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Zhu W, Zhao X, Xu Q, Xue Y. Associations of cognitive impairment and functional limitation with all-cause mortality risk in older adults: A population-based study from the National Health and Nutrition Examination Survey. APPLIED NEUROPSYCHOLOGY. ADULT 2024:1-10. [PMID: 38803116 DOI: 10.1080/23279095.2024.2353867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2024]
Abstract
Cognitive impairment and functional limitation are commonly observed in older adults. They have a complex correlation, and both are risk factors for mortality. This prospective cohort study aimed to explore the independent and joint impact of cognitive impairment and functional limitations on all-cause mortality in older adults. A total of 3,759 participants aged ≥ 60 years who had available information on mortality data, cognitive function, physical function, and covariates were enrolled. Cox proportional hazards regression models were employed to assess the independent and joint impacts of cognitive impairment and functional limitation on all-cause mortality. Smoothing curve fitting was used to show the nonlinear relationship between the Digit Symbol Coding (DSC) score and all-cause mortality. An interaction between cognitive impairment and functional limitation was identified when examining their associations with all-cause mortality. Cognitive impairment and functional limitation independently correlated with all-cause mortality risk even after adjusting for covariates and performing mutual adjustments (HR for cognitive impairment: 1.34, 95% CI 1.15-1.56; HR for functional limitation: 1.50, 95% CI 1.32-1.70). When the DSC score was > 18, as the score increased, the risk of death significantly decreased (HR 0.99, 95% CI 0.98-0.99). Participants with both cognitive impairment and functional limitation had the highest hazard ratio for all-cause mortality (HR 1.98, 95%CI 1.63-2.40). In summary, cognitive impairment and functional limitation independently correlated with increased all-cause mortality risk. A higher DSC score was a protective factor reducing the premature mortality risk. Older adults with cognitive impairment and functional limitation demonstrated the highest all-cause mortality risk.
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Affiliation(s)
- Wenxiu Zhu
- Chongqing General Hospital, Chongqing, China
| | - Xuyan Zhao
- The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qingqin Xu
- Chongqing General Hospital, Chongqing, China
| | - Yun Xue
- Chongqing General Hospital, Chongqing, China
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Adachi T, Iritani N, Kamiya K, Iwatsu K, Kamisaka K, Iida Y, Yamada S. Prognostic effects of cardiac rehabilitation in heart failure patients classified according to physical frailty: A propensity score-matched analysis of a nationwide prospective cohort study. INTERNATIONAL JOURNAL OF CARDIOLOGY. CARDIOVASCULAR RISK AND PREVENTION 2023; 17:200177. [PMID: 36941975 PMCID: PMC10024177 DOI: 10.1016/j.ijcrp.2023.200177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 01/23/2023] [Accepted: 02/09/2023] [Indexed: 03/08/2023]
Abstract
Background Research regarding cardiac rehabilitation (CR) in the prognosis of heart failure (HF) patients and frailty remains lacking. Here, the effects of CR on the 2-year prognosis of HF patients were examined according to their frailty status. Methods This multicenter prospective cohort study enrolled patients hospitalized for HF. Patients who underwent ≥1 session per 2 weeks of CR within 3 months after discharge were categorized in the CR group. Patients were divided in a non-frailty (≤8 points) and physical frailty group (≥9 points) based on their FLAGSHIP frailty score. The score is based on HF prognosis, with a higher score indicating worsened physical frailty. A propensity score-matched analysis was performed to compare survival rates between the two groups according to their physical frailty status. Endpoints included HF re-hospitalization and all-cause mortality during a 2-year follow-up period. Results Of 2697 patients included in the analysis, 285 and 95 matched pairs were distributed in the non-frailty and physical frailty groups, respectively, after propensity-score matching. CR was associated with lower incidence of HF rehospitalization in both non-frailty (hazard ratio 0.65; 95% confidence interval 0.44-0.96; p = 0.032) and physical frailty (0.54; 0.32-0.90; p = 0.019) groups. CR was not associated with all-cause mortality in either group (log-rank test, p > 0.05). Conclusion These findings suggest the effects of CR on reduced HF rehospitalization, regardless of physical frailty status.
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Affiliation(s)
- Takuji Adachi
- Department of Integrated Health Sciences, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Naoki Iritani
- Department of Cardiac Rehabilitation, Toyohashi Heart Center, Toyohashi, Japan
| | - Kuniyasu Kamiya
- Department of Hygiene & Public Health, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| | - Kotaro Iwatsu
- Department of Rehabilitation, Hirakata Kohsai Hospital, Hirakata, Japan
| | - Kenta Kamisaka
- Department of Rehabilitation, Tazuke Kofukai Medical Institute Kitano Hospital, Osaka, Japan
| | - Yuki Iida
- Department of Physical Therapy, Toyohashi SOZO University, Toyohashi, Japan
| | - Sumio Yamada
- Department of Integrated Health Sciences, Nagoya University Graduate School of Medicine, Nagoya, Japan
- Corresponding author. PT Department of Cardiology, Aichi Medical University 1Yazakokarimata, Nagakute, 480TEL, Japan.
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Funaki K, Adachi T, Kameshima M, Fujiyama H, Iritani N, Tanaka C, Sakui D, Hara Y, Sugiura H, Yamada S. Factors Associated With Changes in Objectively Measured Moderate to Vigorous Physical Activity in Patients After Percutaneous Coronary Intervention: A Prospective Cohort Study. J Phys Act Health 2023; 20:279-291. [PMID: 36812917 DOI: 10.1123/jpah.2022-0396] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Revised: 12/03/2022] [Accepted: 01/05/2023] [Indexed: 02/24/2023]
Abstract
BACKGROUND This study aimed to clarify factors affecting changes in moderate to vigorous physical activity (MVPA) in patients 1 to 3 months after undergoing percutaneous coronary intervention (PCI). METHODS In this prospective cohort study, we enrolled patients aged <75 years who underwent PCI. MVPA was objectively measured using an accelerometer at 1 and 3 months after hospital discharge. Factors associated with increased MVPA (≥150 min/wk at 3 mo) were analyzed in participants with MVPA < 150 minutes per week at 1 month. Univariate and multivariate logistic regression analyses were performed to explore variables potentially associated with increasing MVPA, using MVPA ≥ 150 minutes per week at 3 months as the dependent variable. Factors associated with decreased MVPA (<150 min/wk at 3 mo) were also analyzed in participants with MVPA ≥ 150 minutes per week at 1 month. Logistic regression analysis was performed to explore factors of declining MVPA, using MVPA < 150 minutes per week at 3 months as the dependent variable. RESULTS We analyzed 577 patients (median age 64 y, 13.5% female, and 20.6% acute coronary syndrome). Increased MVPA was significantly associated with participation in outpatient cardiac rehabilitation (odds ratio 3.67; 95% confidence interval, 1.22-11.0), left main trunk stenosis (13.0; 2.49-68.2), diabetes mellitus (0.42; 0.22-0.81), and hemoglobin (1.47, per 1 SD; 1.09-1.97). Decreased MVPA was significantly associated with depression (0.31; 0.14-0.74) and Self-Efficacy for Walking (0.92, per 1 point; 0.86-0.98). CONCLUSIONS Identifying patient factors associated with changes in MVPA may provide insight into behavioral changes and help with individualized PA promotion.
