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Chen JH, Lei H, Wan YF, Zhu XC, Zeng LY, Tang HX, Zhao YF, Pan Y, Deng YQ, Liu KX. Frailty and psychiatric disorders: A bidirectional Mendelian randomization study. J Affect Disord 2024; 356:346-355. [PMID: 38626809 DOI: 10.1016/j.jad.2024.04.024] [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] [Received: 10/21/2023] [Revised: 03/31/2024] [Accepted: 04/05/2024] [Indexed: 04/20/2024]
Abstract
BACKGROUND The association between frailty and psychiatric disorders has been reported in observational studies. However, it is unclear whether frailty facilitates the appearance of psychiatric disorders or vice versa. Therefore, we conducted a bidirectional Mendelian randomization (MR) study to evaluate the causality. METHODS Independent genetic variants associated with frailty index (FI) and psychiatric disorders were obtained from large genome-wide association studies (GWAS). The inverse variance weighted method was utilized as the primary method to estimate causal effects, followed by various sensitivity analyses. Multivariable analyses were performed to further adjust for potential confounders. RESULTS The present MR study revealed that genetically predicted FI was significantly and positively associated with the risk of major depressive disorder (MDD) (odds ratio [OR] 1.79, 95 % confidence interval [CI] 1.48-2.15, P = 1.06 × 10-9), anxiety disorder (OR 1.61, 95 % CI 1.19-2.18, P = 0.002) and neuroticism (OR 1.38, 95 % CI 1.18-1.61, P = 3.73 × 10-5). In the reverse MR test, genetic liability to MDD (beta 0.232, 95 % CI 0.189-0.274, P = 1.00 × 10-26) and neuroticism (beta 0.128, 95 % CI 0.081-0.175, P = 8.61 × 10-8) were significantly associated with higher FI. Multivariable analyses results supported the causal association between FI and MDD and neuroticism. LIMITATIONS Restriction to European populations, and sample selection bias. CONCLUSIONS Our study suggested a bidirectional causal association between frailty and MDD neuroticism, and a positive correlation of genetically predicted frailty on the risk of anxiety disorder. Developing a deeper understanding of these associations is essential to effectively manage frailty and optimize mental health in older adults.
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Affiliation(s)
- Jie-Hai Chen
- Department of Anesthesiology, Nanfang Hospital, Southern Medical University; Guangdong Provincial Key Laboratory of Precision Anaesthesia and Perioperative Organ Protection, Guangzhou, Guangdong 510515, China; Dongguan Maternal and Child Health Care Hospital, Dongguan, 523125, Guangdong, China
| | - Hang Lei
- Department of Pathophysiology, Guangdong Provincial Key Laboratory of Proteomics, School of Basic Medical Sciences, Southern Medical University, Guangzhou, Guangdong Province, China
| | - Yu-Fei Wan
- Department of Pathophysiology, Guangdong Provincial Key Laboratory of Proteomics, School of Basic Medical Sciences, Southern Medical University, Guangzhou, Guangdong Province, China
| | - Xiao-Chun Zhu
- Division of Cardiology, Dongguan Songshan Lake Central Hospital, Dongguan, Guangdong Province, China
| | - Li-Ying Zeng
- Department of Pathophysiology, Guangdong Provincial Key Laboratory of Proteomics, School of Basic Medical Sciences, Southern Medical University, Guangzhou, Guangdong Province, China
| | - Hao-Xuan Tang
- Department of Pathophysiology, Guangdong Provincial Key Laboratory of Proteomics, School of Basic Medical Sciences, Southern Medical University, Guangzhou, Guangdong Province, China
| | - Yun-Feng Zhao
- Department of Pathophysiology, Guangdong Provincial Key Laboratory of Proteomics, School of Basic Medical Sciences, Southern Medical University, Guangzhou, Guangdong Province, China
| | - Ying Pan
- Department of Pathophysiology, Guangdong Provincial Key Laboratory of Proteomics, School of Basic Medical Sciences, Southern Medical University, Guangzhou, Guangdong Province, China
| | - Yong-Qiang Deng
- Department of Pathophysiology, Guangdong Provincial Key Laboratory of Proteomics, School of Basic Medical Sciences, Southern Medical University, Guangzhou, Guangdong Province, China.
| | - Ke-Xuan Liu
- Department of Anesthesiology, Nanfang Hospital, Southern Medical University; Guangdong Provincial Key Laboratory of Precision Anaesthesia and Perioperative Organ Protection, Guangzhou, Guangdong 510515, China.
