- Department of Translational Medical Sciences, University of Naples "Federico II", Naples, Italy.,Department of Medicine and Health Sciences, University of Molise, Campobasso, Italy
| | - Francesco Cacciatore
- Department of Translational Medical Sciences, University of Naples "Federico II", Naples, Italy.,Azienda Ospedaliera dei Colli, Monaldi Hospital, Heart Transplantation Unit, Naples, Italy
| | - Domenico Bonaduce
- Department of Translational Medical Sciences, University of Naples "Federico II", Naples, Italy
| | - Pasquale Abete
- Department of Translational Medical Sciences, University of Naples "Federico II", Naples, Italy
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28
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Liguori I, Russo G, Curcio F, Bulli G, Aran L, Della-Morte D, Gargiulo G, Testa G, Cacciatore F, Bonaduce D, Abete P. Oxidative stress, aging, and diseases. Clin Interv Aging 2018; 13:757-772. [PMID: 29731617 PMCID: PMC5927356 DOI: 10.2147/cia.s158513] [Citation(s) in RCA: 2018] [Impact Index Per Article: 336.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Reactive oxygen and nitrogen species (RONS) are produced by several endogenous and exogenous processes, and their negative effects are neutralized by antioxidant defenses. Oxidative stress occurs from the imbalance between RONS production and these antioxidant defenses. Aging is a process characterized by the progressive loss of tissue and organ function. The oxidative stress theory of aging is based on the hypothesis that age-associated functional losses are due to the accumulation of RONS-induced damages. At the same time, oxidative stress is involved in several age-related conditions (ie, cardiovascular diseases [CVDs], chronic obstructive pulmonary disease, chronic kidney disease, neurodegenerative diseases, and cancer), including sarcopenia and frailty. Different types of oxidative stress biomarkers have been identified and may provide important information about the efficacy of the treatment, guiding the selection of the most effective drugs/dose regimens for patients and, if particularly relevant from a pathophysiological point of view, acting on a specific therapeutic target. Given the important role of oxidative stress in the pathogenesis of many clinical conditions and aging, antioxidant therapy could positively affect the natural history of several diseases, but further investigation is needed to evaluate the real efficacy of these therapeutic interventions. The purpose of this paper is to provide a review of literature on this complex topic of ever increasing interest.
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Affiliation(s)
- Ilaria Liguori
- Department of Translational Medical Sciences, University of Naples "Federico II", Naples, Italy
| | - Gennaro Russo
- Department of Translational Medical Sciences, University of Naples "Federico II", Naples, Italy
| | - Francesco Curcio
- Department of Translational Medical Sciences, University of Naples "Federico II", Naples, Italy
| | - Giulia Bulli
- Department of Translational Medical Sciences, University of Naples "Federico II", Naples, Italy
| | - Luisa Aran
- Department of Translational Medical Sciences, University of Naples "Federico II", Naples, Italy
| | - David Della-Morte
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy.,San Raffaele Roma Open University, Rome, Italy
| | - Gaetano Gargiulo
- Division of Internal Medicine, AOU San Giovanni di Dio e Ruggi di Aragona, Salerno, Italy
| | - Gianluca Testa
- Department of Translational Medical Sciences, University of Naples "Federico II", Naples, Italy.,Department of Medicine and Health Sciences, University of Molise, Campobasso, Italy
| | - Francesco Cacciatore
- Department of Translational Medical Sciences, University of Naples "Federico II", Naples, Italy.,Azienda Ospedaliera dei Colli, Monaldi Hospital, Heart Transplantation Unit, Naples, Italy
| | - Domenico Bonaduce
- Department of Translational Medical Sciences, University of Naples "Federico II", Naples, Italy
| | - Pasquale Abete
- Department of Translational Medical Sciences, University of Naples "Federico II", Naples, Italy
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29