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Affiliation(s)
- Kuya Funaki
- Program in Physical and Occupational Therapy, Nagoya University Graduate School of Medicine, Nagoya,Japan
| | - Takuji Adachi
- Department of Integrated Health Sciences, Nagoya University Graduate School of Medicine, Nagoya,Japan
| | | | - Hiroaki Fujiyama
- Department of Cardiac Rehabilitation, Nagoya Heart Center, Nagoya,Japan
| | - Naoki Iritani
- Department of Cardiac Rehabilitation, Toyohashi Heart Center, Toyohashi,Japan
| | - Chikako Tanaka
- Department of Cardiac Rehabilitation, Toyohashi Heart Center, Toyohashi,Japan
| | - Daisuke Sakui
- Department of Cardiac Rehabilitation, Gifu Heart Center, Gifu,Japan
| | - Yasutaka Hara
- Department of Cardiac Rehabilitation, Gifu Heart Center, Gifu,Japan
| | - Hideshi Sugiura
- Department of Integrated Health Sciences, Nagoya University Graduate School of Medicine, Nagoya,Japan
| | - Sumio Yamada
- Department of Cardiology, Aichi Medical University, Nagakute,Japan
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Ashikawa H, Adachi T, Iwatsu K, Kamisaka K, Kamiya K, Uchiyama Y, Yamada S. Physical Frailty May Predict 2-Year Prognosis in Elderly Patients With Acute Myocardial Infarction - A Report From the FLAGSHIP Study. Circ J 2023; 87:490-497. [PMID: 36567107 DOI: 10.1253/circj.cj-22-0515] [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] [Indexed: 12/24/2022]
Abstract
BACKGROUND Elderly patients with acute myocardial infarction (AMI) are a high-risk population for heart failure (HF), but the association between physical frailty and worsening prognosis, including HF development, has not been documented extensively. METHODS AND RESULTS As part of the FLAGSHIP study, we enrolled 524 patients aged ≥70 years hospitalized for AMI and capable of walking at discharge. Physical frailty was assessed using the FLAGSHIP frailty score. The primary outcome was a composite outcome of all-cause death and HF rehospitalization within 2 years after discharge. The secondary outcome was all-cause death and HF rehospitalization. After adjusting for confounders, physical frailty showed a significant association with an increased risk of the composite outcome (hazard ratio [HR]=2.09, 95% confidence interval [CI]: 1.03-4.22, P=0.040). The risk of HF rehospitalization increased with physical frailty, but the association was not statistically significant (HR=2.14, 95% CI: 0.84-5.44, P=0.110). Physical frailty was not associated with an increased risk of all-cause death (HR=1.45, 95% CI: 0.49-4.26, P=0.501). CONCLUSIONS The findings suggest that physical frailty assessment serves as a stratifying tool to identify high-risk populations for post-discharge clinical events among ambulant elderly patients with AMI.
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Affiliation(s)
- Hironobu Ashikawa
- Program in Physical and Occupational Therapy, Nagoya University Graduate School of Medicine
| | - Takuji Adachi
- Department of Integrated Health Sciences, Nagoya University Graduate School of Medicine
| | - Kotaro Iwatsu
- Department of Rehabilitation, Hirakata Kohsai Hospital
| | - Kenta Kamisaka
- Department of Rehabilitation, Tazuke Kofukai Medical Institute Kitano Hospital
| | - Kuniyasu Kamiya
- Department of Hygiene & Public Health, Osaka Medical and Pharmaceutical University
| | - Yasushi Uchiyama
- Department of Integrated Health Sciences, Nagoya University Graduate School of Medicine
| | - Sumio Yamada
- Department of Integrated Health Sciences, Nagoya University Graduate School of Medicine
- Department of Cardiology, Aichi Medical University
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Associations of body mass index and hospital-acquired disability with post-discharge mortality in older patients with acute heart failure. J Geriatr Cardiol 2022; 19:209-217. [PMID: 35464643 PMCID: PMC9002089 DOI: 10.11909/j.issn.1671-5411.2022.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVES To investigate the effect of hospital-acquired disability (HAD) on all-cause mortality after discharge according to the body mass index (BMI) in older patients with acute decompensated heart failure. METHODS We included 408 patients aged ≥ 65 years who were hospitalized for acute decompensated heart failure and had undergone an acute phase of cardiac rehabilitation at the Sakakibara Heart Institute between April 2013 and September 2015 (median age: 82 years, interquartile range (IQR): 76-86; 52% male). Patients were divided into three groups based on BMI at hospital admission: underweight (< 18.5 kg/m2), normal weight (18.5 to 25 kg/m2), and overweight (≥ 25 kg/m2). HAD was defined as a decrease of at least five points at discharge compared to before hospitalization according to the Barthel Index. RESULTS The median follow-up period was 475 (IQR: 292-730) days, and all-cause mortality during the follow-up period was 84 deaths (21%). According to multivariate Cox regression analysis, being underweight (HR: 1.941, 95% CI: 1.134-3.321,P = 0.016) or overweight (HR: 0.371, 95% CI: 0.171-0.803,P = 0.012), with normal BMI as the reference, and HAD (HR: 1.857, 95% CI: 1.062-3.250,P = 0.030) were independently associated with all-cause mortality. Patients with HAD exhibited a significantly lower cumulative survival rate in the underweight group (P = 0.001) and tended to have a lower cumulative survival rate in the normal weight group (P = 0.072). HAD was not significantly associated with cumulative survival in the overweight group (P = 0.392). CONCLUSIONS BMI and HAD independently predicted all-cause mortality after discharge in older patients with acute decompensated heart failure. Furthermore, HAD was significantly associated with higher all-cause mortality after discharge, especially in the underweight group.