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Tang M, Zhao R, Lv Q. Status and influencing factors of frailty in hospitalized patients with chronic heart failure: A cross-sectional study. J Clin Nurs 2024. [PMID: 38867616 DOI: 10.1111/jocn.17324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 05/12/2024] [Accepted: 06/03/2024] [Indexed: 06/14/2024]
Abstract
OBJECTIVES To investigate the frailty status of inpatients with chronic heart failure (CHF) and analyse its influencing factors, so as to provide evidence for the early identification of high-risk groups and frailty management. BACKGROUND Early identification of frailty can guide the development and implementation of holistic and individualized treatment plans. However, at present, the frailty of patients with CHF has not attracted enough attention. DESIGN A cross-sectional study. METHODS From June 2022 to June 2023, a convenience sample of 256 participants were recruited at a hospital in China. Multivariate logistic regression analysis was used to explore the influencing factors of frailty in patients with CHF, and an ROC curve was drawn to determine the cut-off values for each influencing factor. STROBE checklist guides the reporting of the manuscript. RESULTS A total of 270 questionnaires were sent out during the survey, and 256 valid questionnaires were ultimately recovered, resulting in an effective recovery rate of 94.8%. The incidence of frailty in hospitalized patients with CHF was 68.75%. Multivariable logistic regression analysis showed that age, self-care ability, nutritional risk, Kinesiophobia and NT-proBNP were risk factors for frailty, while albumin and LVEF were protective factors. CONCLUSION Multidimensional frailty was prevalent in hospitalized patients with CHF. Medical staff should take measures as early as possible from the aspects of exercise, nutrition, psychology and disease to delay the occurrence and development of frailty and reduce the occurrence of clinical adverse events caused by frailty. RELEVANCE TO CLINICAL PRACTICE This study emphasizes the importance of the early identification of multidimensional frailty and measures can be taken to delay the occurrence and development of frailty through exercise, nutrition, psychology and disease treatment. PATIENT OR PUBLIC CONTRIBUTION Patients contributed through sharing their information required for the case report form and filling out questionnaires.
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Affiliation(s)
- Miaoyan Tang
- Department of Cardiovascular Medicine, Shaoxing People's Hospital, Zhejiang, China
| | - Ruifang Zhao
- Department of Cardiovascular Medicine, Shaoxing People's Hospital, Zhejiang, China
| | - Qiaoxia Lv
- The Nursing Department, Shaoxing People's Hospital, Zhejiang, China
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Jamil Y, Park DY, Rao SV, Ahmad Y, Sikand NV, Bosworth HB, Coles T, Damluji AA, Nanna MG, Samsky MD. Association Between Frailty and Management and Outcomes of Acute Myocardial Infarction Complicated by Cardiogenic Shock. JACC. ADVANCES 2024; 3:100949. [PMID: 38938859 PMCID: PMC11198471 DOI: 10.1016/j.jacadv.2024.100949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 11/27/2023] [Accepted: 01/23/2024] [Indexed: 06/29/2024]
Abstract
Background Cardiogenic shock (CS) in the setting of acute myocardial infarction (AMI) is associated with high morbidity and mortality. Frailty is a common comorbidity in patients with cardiovascular disease and is also associated with adverse outcomes. The impact of preexisting frailty at the time of CS diagnosis following AMI has not been studied. Objectives The purpose of this study was to examine the prevalence of frailty in patients admitted with AMI complicated by CS (AMI-CS) hospitalizations and its associations with in-hospital outcomes. Methods We retrospectively analyzed the National Inpatient Sample from 2016 to 2020 and identified all hospitalizations for AMI-CS. We classified them into frail and nonfrail groups according to the hospital frailty risk score cut-off of 5 and compared in-hospital outcomes. Results A total of 283,700 hospitalizations for AMI-CS were identified. Most (70.8%) occurred in the frail. Those with frailty had higher odds of in-hospital mortality (adjusted OR [aOR]: 2.17, 95% CI: 2.07 to 2.26, P < 0.001), do-not-resuscitate status, and discharge to a skilled nursing facility compared with those without frailty. They also had higher odds of in-hospital adverse events, including intracranial hemorrhage, gastrointestinal hemorrhage, acute kidney injury, and delirium. Importantly, AMI-CS hospitalizations in the frail had lower odds of coronary revascularization (aOR: 0.55, 95% CI: 0.53-0.58, P < 0.001) or mechanical circulatory support (aOR: 0.89, 95% CI: 0.85-0.93, P < 0.001). Lastly, hospitalizations for AMI-CS showed an overall increase from 53,210 in 2016 to 57,065 in 2020 (P trend <0.001), with this trend driven by a rise in the frail. Conclusions A high proportion of hospitalizations for AMI-CS had concomitant frailty. Hospitalizations with AMI-CS and frailty had higher rates of in-hospital morbidity and mortality compared to those without frailty.