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Hawkins RB, Mehaffey JH, Charles EJ, Kern JA, Lim DS, Teman NR, Ailawadi G. Psoas Muscle Size Predicts Risk-Adjusted Outcomes After Surgical Aortic Valve Replacement. Ann Thorac Surg 2018. [PMID: 29530777 DOI: 10.1016/j.athoracsur.2018.02.010] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Frailty is an important predictor of outcomes after cardiac surgery, but utility is limited by difficult assessment and quantification. We hypothesize that sarcopenia defined as psoas muscle cross-sectional area is a useful predictor of surgical aortic valve replacement outcomes in moderate to high-risk patients. METHODS Moderate to high risk patients (predicted risk of mortality greater than 3%) who underwent surgical aortic valve replacement with or without coronary artery bypass were extracted from an institutional database (2009 to 2016). Psoas index was calculated as the cross-sectional area of the psoas muscle at the L4 vertebral level normalized to body surface area. Patients were stratified by sarcopenia status, defined as less than 25th sex-specific percentile. Multivariable regression analysis identified risk-adjusted associations with psoas index using The Society of Thoracic Surgeons predicted risk scores. RESULTS Of the 240 patients included, the median predicted risk of mortality was 6%, median age 80 years, and 40% were female. Patients with (33.3%) and without (66.7%) sarcopenia had equivalent baseline risk (median predicted risk of mortality 5.7% versus 6.0%, p = 0.29). Patients with sarcopenia had higher 1-year mortality (31.9% versus 16.9% p = 0.03). Psoas index significantly predicted risk-adjusted 1-year mortality (odds ratio 0.84, p = 0.02) and long-term mortality (hazard ratio 0.92, p = 0.04), as well as risk-adjusted major morbidity, prolonged ventilation, length of stay, discharge to a facility, and hospital cost. Finally, psoas index measurements were highly reproducible (Pearson correlation coefficient 0.944). CONCLUSIONS Psoas index is an easily obtained and reproducible measure of frailty that predicts risk-adjusted resource utilization, morbidity, and long-term mortality. Psoas index may improve procedural selection and risk adjustment in high-risk patients with aortic valve disease.
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Affiliation(s)
- Robert B Hawkins
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Virginia, Charlottesville, Virginia; Center for Health Policy, University of Virginia, Charlottesville, Virginia
| | - J Hunter Mehaffey
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Virginia, Charlottesville, Virginia; Center for Health Policy, University of Virginia, Charlottesville, Virginia
| | - Eric J Charles
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Virginia, Charlottesville, Virginia; Center for Health Policy, University of Virginia, Charlottesville, Virginia
| | - John A Kern
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Virginia, Charlottesville, Virginia
| | - D Scott Lim
- Department of Cardiology, University of Virginia, Charlottesville, Virginia
| | - Nicholas R Teman
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Virginia, Charlottesville, Virginia
| | - Gorav Ailawadi
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Virginia, Charlottesville, Virginia.
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30
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Lurz E, Quammie C, Englesbe M, Alonso EM, Lin HC, Hsu EK, Furuya KN, Gupta NA, Venkat VL, Daniel JF, Leonis MA, Miloh T, Telega GW, Yap J, Menendez J, Book LS, Himes RW, Sundaram SS, Parekh R, Sonnenday C, Bucuvalas J, Ng VL, Kamath BM. Frailty in Children with Liver Disease: A Prospective Multicenter Study. J Pediatr 2018; 194:109-115.e4. [PMID: 29478492 DOI: 10.1016/j.jpeds.2017.10.066] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Revised: 10/02/2017] [Accepted: 10/26/2017] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To assess frailty, a measure of physiologic declines in multiple organ systems, in children with chronic liver disease using a novel pediatric frailty tool. STUDY DESIGN We performed a prospective cross-sectional multicenter study at 17 liver transplantation (LT) centers. 71 children (5-17 years of age), 36 with compensated chronic liver disease (CCLD) and 35 with end-stage liver disease (ESLD) and listed for LT, were assessed for frailty using validated pediatric tools to assess the 5 classic Fried Frailty Criteria-slowness, weakness, exhaustion, diminished physical activity, and shrinkage. Test scores were translated to age- and sex-dependent z scores, generating a maximum frailty score of 10. RESULTS The median frailty score of the cohort was 4 (IQR 3, 5). Subjects with ESLD had significantly higher frailty scores (median 5; IQR 4, 7) than subjects with CCLD (median 3; IQR 2, 4); (P < .0001). Area under the curve receiver operating characteristic for frailty scores to discriminate between ESLD and CCLD was 0.83 (95% CI 0.73, 0.93). Forty-six percent of children with ESLD were frail and there was no correlation between pediatric frailty scores and physician's global assessments (r = -0.24, 95% CI -0.53, 0.10). CONCLUSIONS A novel frailty tool assessed additional dimensions of health, not captured by standard laboratory measures and identified the sickest individuals among a cohort of children with chronic liver disease. This tool may have applicability to other children with chronic disease.
