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Uchmanowicz I, Młynarska A, Lisiak M, Kałużna-Oleksy M, Wleklik M, Chudiak A, Dudek M, Migaj J, Hinterbuchner L, Gobbens R. Heart Failure and Problems with Frailty Syndrome: Why it is Time to Care About Frailty Syndrome in Heart Failure. Card Fail Rev 2019; 5:37-43. [PMID: 30847244 PMCID: PMC6396065 DOI: 10.15420/cfr.2018.37.1] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Frailty syndrome (FS) is an independent predictor of mortality in cardiovascular disease and is found in 15–74% of patients with heart failure (HF). The syndrome has a complex, multidimensional aetiology and contributes to adverse outcomes. Proper FS diagnosis and treatment determine prognosis and support the evaluation of treatment outcomes. Routine FS assessment for HF patients should be included in daily clinical practice as an important prognostic factor within a holistic process of diagnosis and treatment. Multidisciplinary team members, particularly nurses, play an important role in FS assessment in hospital and primary care settings, and in the home care environment. Raising awareness of concurrent FS in patients with HF patients and promoting targeted interventions may contribute to a decreased risk of adverse events, and a better prognosis and quality of life.
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Affiliation(s)
- Izabella Uchmanowicz
- Department of Clinical Nursing, Faculty of Health Science, Wroclaw Medical University Poland
| | - Agnieszka Młynarska
- Department of Gerontology and Geriatric Nursing, School of Health Sciences, Medical University of Silesia Poland
| | - Magdalena Lisiak
- Department of Clinical Nursing, Faculty of Health Science, Wroclaw Medical University Poland
| | | | - Marta Wleklik
- Department of Clinical Nursing, Faculty of Health Science, Wroclaw Medical University Poland
| | - Anna Chudiak
- Department of Clinical Nursing, Faculty of Health Science, Wroclaw Medical University Poland
| | - Magdalena Dudek
- Department of Cardiology, Poznan University of Medical Sciences Poland
| | - Jacek Migaj
- Department of Cardiology, Poznan University of Medical Sciences Poland
| | - Lynne Hinterbuchner
- Department for Internal Medicine and Cardiology, Salzburg University Hospital Austria
| | - Robbert Gobbens
- Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences Amsterdam, the Netherlands.,Zonnehuisgroep Amstelland, Amstelveen the Netherlands.,Department of Primary and Interdisciplinary Care, Faculty of Medicine and Health Sciences, University of Antwerp Antwerp, Belgium
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Veronese N, Stubbs B, Noale M, Solmi M, Pilotto A, Vaona A, Demurtas J, Mueller C, Huntley J, Crepaldi G, Maggi S. Polypharmacy Is Associated With Higher Frailty Risk in Older People: An 8-Year Longitudinal Cohort Study. J Am Med Dir Assoc 2017; 18:624-628. [PMID: 28396180 PMCID: PMC5484754 DOI: 10.1016/j.jamda.2017.02.009] [Citation(s) in RCA: 122] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Accepted: 02/10/2017] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To investigate whether polypharmacy is associated with a higher incidence of frailty in a large cohort of North Americans during 8 years of follow-up. DESIGN Longitudinal study, follow-up of 8 years. PARTICIPANTS A total of 4402 individuals at high risk or having knee osteoarthritis free from frailty at baseline. MEASUREMENTS Details regarding medication prescription were captured and categorized as 0-3, 4-6, and ≥7. Frailty was defined using the Study of Osteoporotic Fracture index as the presence of ≥2 out of (1) weight loss ≥5% between baseline and the subsequent follow-up visit; (2) inability to do 5 chair stands; and (3) low energy level according to the Study of Osteoporotic Fracture definition. Cox's regression models calculating a hazard ratio (HR) with 95% confidence intervals (CIs), adjusted for potential confounders, were undertaken. RESULTS During the 8-year follow-up, from 4402 participants at baseline, 361 became frail. Compared with participants taking 0-3 medications, the incidence of frailty was approximately double in those taking 4-6 medications and 6 times higher in people taking ≥7 medications. After adjusting for 11 potential baseline confounders, participants using 4-6 medications had a higher risk of frailty of 55% (HR = 1.55; 95% CI 1.22-1.96; P < .0001), whereas those using more than 7 drugs were at approximately 147% (HR = 2.47; 95% CI 1.78-3.43; P < .0001). Each additional drug used at the baseline increased the risk of frailty at the follow-up of 11% (HR = 1.11; 95% CI 1.07-1.15; P < .0001). CONCLUSIONS Polypharmacy is associated with a higher incidence of frailty over 8-year follow-up period. Our data suggest evidence of a dose response relationship. Future research is required to confirm our findings and explore underlying mechanisms.