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Adachi T, Iritani N, Kamiya K, Iwatsu K, Kamisaka K, Iida Y, Yamada S. Prognostic Effects of Cardiac Rehabilitation in Patients With Heart Failure (from a Multicenter Prospective Cohort Study). Am J Cardiol 2022; 164:79-85. [PMID: 34848049 DOI: 10.1016/j.amjcard.2021.10.038] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 10/04/2021] [Accepted: 10/06/2021] [Indexed: 12/16/2022]
Abstract
The prognostic effects of cardiac rehabilitation (CR) are inconsistent in recent reports on heart failure (HF). Generally, participants in previous trials were relatively young and had HF with reduced ejection fraction. Herein, we examined the effects of CR on HF prognosis using a nationwide cohort study. This multicenter prospective cohort study included hospitalized patients with acute HF or worsening chronic HF. Patients who underwent CR once or more times weekly for 6 months after discharge were included in the CR group. The main study end point was a composite of all-cause mortality and HF rehospitalization during a 2-year follow-up period. We performed propensity score matching to compare the survival rates between the CR and non-CR groups. Of the 2,876 enrolled patients, 313 underwent CR for 6 months. After propensity score matching using confounding factors, 626 patients (313 pairs) were included in the survival analysis (median age: 74 years). CR was associated with a reduced risk of composite outcomes (hazard ratio [HR] 0.66; 95% confidence interval [CI] 0.48 to 0.91; p = 0.011), all-cause mortality (HR 0.53; 95% CI 0.30 to 0.95; p = 0.032), and HF rehospitalization (HR 0.66; 95% CI 47 to 0.92; p = 0.012). Subgroup analysis showed similar CR effects in patients with HF with preserved ejection fraction (≥50%) and HF with reduced ejection fraction (<40%). In the landmark analysis, CR did not reduce the aforementioned end points beyond 6 months after discharge (log-rank test: composite outcomes, p = 0.943; all-cause mortality, p = 0.258; HF rehospitalization, p = 0.831). CR is a standard treatment for HF regardless of HF type; however, further challenges may affect the long-term prognostic effects of CR.
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OUP accepted manuscript. Eur J Cardiovasc Nurs 2022; 21:741-749. [DOI: 10.1093/eurjcn/zvac004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 11/08/2021] [Accepted: 01/12/2022] [Indexed: 11/12/2022]
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Yamada S, Adachi T, Izawa H, Murohara T, Kondo T. Prognostic score based on physical frailty in patients with heart failure: a multicenter prospective cohort study (FLAGSHIP). J Cachexia Sarcopenia Muscle 2021; 12:1995-2006. [PMID: 34595836 PMCID: PMC8718028 DOI: 10.1002/jcsm.12803] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 08/03/2021] [Accepted: 08/23/2021] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND In patients with heart failure (HF), physical frailty should be assessed to enable risk stratification. No conventional frailty criteria have so far been developed considering HF-specific outcomes. This study aimed to propose a frailty-based prognostic score using a nationwide cohort study of Japanese patients with HF. METHODS We analysed 2721 patients hospitalized for HF and capable of walking at discharge (median age: 76 years [interquartile range 67-83], men: 60.5%). Physical frailty was evaluated at discharge using four quantitative measures: usual walking speed, grip strength, Performance Measure for Activities of Daily Living-8 (PMADL-8), and Self-Efficacy for Walking-7 (SEW-7). The primary outcome was a composite of HF rehospitalization and all-cause mortality within 2 years. A cut-off point was identified for each measure using receiver operating characteristic analysis in a derivation cohort (n = 1778). Cox proportional hazards model was used to assign a score to each frailty domain according to the correlation with the endpoint. Patients were divided into four categories according to the sum score, and survival was compared by analysing the Kaplan-Meier curve and Cox proportional hazards model. Cumulative incidences of the events according to frailty categories were compared between the derivation cohort and a validation cohort (n = 943). RESULTS The cut-off value and assigned score of each indicator was determined as follows: usual walking speed < 0.98 m/s = 4 points; grip strength < 30.0 kg (men) or 17.5 kg (women) = 5 points; PMADL-8 ≥ 21 points = 2 points; SEW-7 ≤ 20 points = 3 points. We stratified patients into four categories according to the sum score: Category I, ≤3 points; Categories II, 4-8 points; Category III, 9-13 points; and Category IV, 14 points. The prevalence and cumulative incidence of the composite outcome for Categories I to IV in the derivation cohort were 27.4%, 25.2%, 26.4%, and 21.0%, and 9.5, 16.3, 26.3, and 36.8/100 person-years, respectively. Similar results were confirmed in the validation cohort. In Cox proportional hazards model, frailty categories were associated with the composite outcome independent of potential confounders (hazard ratio [95% confidence interval] in reference to Category I: Categories II, 1.51 [0.84-2.72], P = 0.169; Category III, 2.37 [1.32-4.23], P = 0.004; Category IV, 2.66 [1.45-4.89], P = 0.002). CONCLUSIONS The frailty-based prognostic score proposed in this study was well associated with prognosis and will serve for risk stratification in patients with HF.