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Affiliation(s)
- Eberhard Lurz
- Division of Gastroenterology, Hepatology and Nutrition, Division of Nephrology, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Pediatric, University of Toronto, Toronto, Ontario, Canada
| | - Claudia Quammie
- Division of Gastroenterology, Hepatology and Nutrition, Division of Nephrology, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Pediatric, University of Toronto, Toronto, Ontario, Canada
| | - Michael Englesbe
- Department of Transplantation Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Estella M Alonso
- Division of Gastroenterology, Hepatology and Nutrition, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Henry C Lin
- Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Evelyn K Hsu
- Division of Gastroenterology, Hepatology and Nutrition, University of Washington-Seattle Children's Hospital, Seattle, WA, USA
| | - Katryn N Furuya
- Division of Gastroenterology, Hepatology and Nutrition, Alfred I. duPont Hospital for Children, Wilmington, NC, USA; Division of Gastroenterology, Hepatology and Nutrition, Mayo clinic, Rochester, MN, USA
| | - Nitika A Gupta
- Division of Gastroenterology, Hepatology and Nutrition, Children's Healthcare of Atlanta Emory University School of Medicine, Atlanta, GA, USA
| | - Veena L Venkat
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - James F Daniel
- Division of Pediatric Gastroenterology, Children's Mercy Hospital, Kansas City, MO, USA
| | - Mike A Leonis
- Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Tamir Miloh
- Division of Gastroenterology, Hepatology and Nutrition, Phoenix Children's Hospital, Phoenix, AZ, USA; Division of Gastroenterology, Hepatology and Nutrition, Texas Children's Hospital, Houston, TX, USA
| | - Grzegorz W Telega
- Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Wisconsin, Milwaukee, WI, USA
| | - Jason Yap
- Division of Gastroenterology, Hepatology and Nutrition, Stollery Children's Hospital/Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Jerome Menendez
- Division of Pediatric Gastroenterology, Levine Children's Hospital Carolinas Health Care Center, Charlotte, NC, USA
| | - Linda S Book
- Division of Pediatric Gastroenterology, Primary Children's Hospital, Salt Lake, UT, USA
| | - Ryan W Himes
- Division of Gastroenterology, Hepatology and Nutrition, Texas Children's Hospital, Houston, TX, USA
| | - Shikha S Sundaram
- Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital Colorado, Aurora, CO, USA
| | - Rulan Parekh
- Division of Gastroenterology, Hepatology and Nutrition, Division of Nephrology, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Pediatric, University of Toronto, Toronto, Ontario, Canada
| | - Chris Sonnenday
- Department of Transplantation Surgery, University of Michigan, Ann Arbor, MI, USA
| | - John Bucuvalas
- Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Vicky L Ng
- Division of Gastroenterology, Hepatology and Nutrition, Division of Nephrology, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Pediatric, University of Toronto, Toronto, Ontario, Canada
| | - Binita M Kamath
- Division of Gastroenterology, Hepatology and Nutrition, Division of Nephrology, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Pediatric, University of Toronto, Toronto, Ontario, Canada.
