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Wleklik M, Denfeld Q, Czapla M, Jankowska EA, Piepoli MF, Uchmanowicz I. A patient with heart failure, who is frail: How does this affect therapeutic decisions? Cardiol J 2023; 30:825-831. [PMID: 37067336 PMCID: PMC10635718 DOI: 10.5603/cj.a2023.0027] [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: 08/30/2022] [Revised: 03/06/2023] [Accepted: 03/29/2023] [Indexed: 04/18/2023] Open
Abstract
Patients with heart failure (HF) are heterogeneous, not only related to comorbidities but also in the presentation of frailty syndrome. Frailty syndrome also affects patients with HF across the lifespan. Frailty in patients with HF has a significant impact on clinical features, diagnosis, management, adverse medical outcomes and costs. In everyday clinical practice, frail patients with HF require an individualized approach, often imposing the need to modify therapeutic decisions. The aim of this review is to illustrate how frailty and multimorbidity in HF can affect therapeutic decisions. The scientific evidence underlying this publication was obtained from an analysis of papers indexed in the PubMed database. The search was limited to articles published between 1990 and July 2022. The search was limited to full-text papers published in English. The database was searched for relevant MeSH phrases and their combinations and keywords including: "elderly, frail"; "frailty, elderly"; "frail older adults"; "frailty, older adults"; "adult, frail older"; "frailty, heart failure"; "frailty, multimorbidity"; "multimorbidity, heart failure"; "multimorbidity, elderly"; "older adults, cardiovascular diseases". In therapeutic decisions regarding patients with HF, additionally burdened with multimorbidity and frailty, it becomes necessary to individualize the approach in relation to optimization and treatment of coexisting diseases, frailty assessment, pharmacological and non-pharmacological treatment and in the implementation of invasive procedures in the form of implantable devices or cardiac surgery.
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Affiliation(s)
- Marta Wleklik
- Department of Nursing and Obstetrics, Faculty of Health Sciences, Wroclaw Medical University, Wroclaw, Poland
- Institute of Heart Diseases, University Hospital, Wroclaw, Poland
| | - Quin Denfeld
- School of Nursing, Oregon Health and Science University, Portland, OR, United States
| | - Michal Czapla
- Institute of Heart Diseases, University Hospital, Wroclaw, Poland.
- Department of Emergency Medical Service, Wroclaw Medical University, Wroclaw, Poland.
- Group of Research in Care (GRUPAC), Faculty of Health Science, University of La Rioja, Logroño, Spain.
| | - Ewa A Jankowska
- Institute of Heart Diseases, University Hospital, Wroclaw, Poland
- Institute of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland
| | - Massimo Francesco Piepoli
- Dipartimento delle Scienze Biomediche per la Salute, University of Milan, Via Festa del Perdono, Milan, Italy
- Cardiology Unit, IRCCS Policlinico San Donato Milanese, Milan, Italy
- Institute of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland
| | - Izabella Uchmanowicz
- Department of Nursing and Obstetrics, Faculty of Health Sciences, Wroclaw Medical University, Wroclaw, Poland
- Institute of Heart Diseases, University Hospital, Wroclaw, Poland
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Miller PE, Thomas A, Breen TJ, Chouairi F, Kunitomo Y, Aslam F, Damluji AA, Anavekar NS, Murphy JG, van Diepen S, Barsness GW, Brennan J, Jentzer J. Prevalence of Noncardiac Multimorbidity in Patients Admitted to Two Cardiac Intensive Care Units and Their Association with Mortality. Am J Med 2021; 134:653-661.e5. [PMID: 33129785 PMCID: PMC8079541 DOI: 10.1016/j.amjmed.2020.09.035] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 09/16/2020] [Accepted: 09/21/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Current cardiac intensive care unit (CICU) practice has seen an increase in patient complexity, including an increase in noncardiac organ failure, critical care therapies, and comorbidities. We sought to describe the changing epidemiology of noncardiac multimorbidity in the CICU population. METHODS We analyzed consecutive unique patient admissions to 2 geographically distant tertiary care CICUs (n = 16,390). We assessed for the prevalence of 0, 1, 2, and ≥3 noncardiac comorbidities (diabetes, chronic lung, liver, and kidney disease, cancer, and stroke/transient ischemic attack) and their associations with hospital and postdischarge 1-year mortality using multivariable logistic regression. RESULTS The prevalence of 0, 1, 2, and ≥3 noncardiac comorbidities was 37.7%, 31.4%, 19.9%, and 11.0%, respectively. Increasing noncardiac comorbidities were associated with a stepwise increase in mortality, length of stay, noncardiac indications for ICU admission, and increased utilization of critical care therapies. After multivariable adjustment, compared with those without noncardiac comorbidities, there was an increased hospital mortality for patients with 1 (odds ratio [OR] 1.30; 95% confidence interval [CI], 1.10-1.54, P = .002), 2 (OR 1.47; 95% CI, 1.22-1.77, P < .001), and ≥3 (OR 1.79; 95% CI, 1.44-2.22, P < .001) noncardiac comorbidities. Similar trends for each additional noncardiac comorbidity were seen for postdischarge 1-year mortality (P < .001, all). CONCLUSIONS In 2 large contemporary CICU populations, we found that noncardiac multimorbidity was highly prevalent and a strong predictor of short- and long-term adverse clinical outcomes. Further study is needed to define the best care pathways for CICU patients with acute cardiac illness complicated by noncardiac multimorbidity.
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Affiliation(s)
- P Elliott Miller
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, Conn; Yale National Clinicians Scholar Program, New Haven, Conn.
| | - Alexander Thomas
- Department of Internal Medicine, Yale School of Medicine, New Haven, Conn
| | - Thomas J Breen
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minn
| | - Fouad Chouairi
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, Conn
| | - Yukiko Kunitomo
- Department of Internal Medicine, Yale School of Medicine, New Haven, Conn
| | - Faisal Aslam
- Department of Internal Medicine, Yale School of Medicine, New Haven, Conn
| | - Abdulla A Damluji
- Inova Center of Outcomes Research, Inova Heart and Vascular Institute, Falls Church, Va; Division of Cardiology, Johns Hopkins Hospital, Baltimore, Md
| | | | - Joseph G Murphy
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minn
| | - Sean van Diepen
- Department of Critical Care Medicine and Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | | | - Joseph Brennan
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, Conn
| | - Jacob Jentzer
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minn; Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, Minn
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