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Affiliation(s)
- Sumio Yamada
- Department of Integrated Health SciencesNagoya University Graduate School of MedicineNagoyaJapan
| | - Takuji Adachi
- Department of Integrated Health SciencesNagoya University Graduate School of MedicineNagoyaJapan
| | - Hideo Izawa
- Department of CardiologyFujita Health UniversityToyoakeJapan
| | - Toyoaki Murohara
- Department of CardiologyNagoya University Graduate School of MedicineNagoyaJapan
| | - Takaaki Kondo
- Department of Integrated Health SciencesNagoya University Graduate School of MedicineNagoyaJapan
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Kamisaka K, Kamiya K, Iwatsu K, Iritani N, Imoto S, Adachi T, Iida Y, Yamada S. Impact of weight loss in patients with heart failure with preserved ejection fraction: results from the FLAGSHIP study. ESC Heart Fail 2021; 8:5293-5303. [PMID: 34599855 PMCID: PMC8712923 DOI: 10.1002/ehf2.13619] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 07/12/2021] [Accepted: 09/04/2021] [Indexed: 02/06/2023] Open
Abstract
Aims Weight loss (WL) is a poor prognostic factor for patients with heart failure (HF) with reduced ejection fraction. However, its prognostic impact on patients with HF with preserved ejection fraction (HFpEF) remains unestablished. The evidence regarding the effects of obesity on the prognosis of WL is also unclear. We aimed to identify the risk factors for WL and examine the association between WL and prognosis of HFpEF in obese and non‐obese patients. Methods and results In this multicentre cohort study, the data of 573 patients hospitalized with HFpEF [median age: 78 years (interquartile range, 71–84 years); 49.2% female] were identified from hospital databases. WL was defined as ≥5% weight reduction within 6 months after discharge. Obesity was defined according to Japanese criteria as body mass index ≥25 kg/m2. The main study outcomes were all‐cause mortality and HF rehospitalization between 6 and 24 months after hospital discharge. Logistic regression analysis and Cox proportional hazards regression analysis were performed to identify independent the risk factors associated with WL and to calculate the hazard ratios (HRs) associated with adverse outcomes. The prevalence of obesity at discharge was 21.1%. At 6 month follow‐up, WL occurred in 17.4% and 10.8% of the obese and non‐obese patients, respectively. Onset of WL in non‐obese patients was associated with prior hospitalization for HF [odds ratio (OR) 2.39, 95% confidence interval (CI) 1.22–4.68, P = 0.011] and high levels of brain natriuretic peptide (OR 2.32, CI 1.17–4.60, P = 0.015). In obese patients, WL was associated with the use of mineralocorticoid receptor antagonists (OR 3.26, CI 1.08–9.76, P = 0.03) and vasopressin receptor antagonists (OR 6.61, CI 2.03–21.2, P = 0.001). During 1021.3 person‐years of follow‐up, 31 patients died, and upon 1081.0 person‐years follow‐up, 84 patients required rehospitalization for HF. In proportional hazards analysis, WL was associated with all‐cause mortality (HR 5.12, CI 2.08–12.5, P < 0.001) and HF rehospitalization (HR 2.63, CI 1.38–5.01, P = 0.003) after adjustment for confounders in non‐obese patients, but not in obese patients. Conclusions Weight loss should be considered as an indicator for monitoring worsening of HF condition in non‐obese patients with HFpEF. WL was not associated with adverse events in obese patients with HFpEF, possibly due to appropriate fluid management during follow‐up.
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Affiliation(s)
- Kenta Kamisaka
- Department of Rehabilitation, Kitano Hospital, Osaka, Japan
| | - Kuniyasu Kamiya
- Department of Hygiene and Public Health, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| | - Kotaro Iwatsu
- Department of Rehabilitation, Hirakata Kohsai Hospital, Hirakata, Japan
| | - Naoki Iritani
- Department of Rehabilitation, Toyohashi Heart Center, Toyohashi, Japan
| | - Shota Imoto
- Department of Rehabilitation, Kainan Hospital, Yatomi, Japan
| | - Takuji Adachi
- Department of Integrated Health Sciences, Nagoya University Graduate School of Medicine, 1-1-20, Daiko-minami, Higashi-ku, Nagoya, 4618673, Japan
| | - Yuki Iida
- Department of Physical Therapy, Toyohashi SOZO University School of Health Sciences, Toyohashi, Japan
| | - Sumio Yamada
- Department of Integrated Health Sciences, Nagoya University Graduate School of Medicine, 1-1-20, Daiko-minami, Higashi-ku, Nagoya, 4618673, Japan
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Zhang D, Abraham L, Demb J, Miglioretti DL, Advani S, Sprague BL, Henderson LM, Onega T, Wernli KJ, Walter LC, Kerlikowske K, Schousboe JT, O'Meara ES, Braithwaite D. Function-related Indicators and Outcomes of Screening Mammography in Older Women: Evidence from the Breast Cancer Surveillance Consortium Cohort. Cancer Epidemiol Biomarkers Prev 2021; 30:1582-1590. [PMID: 34078641 DOI: 10.1158/1055-9965.epi-21-0152] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 04/02/2021] [Accepted: 05/19/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Previous reports suggested risk of death and breast cancer varied by comorbidity and age in older women undergoing mammography. However, impacts of functional limitations remain unclear. METHODS We used data from 238,849 women in the Breast Cancer Surveillance Consortium-Medicare linked database (1999-2015) who had screening mammogram at ages 66-94 years. We estimated risk of breast cancer, breast cancer death, and non-breast cancer death by function-related indicator (FRI) which incorporated 16 claims-based items and was categorized as an ordinal variable (0, 1, and 2+). Fine and Gray proportional sub-distribution hazards models were applied with breast cancer and death treated as competing events. Risk estimates by FRI scores were adjusted by age and NCI comorbidity index separately and stratified by these factors. RESULTS Overall, 9,252 women were diagnosed with breast cancer, 406 died of breast cancer, and 41,640 died from non-breast cancer causes. The 10-year age-adjusted invasive breast cancer risk slightly decreased with FRI score [FRI = 0: 4.0%, 95% confidence interval (CI) = 3.8-4.1; FRI = 1: 3.9%, 95% CI = 3.7-4.2; FRI ≥ 2: 3.5%, 95% CI = 3.1-3.9). Risk of non-breast cancer death increased with FRI score (FRI = 0: 18.8%, 95% CI = 18.5-19.1; FRI = 1: 24.4%, 95% CI = 23.9-25.0; FRI ≥ 2: 39.8%, 95% CI = 38.8-40.9]. Risk of breast cancer death was low with minimal differences across FRI scores. NCI comorbidity index-adjusted models and stratified analyses yielded similar patterns. CONCLUSIONS Risk of non-breast cancer death substantially increases with FRI score, whereas risk of breast cancer death is low regardless of functional status. IMPACT Older women with functional limitations should be informed that they may not benefit from screening mammography.