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32
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Wang HT, Fafard J, Ahern S, Vendittoli PA, Hebert P. Frailty as a predictor of hospital length of stay after elective total joint replacements in elderly patients. BMC Musculoskelet Disord 2018; 19:14. [PMID: 29338705 PMCID: PMC5771036 DOI: 10.1186/s12891-018-1935-8] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Accepted: 01/11/2018] [Indexed: 01/21/2023] Open
Abstract
Background Total joint replacement procedures are increasing in number because of population aging and osteoarthritis development. Defined as a lack of physiological reserves and the inability to adequately respond to external stressors, frailty may be more common than expected in older patients with degenerative arthritis awaiting total joint replacements. The aim of the present study was to assess associations between frailty and adverse outcomes, frailty prevalence among elderly patients awaiting elective TJR, and agreement between 2 frailty screening instruments. Methods We undertook a prospective, observational, pilot study in our institution. We enrolled patients 65 years or older who were awaiting elective knee or hip replacement surgery and evaluated them in our preoperative clinic with planned postoperative hospital length of stay greater than 24 h. Patients were asked to grade their perceived well-being on the Clinical Frailty Scale and to answer questions on the FRAIL Scale. Results The Clinical Frailty Scale classified 40 patients (45.9%) as robust, 43 patients (49.4%) as prefrail and 4 patients (4.5%) as frail, while the FRAIL Scale categorized 12 patients (13.7%) as robust, 54 patients (62.0%) as prefrail, and 20 patients (22.9%) as frail. Robustness, ascertained on the Clinical Frailty Scale was, while the FRAIL Scale was not, significantly associated with shorter hospital length of stay and fewer discharges to the rehabilitation center. Both scales showed moderate mutual agreement. Conclusion Screening for frailty identified between 5% and 10% of patients at risk of adverse outcomes. The Clinical Frailty Scale was, while the FRAIL scale was not, significantly associated with hospital length of stay and discharge to rehabilitation center in our cohort of total joint replacement patients.
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Affiliation(s)
- Han Ting Wang
- Department of Internal medicine and Critical Care Medicine, Centre Integre Universitaire de Sante et Services Sociaux (CIUSSS) de l'est de l'île de Montréal, Hopital Maisonneuve-Rosemont, 5415 boul. l'Assomption, H1T 2M4, Montreal, Quebec, Canada.
| | - Josée Fafard
- Department of Internal medicine and Critical Care Medicine, Centre Integre Universitaire de Sante et Services Sociaux (CIUSSS) de l'est de l'île de Montréal, Hopital Maisonneuve-Rosemont, 5415 boul. l'Assomption, H1T 2M4, Montreal, Quebec, Canada
| | - Stéphane Ahern
- Department of Internal medicine and Critical Care Medicine, Centre Integre Universitaire de Sante et Services Sociaux (CIUSSS) de l'est de l'île de Montréal, Hopital Maisonneuve-Rosemont, 5415 boul. l'Assomption, H1T 2M4, Montreal, Quebec, Canada
| | - Pascal-André Vendittoli
- Department of Surgery, Centre Integre Universitaire de Sante et Services Sociaux (CIUSSS) de l'est de l'île de Montréal, Hôpital Maisonneuve-Rosemont, 5415 boul. l'Assomption, H1T 2M4, Montreal, Quebec, Canada
| | - Paul Hebert
- Departments of Medicine and Critical Care Medicine and Centre de recherche, Centre hospitalier de l'Université de Montréal (CRCHUM), 900 St-Denis, H2X 0A9, Montréal, Québec, Canada
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Song M, Xia L, Liu Q, Sun M, Wang F, Yang C. Sarcopenia in Liver Disease: Current Evidence and Issues to Be sResolved. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2018; 1088:413-433. [PMID: 30390263 DOI: 10.1007/978-981-13-1435-3_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Sarcopenia is a common clinical symptom in aging and patients with wasting diseases, characterized by a decreased skeletal muscle mass. As a consequence of lifestyle change, the nonalcoholic fatty liver disease (NAFLD) presents a rising trend. In the past three decades, increasing evidence has proved that sarcopenia is related to NAFLD. In this chapter, we will summarize the emerging evidence of the predictive role of sarcopenia in NAFLD and review the diagnosis value, feasible mechanism, and therapy strategies of sarcopenia in NAFLD. Sarcopenia is a potential risk factor for NAFLD, and targeting sarcopenia can benefit NAFLD to some extent.
