New horizons in management of heart failure in older patients

Global historical retrospect and future prospects on biomarkers of heart failure: A bibliometric analysis and science mapping

Introduction

Heart failure is a rapidly growing public health problem and has become a major cause of hospitalization in middle-aged and older adults. Biomarkers are clinically important in managing heart failure and have attracted more attention from researchers in recent years. This study aimed to evaluate the global research of heart failure biomarkers by bibliometrics and to identify the hot spots and perspectives for further advancement.

Methods

Selection of relevant documents was from the Web of Science Core Collection. Microsoft Excel, VOSviewer, SciMA, and CiteSpace software were used for bibliometric analysis.

Results

As of October 29, 2021, 5,978 documents for heart failure biomarkers have been identified from 1989 to 2021. European Journal of Heart Failure and Circulation respectively ranked first in terms of the number of publications and the number of co-citations. A total of 5,698 institutions from 90 countries participated in these publications, with the USA leading with 2,045 documents. The most productive institution was Harvard University. Januzzi, J.L. and Maisel, A.S. were the most productive and most cited authors respectively. Natriuretic peptide, copeptin, valsartan, ferric carboxymaltose, empagliflozin, preserved ejection fraction, myocardial fibrosis, and heart transplantation were hot themes.

Conclusions

Extensive national and inter-institutional collaboration should be enhanced to bridge the gap between developed and less developed countries in heart failure biomarkers research. The research in this field seems to have reached a relatively mature stage, with a decrease in research fervor in recent years. The study of the natriuretic peptide family still has high centrality, with advances in the study of expression products and inflammatory markers. Cardiac fibrosis, cardiac remodeling, and therapies regarding heart failure have become hot spots.

Prognostic value of functional capacity after transitional rehabilitation in older patients hospitalized for heart failure

Background

Poor functional status is highly prevalent among older patients hospitalized for HF and marks a downward inflection point in functional and prognostic trajectories. We assessed the prognostic value of 6‐min walk test after transitional cardiac rehabilitation in older patients hospitalized for heart failure (HF).

Methods

We studied 759 patients aged ≥60 years who had been transferred to six inpatient rehabilitation facilities (IRF) from acute care hospitals after a hospitalization for acute HF. The primary outcome was 3‐year all‐cause mortality. We used multivariable Cox analysis to determine the association between 6‐min walk distance (6MWD) at discharge from the IRFs and the primary outcome, adjusting for established predictors of death. The optimal cutoff for 6MWD was considered as the one that maximized the chi‐square statistic.

Results

Mean age was 75 ± 8 years. 6MWD significantly increased from admission to discharge (145 to 210 m; p < 0.001). The optimal cutoff for 6MWD was 198 m. After full adjustment, the hazard ratio for each 50 m‐increase in discharge 6MWD was 0.90 (0.87–0.94; p < 0.001) and that for discharge 6MWD dichotomized at the optimal cutoff 0.48 (0.38–0.60; p < 0.001). The incidence rate of death/100 person‐years for the patients who walked >198 m was 13.0 (10.0–15.5) compared with 30.8 (26.9–35.4) for those who walked <198 m. A statistically significant interaction of discharge 6MWD with left ventricular ejection fraction (EF) on the risk of death was observed (p value for interaction 0.047).

Conclusions

A rehabilitation intervention provided in the critical hospital‐to‐home transition period to older patients hospitalized for HF resulted in improved functional capacity. Increasing levels of functional capacity following rehabilitation were closely associated with decreasing risk of death; this association was significantly stronger for the subgroup with preserved EF.

Polypharmacy in Older People With Heart Failure: Roles of the Geriatrician and Pharmacist

Heart failure (HF) is a common health condition that typically affects older adults. Many people with HF are cared for on an inpatient basis, by noncardiologists, such as acute medical physicians, geriatricians and other physicians. Treatment options for HF are ever increasing, and adherence to guidelines for prognostic therapy contributes to polypharmacy, which is very familiar to clinicians who care for older people. This article explores the recent trials in both HF with reduced ejection fraction and HF with preserved ejection fraction and the limitations of international guidance in their management with respect to older people. In addition, this article discusses the challenge of managing polypharmacy in those with advanced age, and the importance of involving a geriatrician and pharmacist in the HF multidisciplinary team to provide a holistic and person-centred approach to optimisation of HF therapies.