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Affiliation(s)
- Yasser Jamil
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Dae Yong Park
- Department of Medicine, Cook County Health, Chicago, Illinois, USA
| | - Sunil V. Rao
- Grossman School of Medicine, New York University Langone Health System, New York University, New York, New York, USA
| | - Yousif Ahmad
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Nikhil V. Sikand
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Hayden B. Bosworth
- Division of General Internal Medicine, Department of Medicine, Duke University, Durham, North Carolina, USA
- Department of Psychiatry and Behavioral Health Sciences, Duke University School of Nursing, Durham, North Carolina, USA
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Theresa Coles
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Abdulla A. Damluji
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Inova Center of Outcomes Research, Falls Church, Virginia, USA
| | - Michael G. Nanna
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Marc D. Samsky
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, Connecticut, USA
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Su D, Wang F, Yang Y, Zhu Y, Wang T, Zheng K, Tang J. The association between frailty and in-hospital mortality in critically ill patients with congestive heart failure: results from MIMIC-IV database. Front Cardiovasc Med 2024; 11:1361542. [PMID: 38863896 PMCID: PMC11165203 DOI: 10.3389/fcvm.2024.1361542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Accepted: 05/14/2024] [Indexed: 06/13/2024] Open
Abstract
Background Frailty correlates with adverse outcomes in many cardiovascular diseases and is prevalent in individuals with heart failure (HF). The Hospital Frailty Risk Score (HFRS) offers an integrated, validated solution for frailty assessment in acute care settings, but its application in critically ill patients with congestive HF lacks exploration. This study aimed to identify the association between frailty assessed by the HFRS and in-hospital mortality in critically ill patients with congestive HF. Methods This observational study retrospectively enrolled 12,179 critically ill patients with congestive HF. Data from the Medical Information Mart for Intensive Care IV database was used. The HFRS was calculated to assess frailty. Patients were categorized into three groups: non-frailty (HFRS < 5, n = 7,961), pre-frailty (5 ≤ HFRS < 15, n = 3,684), and frailty (HFRS ≥ 15, n = 534). Outcomes included in-hospital mortality, length of intensive care unit stay, and length of hospital stay. Multiple logistic regression and Locally Weighted Scatterplot Smoothing (LOWESS) smoother were used to investigate the association between frailty and outcomes. Subgroup analysis was employed to elucidate the correlation between frailty levels and in-hospital mortality across diverse subgroups. Results 12,179 patients were enrolled, 6,679 (54.8%) were male, and the average age was 71.05 ± 13.94 years. The overall in-hospital mortality was 11.7%. In-hospital mortality increased with the escalation of frailty levels (non-frailty vs. pre-frailty vs. frailty: 9.7% vs. 14.8% vs. 20.2%, P < 0.001). The LOWESS curve demonstrated that the HFRS was monotonically positively correlated with in-hospital mortality. Upon controlling for potential confounders, both pre-frailty and frailty statuses were found to be independently linked to a heightened risk of mortality during hospitalization (odds ratio [95% confidence interval]: pre-frailty vs. non-frailty: 1.27 [1.10-1.47], P = 0.001; frailty vs. non-frailty: 1.40 [1.07-1.83], P = 0.015; P for trend < 0.001). Significant interactions between frailty levels and in-hospital mortality were observed in the following subgroups: race, heart rate, creatinine, antiplatelet drug, diabetes, cerebrovascular disease, chronic renal disease, and sepsis. Conclusion In critically ill patients with congestive HF, frailty as assessed by the HFRS emerged as an independent predictor for the risk of in-hospital mortality. Prospective, randomized studies are required to determine whether improvement of frailty levels could improve clinical prognosis.