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Affiliation(s)
- Meiyi Song
- Division of Gastroenterology and Hepatology, Digestive Disease Institute, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Lu Xia
- Division of Gastroenterology and Hepatology, Digestive Disease Institute, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Qi Liu
- Department of Endocrinology, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Mengxue Sun
- Division of Gastroenterology and Hepatology, Digestive Disease Institute, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Fei Wang
- Division of Gastroenterology and Hepatology, Digestive Disease Institute, Tongji Hospital, Tongji University School of Medicine, Shanghai, China.
| | - Changqing Yang
- Division of Gastroenterology and Hepatology, Digestive Disease Institute, Tongji Hospital, Tongji University School of Medicine, Shanghai, China.
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Yamashita M, Kamiya K, Matsunaga A, Kitamura T, Hamazaki N, Matsuzawa R, Nozaki K, Tanaka S, Nakamura T, Maekawa E, Masuda T, Ako J, Miyaji K. Prognostic Value of Psoas Muscle Area and Density in Patients Who Undergo Cardiovascular Surgery. Can J Cardiol 2017; 33:1652-1659. [PMID: 29173605 DOI: 10.1016/j.cjca.2017.10.009] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Revised: 10/02/2017] [Accepted: 10/02/2017] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Low skeletal muscle density, determined using computed tomography (CT), has yet to be examined in terms of muscle function and prognostic capability in patients who require open cardiovascular surgery. This study was performed to examine whether psoas muscle area and density, determined using CT, are associated with postoperative mortality in patients who undergo cardiovascular surgery. METHODS We reviewed the findings in 773 consecutive patients who underwent preoperative CT imaging, including the level of the third lumbar vertebra for clinical purposes. We measured grip strength, gait speed, and 6-minute walking distance to assess muscle function before hospital discharge. Skeletal muscle area was calculated from psoas muscle cross-sectional area (in squared centimeters) on preoperative CT images at the level of the third lumbar vertebra divided by the square of the patient's height in metres to give the skeletal muscle index (SMI). Skeletal muscle density determined by muscle attenuation (MA) was calculated by measuring the average Hounsfield units of the psoas muscle cross-sectional area. RESULTS The mean age of the study population was 65.0 ± 13.1 years, and 64.7% of the patients were male. Multivariate logistic regression analysis and multivariate Cox regression analysis showed that low MA, but not SMI, was significantly associated with muscle function, and all-cause mortality (P < 0.05). Kaplan-Meier analysis showed that low MA, but not low SMI, predicted mortality (P = 0.014). CONCLUSIONS Low skeletal muscle density, but not skeletal muscle area, predicted poorer muscle function and mortality in patients who undergo cardiac surgery.
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Affiliation(s)
- Masashi Yamashita
- Department of Rehabilitation Sciences, Kitasato University, Graduate School of Medical Sciences, Sagamihara, Japan
| | - Kentaro Kamiya
- Department of Rehabilitation Sciences, Kitasato University, Graduate School of Medical Sciences, Sagamihara, Japan; Department of Rehabilitation, School of Allied Health Sciences, Kitasato University, Sagamihara, Japan.