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Affiliation(s)
- Dongyu Zhang
- Department of Epidemiology, University of Florida College of Public Health and Health Professions, Gainesville, Florida.,University of Florida Health Cancer Center, Gainesville, Florida
| | - Linn Abraham
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington
| | - Joshua Demb
- Division of Gastroenterology, Department of Internal Medicine, University of California, San Diego, La Jolla, California
| | - Diana L Miglioretti
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington.,Division of Biostatistics, Department of Public Health Sciences, University of California, Davis, California
| | - Shailesh Advani
- Transplant Education Research Center, Terasaki Institute of Biomedical Innovation, Los Angeles, California
| | - Brian L Sprague
- Department of Surgery, University of Vermont College of Medicine, Burlington, Vermont
| | - Louise M Henderson
- Department of Radiology, University of North Carolina at Chapel Hill, North Carolina
| | - Tracy Onega
- Department of Population Health Sciences, University of Utah, and Huntsman Cancer Institute, Salt Lake City, Utah
| | - Karen J Wernli
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington
| | - Louise C Walter
- Department of Medicine, University of California, San Francisco, San Francisco, California
| | - Karla Kerlikowske
- Department of Medicine, University of California, San Francisco, San Francisco, California.,Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California
| | - John T Schousboe
- Park Nicollet Clinic and HealthPartners Institute, HealthPartners Inc, Bloomington, Minnesota.,Division of Health Policy and Management, University of Minnesota, Minneapolis, Minnesota
| | - Ellen S O'Meara
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington
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Kamiya K, Adachi T, Iwatsu K, Kamisaka K, Iida Y, Iritani N, Yamada S. Association between a pre-admission limitation in walking ability and post-discharge adverse outcomes among hospitalized patients with heart failure: Report from a multicenter prospective cohort study. Int J Cardiol 2021; 337:105-112. [PMID: 33991566 DOI: 10.1016/j.ijcard.2021.05.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 04/06/2021] [Accepted: 05/10/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND Although limited walking ability at discharge is a known risk factor for adverse outcomes in older patients with heart failure (HF), the association between pre-admission limitations and adverse outcomes is unknown. Therefore, we evaluated the prevalence of a pre-admission limitation in walking ability and its relationship with post-discharge outcomes among patients with HF with reduced, mid-range, and preserved left-ventricular ejection fraction (HFrEF, HFmrEF, and HFpEF). METHODS We followed 2042 patients aged ≥65 years (HFrEF, n = 668; HFmrEF, n = 360; HFpEF, n = 1014) from a multicenter cohort study in Japan. A limitation in walking ability was defined as the necessity of any assistance or a walking aid. Adverse outcomes were defined as the composite of HF rehospitalization and all-cause death within 2 years after discharge. RESULTS During 2978.0 person-years of follow-up, 563 patients were rehospitalized due to HF exacerbation and 103 patients died. In HFrEF, HFmrEF, and HFpEF groups, the prevalence of a pre-admission limitation in walking ability was 12.1%, 18.6%, and 21.1%, respectively, the crude hazard ratios [95% confidence interval] of a pre-admission limitation in walking ability were 2.46 [1.79-3.39], 1.34 [0.87-2.06], and 1.94 [1.53-2.47], and the adjusted hazard ratios were 2.21 [1.58-3.16], 1.19 [0.75-1.89], and 1.39 [1.06-1.82], respectively. CONCLUSIONS A pre-admission limitation in walking ability is a predictor of post-discharge HF rehospitalization or all-cause death among patients with HFrEF and HFpEF, but not among patients with HFmrEF. Shortly after admission, information regarding pre-admission functional limitations should be obtained to better understand the risk of post-discharge adverse outcomes.
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Affiliation(s)
- Kuniyasu Kamiya
- Department of Hygiene and Public Health, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| | - Takuji Adachi
- Department of Integrated Health Sciences, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kotaro Iwatsu
- Department of Rehabilitation, Hirakata Kosai Hospital, Hirakata, Japan
| | - Kenta Kamisaka
- Department of Rehabilitation, Kitano Hospital, Osaka, Japan
| | - Yuki Iida
- Department of Physical Therapy, Toyohashi SOZO University School of Health Sciences, Toyohashi, Japan
| | - Naoki Iritani
- Department of Rehabilitation, Toyohashi Heart Center, Toyohashi, Japan
| | - Sumio Yamada
- Department of Integrated Health Sciences, Nagoya University Graduate School of Medicine, Nagoya, Japan.
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12
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Castro RRT, Joyce E, Lakdawala NK, Stewart G, Nohria A, Givertz MM, Desai A, Lewis EF, Stevenson LW. Patients report more severe daily limitations than recognized by their physicians. Clin Cardiol 2019; 42:1181-1188. [PMID: 31571248 PMCID: PMC6906987 DOI: 10.1002/clc.23269] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 09/06/2019] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Patient limitations guide selection of heart failure therapies, for which indications often specify New York Heart Association Class. OBJECTIVES To determine the extent of patient-reported limitations during daily activities and compare to New York Heart Association class assigned by providers during the same visit, and to left ventricular ejection fraction (LVEF) group. METHODS AND RESULTS While waiting for their appointment, 948 patients on return visits to an ambulatory HF clinic completed a written questionnaire assessing specific activity limitations, which were compared to physician-assigned NYHA class during the same visit. Patient-reported limitation to perform daily activity ranged from 25% for bathing to 61% for yardwork or housework and 71% for jogging or hurrying. Most patients who did not report limitations to perform daily life activities were correctly classified as NYHA I by the physicians (76%), but 12% of the 376 patients classified as NYHA I reported limitations to showering or bathing and 73% reported limitations while doing yardwork or house work. Limitation to walking was reported by 172 patients (50%) classified as class II. Limitations to walking one block were most common in patients with LVEF ≥40% compared to patients with LVEF <40%, and least commonly, in HF with better EF (improved from 31 ± 13 to 52 ± 7). CONCLUSIONS Activity limitations are commonly reported by ambulatory HF patients, but underestimated by physicians. It is not clear how this should guide therapy validated for NYHA class but focused activity questions may merit wider use to track limitations and improvement in ambulatory HF.