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Affiliation(s)
- Dongsheng Su
- Department of Cardiology, Second Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Fengyun Wang
- Department of Cardiology, Second Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yanhua Yang
- Department of Cardiology, Second Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yinchuan Zhu
- Department of Cardiology, Second Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Tong Wang
- Department of Cardiology, Second Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Keyang Zheng
- Centre of Hypertension, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Jianmin Tang
- Department of Cardiology, Second Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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Nozaki K, Hamazaki N, Kamiya K, Uchida S, Noda T, Ueno K, Hotta K, Maekawa E, Matsunaga A, Yamaoka-Tojo M, Ako J. Association between walking speed early after admission and all-cause death and/or re-admission in patients with acute decompensated heart failure. Eur J Cardiovasc Nurs 2024; 23:374-381. [PMID: 37672640 DOI: 10.1093/eurjcn/zvad092] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 08/30/2023] [Accepted: 09/01/2023] [Indexed: 09/08/2023]
Abstract
AIMS Patients with heart failure (HF) frequently experience decreased physical function, including walking speed. Slower walking speed is associated with poorer prognosis. However, most of these reports focused on patients with stable HF, and the relationship between walking speed in acute phase and clinical outcomes is unclear. Therefore, we aimed to investigate the associations between walking speed early after admission and clinical events in patients with acute decompensated HF (ADHF). METHODS AND RESULTS We reviewed consecutive 1391 patients admitted due to ADHF. We measured walking speed the first time to walk on the ward more than 10 m after admission, and the speed within 4 days after admission was included in this study. The primary outcome was combined events (all-cause death and/or re-admission due to HF). The follow-up period was up to 1 year from the discharge. The study population had a median age of 74 years [interquartile range (IQR): 65-80 years], and 35.9% of patients were females. The median walking speed was 0.70 m/s (IQR: 0.54-0.88 m/s). Combined events occurred in 429 (30.8%) patients. Faster walking speed was independently associated with lower rate of combined events (adjusted hazard ratio per 0.1 m/s increasing: 0.951, 95% confidence interval: 0.912-0.992). CONCLUSION Faster walking speed within 4 days after admission was associated with favourable clinical outcomes in patients with ADHF. The results suggest that measuring walking speed in acute phase is useful for earlier risk stratification.