| | - Atsuhiko Matsunaga
- Department of Rehabilitation Sciences, Kitasato University, Graduate School of Medical Sciences, Sagamihara, Japan; Department of Rehabilitation, School of Allied Health Sciences, Kitasato University, Sagamihara, Japan
| | - Tadashi Kitamura
- Department of Cardiovascular Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - Nobuaki Hamazaki
- Department of Rehabilitation, Kitasato University Hospital, Sagamihara, Japan; Department of Cardiovascular Medicine, Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan
| | - Ryota Matsuzawa
- Department of Rehabilitation, Kitasato University Hospital, Sagamihara, Japan
| | - Kohei Nozaki
- Department of Rehabilitation, Kitasato University Hospital, Sagamihara, Japan
| | - Shinya Tanaka
- Department of Cardiovascular Medicine, Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan
| | - Takeshi Nakamura
- Department of Cardiovascular Medicine, Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan
| | - Emi Maekawa
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Japan
| | - Takashi Masuda
- Department of Rehabilitation, School of Allied Health Sciences, Kitasato University, Sagamihara, Japan; Department of Cardiovascular Medicine, Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan
| | - Junya Ako
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Japan
| | - Kagami Miyaji
- Department of Cardiovascular Surgery, Kitasato University School of Medicine, Sagamihara, Japan
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Graham MM, Simpson CS. Aging Well in an Era of High-Tech Cardiovascular Care. Can J Cardiol 2017; 33:961-962. [PMID: 28666615 DOI: 10.1016/j.cjca.2017.05.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 05/17/2017] [Accepted: 05/17/2017] [Indexed: 01/26/2023] Open
Affiliation(s)
- Michelle M Graham
- Division of Cardiology and Department of Medicine, University of Alberta and Mazankowski Alberta Heart Institute, Edmonton, Alberta, Canada.
| | - Christopher S Simpson
- Division of Cardiology and Department of Medicine, Queen's University, Edmonton and Kingston, Canada
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Talbot-Hamon C, Afilalo J. Transcatheter Aortic Valve Replacement in the Care of Older Persons with Aortic Stenosis. J Am Geriatr Soc 2017; 65:693-698. [DOI: 10.1111/jgs.14776] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
- Catherine Talbot-Hamon
- Division of Geriatric Medicine; McGill University; Montreal Quebec
- Department of Epidemiology, Biostatistics, and Occupational Health; McGill University; Montreal Quebec
| | - Jonathan Afilalo
- Division of Cardiology; Jewish General Hospital; McGill University; Montreal Quebec
- Department of Epidemiology, Biostatistics, and Occupational Health; McGill University; Montreal Quebec
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Abstract
PURPOSE OF THE REVIEW The number of adults who are aging successfully and have HIV infection is increasing. More effective antiretroviral therapy (ART) regimens are preventing individuals infected with HIV from reaching end stages of the HIV infection and developing AIDS (acquired immunodeficiency syndrome). However, even at lower viral loads, chronic HIV infection appears to have consequences on aging processes, including the development of frailty. RECENT FINDINGS Frailty is a term used to describe vulnerability in aging. Frailty indices such as the Fried Frailty Index (FFI), the Veterans Aging Cohort Study (VACS) Index, and the Center for Epidemiologic Studies Depression scale (CES-D), an index of emotional frailty, associate with or predict clinical outcomes and death. However, even among existing frailty definitions, components require rigorous and consistent standardization. In the Women's Interagency HIV Study (WIHS), we have shown that frailty does not exist in isolation, even in midlife, and we use frailty to predict death. Frailty indices should be systematically used by health professionals to evaluate health and future risks for adverse events. Frailty prevention efforts, especially among those with HIV infection, appear to be essential for "successful aging" or aging without disability or loss of independence and may prevent HIV transmission. Taking care of elderly people is one of the major challenges of this century, and we must expect and be prepared for an increase in the number of aging adults, some of whom are patients with many co-morbidities and HIV infection.
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Affiliation(s)
- Marion Thurn
- Department of Neurology, State University of New York Downstate Medical Center, 450 Clarkson Avenue, Box 1213, Brooklyn, NY, 11203, USA
| | - Deborah R Gustafson
- Department of Neurology, State University of New York Downstate Medical Center, 450 Clarkson Avenue, Box 1213, Brooklyn, NY, 11203, USA.
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