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Affiliation(s)
- Renata R T Castro
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts.,Hospital Naval Marcilio Dias, Rio de Janeiro, Brazil.,School of Medicine, Universidade Iguaçu, Rio de Janeiro, Brazil
| | - Emer Joyce
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Neal K Lakdawala
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Garrick Stewart
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Anju Nohria
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Michael M Givertz
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Akshay Desai
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Eldrin F Lewis
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Lynne W Stevenson
- Cardiomyopathy & Advanced Heart Disease Training, Vanderbilt Heart and Vascular Institute, Nashville, Tennessee
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13
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Kono Y, Izawa H, Aoyagi Y, Ishikawa A, Sugiura T, Mori E, Ueda S, Fujiwara W, Hayashi M, Saitoh E. The difference in determinant factor of six-minute walking distance between sarcopenic and non-sarcopenic elderly patients with heart failure. J Cardiol 2019; 75:42-46. [PMID: 31387751 DOI: 10.1016/j.jjcc.2019.07.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 12/05/2018] [Indexed: 12/15/2022]
Abstract
BACKGROUND The purpose of this study was to identify the factors determining exercise capacity in elderly patients with heart failure (HF) with and without sarcopenia. METHODS We studied 186 consecutive patients with HF who met the criteria of being >60 years, with no physical disability. During hospitalization, we measured the 6-min walking distance (6MWD) and other physical functional parameters and evaluated echocardiographic and laboratory measurements indicating the severity of HF. First, we divided patients into two groups (the sarcopenia group and the nonsarcopenia group) according to the presence of sarcopenia defined as fulfilling more than or equal to two criteria-body mass index <18.5, walking speed <0.8m/s, and grip strength <26kg in males, or <18kg in females. Then the association between the 6MWD and the clinical variables mentioned above was analyzed by univariate and multiple logistic regression analyses. RESULTS The sarcopenia group comprised 77 patients (41.2%). In univariate analysis, age, grip strength, walking speed, and knee extensor muscle strength were significantly correlated with the 6MWD (p<0.05), whereas other clinical parameters were not. In multivariate analysis, walking speed was selected as an independent factor determining the 6MWD in both groups; however, knee extensor muscle strength was selected as an independent factor determining the 6MWD only in the sarcopenia group. CONCLUSION We demonstrated that knee extensor muscle strength was an independent factor determining exercise capacity-especially in elderly patients with HF with sarcopenia, and provided useful information in terms of exercise prescription.
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Affiliation(s)
- Yuji Kono
- Department of Rehabilitation, Fujita Health University Bantane Hospital, Nagoya, Japan
| | - Hideo Izawa
- Department of Cardiology, Fujita Health University Bantane Hospital, Nagoya, Japan.
| | - Yoichiro Aoyagi
- Department of Rehabilitation Medicine I, Fujita Health University, Toyoake, Japan
| | - Ayako Ishikawa
- Department of Rehabilitation, Fujita Health University Bantane Hospital, Nagoya, Japan
| | - Tsubasa Sugiura
- Department of Rehabilitation, Fujita Health University Bantane Hospital, Nagoya, Japan
| | - Etsuko Mori
- Department of Rehabilitation, Fujita Health University Bantane Hospital, Nagoya, Japan
| | - Sayano Ueda
- Department of Cardiology, Fujita Health University Bantane Hospital, Nagoya, Japan
| | - Wakaya Fujiwara
- Department of Cardiology, Fujita Health University Bantane Hospital, Nagoya, Japan
| | - Mutsuharu Hayashi
- Department of Cardiology, Fujita Health University Bantane Hospital, Nagoya, Japan
| | - Eiichi Saitoh
- Department of Rehabilitation Medicine I, Fujita Health University, Toyoake, Japan
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14
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Kawajiri H, Adachi T, Kono Y, Yamada S. Development of a Self-Efficacy Questionnaire for Walking in Patients with Mild Ischemic Stroke. J Stroke Cerebrovasc Dis 2018; 28:317-324. [PMID: 30389375 DOI: 10.1016/j.jstrokecerebrovasdis.2018.09.055] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 09/06/2018] [Accepted: 09/30/2018] [Indexed: 12/28/2022] Open
Abstract
PURPOSE This study aimed to develop a self-efficacy questionnaire, which particularly focuses on walking in patients with mild ischemic stroke and transient ischemic attack. METHODS We enrolled patients with acute ischemic stroke and transient ischemic attack who scored 0-2 on the modified Rankin Scale. The process of development of questionnaire on self-efficacy for walking with 7 items (SEW-7) was composed of 3 steps: (1) item generation; (2) item reduction; and (3) testing the final version. The measurement properties were assessed according to the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist. RESULTS A total of 168 patients (mean age 69.4 ± 10.1 years) were enrolled for testing the questionnaire on SEW-7. The total score of the SEW-7 ranged from 7 to 35 points. Internal consistency was acceptable with the Cronbach's alpha coefficient of .93. Test-retest reliability was good with intraclass correlation coefficient of .83 (95% confidence interval: .67-.91). The smallest detectable changes at individual and group levels were 8.0 and 1.5, respectively. The results of principal component analysis showed a single factor explaining 71.8% of the total variance. The SEW-7 questionnaire showed moderate to strong correlation with physical activity parameters (step counts: r = .596, P < .001; physical activity-related energy expenditure: r = .615, P < .001; low-intensity physical activity: r = .449, P < .001; moderate- to vigorous-intensity physical activity: r = .581, P < .001). CONCLUSIONS We propose a simple self-report questionnaire for walking, with 7 items. The SEW-7 has adequate measurement properties and may serve as a time-saving tool for promoting physical activity in mild ischemic stroke patients.
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Affiliation(s)
- Hiroyuki Kawajiri
- Program in Physical and Occupational Therapy, Nagoya University Graduate School of Medicine, Nagoya, Japan; Rehabilitation Center, Aichi Medical University Hospital, Nagakute, Japan.
| | - Takuji Adachi
- Program in Physical and Occupational Therapy, Nagoya University Graduate School of Medicine, Nagoya, Japan.
| | - Yuji Kono
- Department of Rehabilitation Science, Nagoya University Graduate School of Medicine, Nagoya, Japan.
| | - Sumio Yamada
- Department of Rehabilitation Science, Nagoya University Graduate School of Medicine, Nagoya, Japan.