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Affiliation(s)
- Nicola Veronese
- National Research Council, Neuroscience Institute, Aging Branch, Padua, Italy; Institute for clinical Research and Education in Medicine, IREM, Padua, Italy; Department of Geriatric Care, OrthoGeriatrics and Rehabilitation, E.O. Galliera Hospital, Genova, Italy.
| | - Brendon Stubbs
- South London and Maudsley NHS Foundation Trust, Denmark Hill, London, United Kingdom; Faculty of Health, Social care and Education, Anglia Ruskin University, Chelmsford, United Kingdom; Institute of Psychiatry, Psychology and Neuroscience (IoPPN) King's College London, London, United Kingdom
| | - Marianna Noale
- National Research Council, Neuroscience Institute, Aging Branch, Padua, Italy
| | - Marco Solmi
- Institute for clinical Research and Education in Medicine, IREM, Padua, Italy; Department of Neurosciences, University of Padova, Padova, Italy
| | - Alberto Pilotto
- Department of Geriatric Care, OrthoGeriatrics and Rehabilitation, E.O. Galliera Hospital, Genova, Italy
| | - Alberto Vaona
- Primary Care Department, Azienda ULSS20 Verona, Verona, Italy
| | - Jacopo Demurtas
- Primary Care Department, Azienda USL Toscana Sud Est, Grosseto, Italy
| | - Christoph Mueller
- South London and Maudsley NHS Foundation Trust, Denmark Hill, London, United Kingdom; Institute of Psychiatry, Psychology and Neuroscience (IoPPN) King's College London, London, United Kingdom
| | - Jonathan Huntley
- South London and Maudsley NHS Foundation Trust, Denmark Hill, London, United Kingdom; Institute of Psychiatry, Psychology and Neuroscience (IoPPN) King's College London, London, United Kingdom
| | - Gaetano Crepaldi
- National Research Council, Neuroscience Institute, Aging Branch, Padua, Italy
| | - Stefania Maggi
- National Research Council, Neuroscience Institute, Aging Branch, Padua, Italy
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Veronese N, Cereda E, Stubbs B, Solmi M, Luchini C, Manzato E, Sergi G, Manu P, Harris T, Fontana L, Strandberg T, Amieva H, Dumurgier J, Elbaz A, Tzourio C, Eicholzer M, Rohrmann S, Moretti C, D'Ascenzo F, Quadri G, Polidoro A, Lourenço RA, Moreira VG, Sanchis J, Scotti V, Maggi S, Correll CU. Risk of cardiovascular disease morbidity and mortality in frail and pre-frail older adults: Results from a meta-analysis and exploratory meta-regression analysis. Ageing Res Rev 2017; 35:63-73. [PMID: 28143778 PMCID: PMC6047747 DOI: 10.1016/j.arr.2017.01.003] [Citation(s) in RCA: 161] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Revised: 12/22/2016] [Accepted: 01/23/2017] [Indexed: 12/30/2022]
Abstract
Frailty is common and associated with poorer outcomes in the elderly, but its role as potential cardiovascular disease (CVD) risk factor requires clarification. We thus aimed to meta-analytically evaluate the evidence of frailty and pre-frailty as risk factors for CVD. Two reviewers selected all studies comparing data about CVD prevalence or incidence rates between frail/pre-frail vs. robust. The association between frailty status and CVD in cross-sectional studies was explored by calculating and pooling crude and adjusted odds ratios (ORs) ±95% confidence intervals (CIs); the data from longitudinal studies were pooled using the adjusted hazard ratios (HRs). Eighteen cohorts with a total of 31,343 participants were meta-analyzed. Using estimates from 10 cross-sectional cohorts, both frailty and pre-frailty were associated with higher odds of CVD than robust participants. Longitudinal data were obtained from 6 prospective cohort studies. After a median follow-up of 4.4 years, we identified an increased risk for faster onset of any-type CVD in the frail (HR=1.70 [95%CI, 1.18-2.45]; I2=66%) and pre-frail (HR=1.23 [95%CI, 1.07-1.36]; I2=67%) vs. robust groups. Similar results were apparent for time to CVD mortality in the frail and pre-frail groups. In conclusion, frailty and pre-frailty constitute addressable and independent risk factors for CVD in older adults.
