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Jiménez-Méndez C, Díez-Villanueva P, Bonanad C, Ortiz-Cortés C, Barge-Caballero E, Goirigolzarri J, Esteban-Fernández A, Pérez-Rivera Á, Cobo M, López J, Sanz-García A, Guerrero C, Pardo HG, Robles C, Iglesias D, Pinilla JMG, Rodríguez LL, Formiga F, Martín-Sánchez FJ, Vidán MT, Ariza A, Martínez-Sellés M, Alfonso F. Frailty and prognosis of older patients with chronic heart failure. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2022; 75:1011-1019. [PMID: 35718066 DOI: 10.1016/j.rec.2022.04.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 04/21/2022] [Indexed: 06/15/2023]
Abstract
INTRODUCTION AND OBJECTIVES Heart failure (HF) is prevalent in advanced ages. Our objective was to assess the impact of frailty on 1-year mortality in older patients with ambulatory HF. METHODS Our data come from the FRAGIC study (Spanish acronym for "Study of the impact of frailty and other geriatric syndromes on the clinical management and prognosis of elderly outpatients with heart failure"), a multicenter prospective registry conducted in 16 Spanish hospitals including outpatients ≥ 75 years with HF followed up by cardiology services in Spain. RESULTS We included 499 patients with a mean age of 81.4±4.3 years, of whom 193 (38%) were women. A total of 268 (54%) had left ventricular ejection fraction <40%, and 84.6% was in NYHA II functional class. The FRAIL scale identified 244 (49%) pre-frail and 111 (22%) frail patients. Frail patients were significantly older, were more frequently female (both, P <.001), and had higher comorbidity according to the Charlson index (P=.017) and a higher prevalence of geriatric syndromes (P <.001). During a median follow-up of 371 [361-387] days, 58 patients (11.6%) died. On multivariate analysis (Cox regression model), frailty detected with the FRAIL scale was marginally associated with mortality (HR=2.35; 95%CI, 0.96-5.71; P=.059), while frailty identified by the visual mobility scale was an independent predictor of mortality (HR=2.26; 95%CI, 1.16-4.38; P=.015); this association was maintained after adjustment for confounding variables (HR=2.13; 95%CI, 1.08-4.20; P=.02). CONCLUSIONS In elderly outpatients with HF, frailty is independently associated with mortality at 1 year of follow-up. It is essential to identify frailty as part of the comprehensive approach to elderly patients with HF.
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Affiliation(s)
| | | | - Clara Bonanad
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - Carolina Ortiz-Cortés
- Servicio de Cardiología, Hospital Universitario San Pedro de Alcántara, Cáceres, Spain
| | - Eduardo Barge-Caballero
- Servicio de Cardiología, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Josebe Goirigolzarri
- Servicio de Cardiología, Hospital Clínico Universitario San Carlos, Madrid, Spain
| | | | - Ángel Pérez-Rivera
- Servicio de Cardiología, Hospital Universitario de Burgos, Burgos, Spain
| | - Marta Cobo
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - Javier López
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Ancor Sanz-García
- Unidad de Análisis de Datos, Instituto de Investigación Sanitaria del Hospital Universitario de La Princesa, Madrid, Spain
| | - Carmen Guerrero
- Servicio de Cardiología, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Héctor García Pardo
- Servicio de Cardiología, Hospital Universitario Río Hortega, Valladolid, Spain
| | - Carolina Robles
- Servicio de Cardiología, Complejo Hospitalario de Toledo, Toledo, Spain
| | - Diego Iglesias
- Servicio de Cardiología, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, Spain
| | - José Manuel García Pinilla
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Unidad de Insuficiencia Cardiaca y Cardiopatías Familiares, Hospital Universitario Virgen de la Victoria, IBIMA, Málaga, Spain
| | | | - Francesc Formiga
- Servicio de Medicina Interna, Hospital de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | | | - María Teresa Vidán
- Servicio de Geriatría, Hospital Universitario Gregorio Marañón, Universidad Complutense, Madrid, Spain; Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (CIBERFES), Spain
| | - Albert Ariza
- Servicio de Cardiología, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Manuel Martínez-Sellés
- Servicio de Cardiología, Hospital Universitario Gregorio Marañón, Universidad Europea, Universidad Complutense, Madrid, Spain
| | - Fernando Alfonso
- Servicio de Cardiología, Hospital Universitario de La Princesa, Madrid, Spain; Servicio de Cardiología, Hospital Universitario San Pedro de Alcántara, Cáceres, Spain
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Baldasseroni S, Silverii MV, Pratesi A, Burgisser C, Orso F, Lucarelli G, Turrin G, Ungar A, Marchionni N, Fattirolli F. Cardiac Rehabilitation in Advanced aGE after PCI for acute coronary syndromes: predictors of exercise capacity improvement in the CR-AGE ACS study. Aging Clin Exp Res 2022; 34:2195-2203. [PMID: 35451734 PMCID: PMC9464170 DOI: 10.1007/s40520-022-02130-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 03/24/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND The positive effect of cardiac rehabilitation (CR) on outcomes after acute coronary syndromes (ACS) is established. Nevertheless, enrollment rates into CR programs remain low, although ACS carry a high risk of functional decline particularly in the elderly. AIM We aimed to determine if a multidisciplinary CR improves exercise capacity in an older population discharged after ACS systematically treated with PCI. METHODS CR-AGE ACS is a prospective, single-center, cohort study. All patients aged 75+ years consecutively referred to Cardiac Rehabilitation outpatient Unit at Careggi University Hospital, were screened for eligibility. Moderate/severe cognitive impairment, disability in 2+ basic activities of daily living, musculoskeletal diseases, contraindication to Cardiopulmonary Exercise Test, and diseases with an expected survival < 6 months, were exclusion criteria. Participants attended a CR program, based on 5-day-per-week aerobic training sessions for 4 weeks. RESULTS We enrolled 253 post-ACS patients with a mean age 80.6 ± 4.4 years. After CR, 136 (56.2%) 77 (31.3%) patients obtained, respectively, at least a moderate (∆+5%) or an optimal (∆+15%) increase in VO2peak. Baseline VO2peak (- 1 ml/kg/min: OR 1.18; 95% CI 1.09-1.28), the number of training sessions (+1 session: OR 1.07; 95% CI 1.01-1.15), and mild-to-moderate baseline disability (yes vs. no: OR 0.22; 95% CI 0.01-0.57) were the predictors of VO2peak changes. CONCLUSIONS A CR program started early after discharge from ACS produces a significant increase in exercise capacity in very old patients with mild-to-moderate post-acute physical impairment. Baseline VO2peak, the number of training sessions, and the level of baseline disability are the independent predictors of improvement.
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Affiliation(s)
- Samuele Baldasseroni
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Cardiac Rehabilitation Unit, Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3; 50134, Florence, Italy
| | | | - Alessandra Pratesi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Costanza Burgisser
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Cardiac Rehabilitation Unit, Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3; 50134, Florence, Italy
| | - Francesco Orso
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Cardiac Rehabilitation Unit, Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3; 50134, Florence, Italy
| | - Giulia Lucarelli
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Giada Turrin
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Andrea Ungar
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Cardiac Rehabilitation Unit, Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3; 50134, Florence, Italy
| | - Niccolò Marchionni
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Cardiac Rehabilitation Unit, Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3; 50134, Florence, Italy
| | - Francesco Fattirolli
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.
- Cardiac Rehabilitation Unit, Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3; 50134, Florence, Italy.
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