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15
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Yamada S, Adachi T, Izawa H, Murohara T, Kondo T. A multicenter prospective cohort study to develop frailty-based prognostic criteria in heart failure patients (FLAGSHIP): rationale and design. BMC Cardiovasc Disord 2018; 18:159. [PMID: 30071828 PMCID: PMC6090927 DOI: 10.1186/s12872-018-0897-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Accepted: 07/25/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Heart failure (HF) and frailty often co-exist, and frailty in HF results in a poor prognosis. However, in Asian populations, prognostic criteria are needed to examine the effect of frailty on HF. Therefore, we conducted a nationwide cohort study to develop frailty-based prognostic criteria in HF patients (FLAGSHIP). FLAGSHIP mainly aims to 1) develop the frailty criteria based on HF-specific outcomes, 2) propose a hypothesis of the potential mechanisms of frailty manifestations in HF, and 3) examine the effects of outpatient cardiac rehabilitation on frailty. METHODS In this prospective study, we consecutively enroll ambulatory patients admitted because of acute HF or exacerbation of HF and elderly patients admitted for acute myocardial infarction (age ≥ 70 years). They will be followed up for 2 years to assess frailty and hard clinical events. The primary endpoints of FLAGSHIP are cardiac events including cardiac mortality and HF-related readmission after discharge. Secondary endpoints are readmissions because of fracture or pneumonia and all-cause mortality. We used clinical data, including the items related to the frailty phenotype to develop diagnostic criteria for frailty and known prognostic factors of HF. Cognitive function, depression, and anorexia are also considered as potential components of frailty. As of March 2018, 2650 patients (85% was patients admitted for HF) have been registered from 30 collaborating hospitals nationwide in Japan. DISCUSSION FLAGSHIP provides diagnostic criteria and fundamental information on frailty manifestations to develop the best practices for the long-term management of HF. Diagnostic criteria on frailty developed by FLAGSHIP is expected to become a novel indicator for the stratification of patients at risk to functional decline after medical or surgical treatment, and in turn to contribute to the best practices in the long-term management of HF.
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Affiliation(s)
- Sumio Yamada
- Department of Health Sciences, Nagoya University Graduate School of Medicine, 1-1-20 Daiko-minami, Higashi-ku, Nagoya, 461-8673, Japan.
| | - Takuji Adachi
- Program in Physical and Occupational Therapy, Nagoya University Graduate School of Medicine, 1-1-20 Daiko-minami, Higashi-ku, Nagoya, 461-8673, Japan
| | - Hideo Izawa
- Department of Cardiology, Fujita Health University Banbuntane Hotokukai Hospital, 3-6-10 Otobashi, Nakagawa-ku, Nagoya, 454-8509, Japan
| | - Toyoaki Murohara
- Department of Cardiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Takaaki Kondo
- Department of Health Sciences, Nagoya University Graduate School of Medicine, 1-1-20 Daiko-minami, Higashi-ku, Nagoya, 461-8673, Japan
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16
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González-Moneo MJ, Sánchez-Benavides G, Verdu-Rotellar JM, Cladellas M, Bruguera J, Quiñones-Ubeda S, Enjuanes C, Peña-Casanova J, Comín-Colet J. Ischemic aetiology, self-reported frailty, and gender with respect to cognitive impairment in chronic heart failure patients. BMC Cardiovasc Disord 2016; 16:163. [PMID: 27577747 PMCID: PMC5006572 DOI: 10.1186/s12872-016-0349-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Accepted: 08/19/2016] [Indexed: 11/10/2022] Open
Abstract
Background Decisive information on the parameters involved in cognitive impairment in patients with chronic heart failure is as yet lacking. Our aim was to determine the functional and psychosocial variables related with cognitive impairment using the mini-mental-state examination (MMSE) with age-and education-corrected scores. Methods A cohort study of chronic heart failure patients included in an integrated multidisciplinary hospital/primary care program. The MMSE (corrected for age and education in the Spanish population) was administered at enrolment in the program. Analyses were performed in 525 patients. Demographic and clinical variables were collected. Comprehensive assessment included depression (Yesavage), family function (family APGAR), social network (Duke), dependence (Barthel Index), frailty (Barber), and comorbidities. Univariate and multivariate logistic regression were performed to determine the predictors of cognitive impairment. Results Cognitive impairment affected 145 patients (27.6 %). Explanatory factors were gender (OR: 2.77 (1.75–4.39) p < 0.001), ischemic etiology (OR: 1.99 (1.25–3.17) p = 0.004), frailty (OR: 1.58 (0.99 to 2.50, p =0.050), albumin > 3.5 (OR: 0.59 (0.35–0.99) p = 0.048), and beta-blocker treatment (OR: 0.36 (0.17 to 0.76, p = 0.007)). No association was found between cognitive impairment and social support or family function. Conclusion The observed prevalence of cognitive impairment using MMSE corrected scores was 27.6 %. A global approach in the management of these patients is needed, especially focusing on women and patients with frailty, low albumin levels, and ischemic aetiology heart failure.
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Affiliation(s)
- María J González-Moneo
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.,Grup de recerca biomedica en malalties del cor GREC (Heart Diseases Biomedical Research Group), IMIM (Hospital del Mar Medical Research Institute), 88, Doctor Aiguader, 08003, Barcelona, Spain.,San Martin Primary Care Center, Barcelona, Spain.,Jordi Gol University Institute for Research Primary Healthcare, Barcelona, Spain
| | - Gonzalo Sánchez-Benavides
- Neurofunctionality of Brain and Language Group, Neurosciences Research Programme, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - José M Verdu-Rotellar
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.,Grup de recerca biomedica en malalties del cor GREC (Heart Diseases Biomedical Research Group), IMIM (Hospital del Mar Medical Research Institute), 88, Doctor Aiguader, 08003, Barcelona, Spain.,San Martin Primary Care Center, Barcelona, Spain.,Jordi Gol University Institute for Research Primary Healthcare, Barcelona, Spain
| | - Mercé Cladellas
- Grup de recerca biomedica en malalties del cor GREC (Heart Diseases Biomedical Research Group), IMIM (Hospital del Mar Medical Research Institute), 88, Doctor Aiguader, 08003, Barcelona, Spain
| | - Jordi Bruguera
- Grup de recerca biomedica en malalties del cor GREC (Heart Diseases Biomedical Research Group), IMIM (Hospital del Mar Medical Research Institute), 88, Doctor Aiguader, 08003, Barcelona, Spain
| | - Sonia Quiñones-Ubeda
- Neurofunctionality of Brain and Language Group, Neurosciences Research Programme, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Cristina Enjuanes
- Grup de recerca biomedica en malalties del cor GREC (Heart Diseases Biomedical Research Group), IMIM (Hospital del Mar Medical Research Institute), 88, Doctor Aiguader, 08003, Barcelona, Spain
| | - Jordi Peña-Casanova
- Neurofunctionality of Brain and Language Group, Neurosciences Research Programme, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Josep Comín-Colet
- Grup de recerca biomedica en malalties del cor GREC (Heart Diseases Biomedical Research Group), IMIM (Hospital del Mar Medical Research Institute), 88, Doctor Aiguader, 08003, Barcelona, Spain.