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Affiliation(s)
- Nicola Veronese
- Department of Medicine (DIMED), Geriatrics Division, University of Padova, Italy; Institute for Clinical Research and Education in Medicine (IREM), Padova, Italy; National Research Council, Neuroscience Institute-Aging Branch, Padova, Italy.
| | - Emanuele Cereda
- Nutrition and Dietetics Service, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Brendon Stubbs
- Physiotherapy Department, South London and Maudsley NHS FoundationTrust, Denmark Hill, London SE5 8AZ, United Kingdom; Health Service and Population Research Department, Institute of Psychiatry, King's College London, De Crespigny Park, London SE5 8AF, United Kingdom; Health, Social Care and Education, Anglia Ruskin University, Chelmsford, United Kingdom
| | - Marco Solmi
- Institute for Clinical Research and Education in Medicine (IREM), Padova, Italy; Department of Neurosciences, University of Padova, Padova, Italy; National Health Care System, Monselice, Padova Local Unit ULSS 17, Italy
| | - Claudio Luchini
- Department of Pathology and Diagnostics, University and Hospital Trust of Verona, Verona, Italy; Surgical Pathology Unit, Santa Chiara Hospital, Trento, Italy
| | - Enzo Manzato
- Department of Medicine (DIMED), Geriatrics Division, University of Padova, Italy; National Research Council, Neuroscience Institute-Aging Branch, Padova, Italy
| | - Giuseppe Sergi
- Department of Medicine (DIMED), Geriatrics Division, University of Padova, Italy
| | - Peter Manu
- South Oaks Hospital, Northwell Health,400 Sunsrise Highway, Amityville, NY 11701, USA
| | - Tamara Harris
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, National Institutes of Health, Bethesda, MD, USA
| | - Luigi Fontana
- Division of Geriatrics and Nutritional Sciences and Center for Human Nutrition, Washington University School of Medicine, St. Louis, MO, USA; Department of Clinical and Experimental Sciences, Brescia University, Brescia, Italy; CEINGE Biotecnologie Avanzate, Napoli, Italy
| | - Timo Strandberg
- University of Helsinki and Helsinki University Hospital, Helsinki, Finland; University of Oulu,Center for Life Course Health Research, Oulu, Finland
| | - Helene Amieva
- Centre de Recherche Inserm, Bordeaux, France; University Victor Segalen Bordeaux 2, Bordeaux, France
| | - Julien Dumurgier
- CMRR Paris Nord AP-HP, Groupe Hospitalier Lariboisière Fernand-Widal Saint-Louis, INSERM, U942, Université Paris Diderot, Sorbonne Paris Cité, UMRS 942, Paris, France
| | - Alexis Elbaz
- CESP, Univ. Paris-Sud, UVSQ, INSERM, Université Paris-Saclay, Villejuif, France
| | | | - Monika Eicholzer
- University of Zurich, Epidemiology, Biostatistics and Prevention Institute, Division of Chronic Disease Epidemiology, Hirschengraben 84, CH-8001 Zurich, Switzerland
| | - Sabine Rohrmann
- University of Zurich, Epidemiology, Biostatistics and Prevention Institute, Division of Chronic Disease Epidemiology, Hirschengraben 84, CH-8001 Zurich, Switzerland
| | - Claudio Moretti
- Division of Cardiology, Department of Science, Città della Salute e della Scienza, Turin, Italy
| | - Fabrizio D'Ascenzo
- Division of Cardiology, Department of Science, Città della Salute e della Scienza, Turin, Italy
| | - Giorgio Quadri
- Division of Cardiology, Department of Science, Città della Salute e della Scienza, Turin, Italy
| | - Alessandro Polidoro
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
| | - Roberto Alves Lourenço
- Department of Internal Medicine, Faculty of Medical Sciences, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Virgilio Garcia Moreira
- Department of Internal Medicine, Faculty of Medical Sciences, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Juan Sanchis
- Department of Cardiology, Hospital Clínico Universitario, School of Medicine, University of Valencia, Valencia, (CIBER-CV), Spain
| | - Valeria Scotti
- Clinical Epidemiology and Biometric Unit, IRCCS Policlinico S. Matteo Foundation, Pavia, Italy
| | - Stefania Maggi
- National Research Council, Neuroscience Institute-Aging Branch, Padova, Italy
| | - Christoph U Correll
- The Zucker Hillside Hospital, Psychiatry Research, Northwell Health, Glen Oaks, New York, USA; Hofstra Northwell School of Medicine, Hempstead, NY, USA; The Feinstein Institute for Medical Research, Manhasset, NY, USA; Albert Einstein College of Medicine, Bronx, NY, USA
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