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17
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Duruturk N, Tonga E, Karatas M, Doganozu E. Activity performance problems of patients with cardiac diseases and their impact on quality of life. J Phys Ther Sci 2015; 27:2023-8. [PMID: 26311919 PMCID: PMC4540810 DOI: 10.1589/jpts.27.2023] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Accepted: 03/17/2015] [Indexed: 12/21/2022] Open
Abstract
[Purpose] To describe the functional consequences of patients with cardiac diseases and analyze associations between activity limitations and quality of life. [Subjects and Methods] Seventy subjects (mean age: 60.1±12.0 years) were being treated by Physical Medicine and Rehabilitation and Cardiology Departments were included in the study. Activity limitations and participation restrictions as perceived by the individual were measured by the Canadian Occupational Performance Measure (COPM). The Nottingham Extended Activities of Daily Living (NEADL) Scale was used to describe limitations in daily living activities. To detect the impact of activity limitations on quality of life the Nottingham Health Profile (NHP) was used. [Results] The subjects described 46 different types of problematic activities. The five most identified problems were walking (45.7%), climbing up the stairs (41.4%), bathing (30%), dressing (28.6%) and outings (27.1%). The associations between COPM performance score with all subgroups of NEADL and NHP; total, energy, physical abilities subgroups, were statistically significant. [Conclusion] Our results showed that patients with cardiac diseases reported problems with a wide range of activities, and that also quality of life may be affected by activities of daily living. COPM can be provided as a patient-focused outcome measure, and it may be a useful tool for identifying those problems.
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Affiliation(s)
- Neslihan Duruturk
- Department of Physiotherapy and Rehabilitation, Faculty of
Health Sciences, Baskent University, Turkey
| | - Eda Tonga
- Department of Physiotherapy and Rehabilitation, Faculty of
Health Sciences, Baskent University, Turkey
| | - Metin Karatas
- Department of Physical Medicine and Rehabilitation, Baskent
University, Turkey
| | - Ersin Doganozu
- Department of Physical Medicine and Rehabilitation, Faculty
of Medicine, Baskent University, Turkey
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18
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Risk factors for onset of depression after heart failure hospitalization. J Cardiol 2013; 64:37-42. [PMID: 24331765 DOI: 10.1016/j.jjcc.2013.11.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2013] [Revised: 10/16/2013] [Accepted: 11/01/2013] [Indexed: 11/20/2022]
Abstract
BACKGROUND Depression is common in chronic heart failure (CHF) and associated with adverse outcomes. Knowing the risk factors for the development of depression at the early post-hospitalization phase may be a key factor of successful disease management programs. The aim of this study was therefore to identify the risk factors related to the onset of depression after heart failure hospitalization in patients with CHF. METHODS The study population included participants with an admission diagnosis of acute heart failure or exacerbation of CHF from a multicenter prospective cohort study. Patients completed clinical evaluation at discharge and functional and social status assessment at 1 month after discharge, and depressive symptoms using the Hospital Anxiety and Depression Scale (HADS-D) at discharge and 1-year later. RESULTS Of the 131 patients without depression at discharge, 29 (22.1%) had developed significant depressive symptoms (HADS-D ≥ 8) at 1-year follow-up. Multiple logistic regression demonstrated that previous ischemic heart disease [odds ratio (OR) 3.09, 95% confidence interval (CI) 1.15-8.33], participation restrictions (OR 0.43, 95% CI 0.26-0.70), and lack of satisfaction with social support (OR 0.48, 95% CI 0.29-0.79) were independent predictors of developing depression. CONCLUSIONS The three clinically accessible variables and targets for interventions identified as predictors in this study may help to guide the optimal post-discharge disease management planning for these patients who are at high risk for depression.
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19
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Fukumoto Y. Impact of left ventricular ejection fraction in Japanese heart failure patients. J Cardiol 2013; 62:203-4. [PMID: 23827048 DOI: 10.1016/j.jjcc.2013.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2013] [Accepted: 05/31/2013] [Indexed: 10/26/2022]
Affiliation(s)
- Yoshihiro Fukumoto
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan.
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20
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Narumi T, Arimoto T, Funayama A, Kadowaki S, Otaki Y, Nishiyama S, Takahashi H, Shishido T, Miyashita T, Miyamoto T, Watanabe T, Kubota I. Prognostic importance of objective nutritional indexes in patients with chronic heart failure. J Cardiol 2013; 62:307-13. [PMID: 23806549 DOI: 10.1016/j.jjcc.2013.05.007] [Citation(s) in RCA: 166] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2013] [Revised: 04/23/2013] [Accepted: 05/08/2013] [Indexed: 01/27/2023]
Abstract
BACKGROUND Although malnutrition indicates an unfavorable prognosis in some clinical settings, the association between nutritional indexes and outcomes for patients with chronic heart failure (CHF) is unclear. METHODS AND RESULTS All the previously established objective nutritional indexes were evaluated. The controlling nutritional status score (CONUT), prognostic nutritional index (PNI), and geriatric nutritional risk index (GNRI) were determined for 388 consecutive patients with CHF (mean age 69.6±12.3 years). The prevalence of malnutrition in this cohort was 60-69%. Patients were followed prospectively, with the endpoints being death due to a cardiovascular event or re-hospitalization. There were 130 events, including 33 deaths and 97 re-hospitalizations, during a mean follow-up period of 28.4 months. Patients experiencing cardiovascular events showed impaired nutritional status, higher CONUT scores, lower PNI scores, and lower GNRI scores, compared with those who did not experience cardiovascular events. CONUT score [hazard ratio 40.9, 95% confidence interval (CI) 10.8-154.8], PNI score (hazard ratio 6.4, 95% CI 5.4-25.1), and GNRI score (hazard ratio 11.6, 95% CI 3.7-10.0) were independently associated with cardiovascular events. Kaplan-Meier analysis showed that there was a significantly higher incidence of cardiovascular events in patients who were malnourished than in those who were not. CONCLUSION Malnutrition was common in patients with CHF. Evaluation of nutritional status may provide additional prognostic information in patients with CHF.
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Affiliation(s)
- Taro Narumi
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, 2-2-2 Iida-nishi, Yamagata 990-9585, Japan
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