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Affiliation(s)
- Kohei Nozaki
- Department of Rehabilitation, Kitasato University Hospital, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa 252-0375, Japan
| | - Nobuaki Hamazaki
- Department of Rehabilitation, Kitasato University Hospital, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa 252-0375, Japan
| | - Kentaro Kamiya
- Department of Rehabilitation, School of Allied Health Sciences, Kitasato University, Sagamihara, Japan
- Department of Cardiovascular Medicine, Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan
| | - Shota Uchida
- Department of Cardiovascular Medicine, Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan
- Research Fellow of Japan Society for the Promotion of Science, Tokyo, Japan
| | - Takumi Noda
- Department of Cardiovascular Medicine, Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan
- Exercise Physiology and Cardiovascular Health Lab, Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Canada
| | - Kensuke Ueno
- Department of Cardiovascular Medicine, Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan
| | - Kazuki Hotta
- Department of Rehabilitation, School of Allied Health Sciences, Kitasato University, Sagamihara, Japan
- Department of Cardiovascular Medicine, Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan
| | - Emi Maekawa
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Japan
| | - Atsuhiko Matsunaga
- Department of Rehabilitation, School of Allied Health Sciences, Kitasato University, Sagamihara, Japan
- Department of Cardiovascular Medicine, Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan
| | - Minako Yamaoka-Tojo
- Department of Rehabilitation, School of Allied Health Sciences, Kitasato University, Sagamihara, Japan
- Department of Cardiovascular Medicine, Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan
| | - Junya Ako
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Japan
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Nakayama Y, Fujiu K, Oshima T, Matsuda J, Sugita J, Matsubara TJ, Liu Y, Goto K, Kani K, Uchida R, Takeda N, Morita H, Xiao Y, Hayashi M, Maru Y, Hasumi E, Kojima T, Ishiguro S, Kijima Y, Yachie N, Yamazaki S, Yamamoto R, Kudo F, Nakanishi M, Iwama A, Fujiki R, Kaneda A, Ohara O, Nagai R, Manabe I, Komuro I. Heart failure promotes multimorbidity through innate immune memory. Sci Immunol 2024; 9:eade3814. [PMID: 38787963 DOI: 10.1126/sciimmunol.ade3814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 05/02/2024] [Indexed: 05/26/2024]
Abstract
Patients with heart failure (HF) often experience repeated acute decompensation and develop comorbidities such as chronic kidney disease and frailty syndrome. Although this suggests pathological interaction among comorbidities, the mechanisms linking them are poorly understood. Here, we identified alterations in hematopoietic stem cells (HSCs) as a critical driver of recurrent HF and associated comorbidities. Bone marrow transplantation from HF-experienced mice resulted in spontaneous cardiac dysfunction and fibrosis in recipient mice, as well as increased vulnerability to kidney and skeletal muscle insults. HF enhanced the capacity of HSCs to generate proinflammatory macrophages. In HF mice, global chromatin accessibility analysis and single-cell RNA-seq showed that transforming growth factor-β (TGF-β) signaling was suppressed in HSCs, which corresponded with repressed sympathetic nervous activity in bone marrow. Transplantation of bone marrow from mice in which TGF-β signaling was inhibited similarly exacerbated cardiac dysfunction. Collectively, these results suggest that cardiac stress modulates the epigenome of HSCs, which in turn alters their capacity to generate cardiac macrophage subpopulations. This change in HSCs may be a common driver of repeated HF events and comorbidity by serving as a key carrier of "stress memory."
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Affiliation(s)
- Yukiteru Nakayama
- Department of Cardiovascular Medicine, University of Tokyo, Tokyo, Japan
| | - Katsuhito Fujiu
- Department of Cardiovascular Medicine, University of Tokyo, Tokyo, Japan
- Department of Advanced Cardiology, University of Tokyo, Tokyo, Japan
| | - Tsukasa Oshima
- Department of Cardiovascular Medicine, University of Tokyo, Tokyo, Japan
| | - Jun Matsuda
- Department of Cardiovascular Medicine, University of Tokyo, Tokyo, Japan
| | - Junichi Sugita
- Department of Cardiovascular Medicine, University of Tokyo, Tokyo, Japan
| | | | - Yuxiang Liu
- Department of Cardiovascular Medicine, University of Tokyo, Tokyo, Japan
| | - Kohsaku Goto
- Department of Cardiovascular Medicine, University of Tokyo, Tokyo, Japan
| | - Kunihiro Kani
- Department of Cardiovascular Medicine, University of Tokyo, Tokyo, Japan
| | - Ryoko Uchida
- Department of Cardiovascular Medicine, University of Tokyo, Tokyo, Japan
- Department of Advanced Cardiology, University of Tokyo, Tokyo, Japan
| | - Norifumi Takeda
- Department of Cardiovascular Medicine, University of Tokyo, Tokyo, Japan
| | - Hiroyuki Morita
- Department of Cardiovascular Medicine, University of Tokyo, Tokyo, Japan
| | - Yingda Xiao
- Department of Cardiovascular Medicine, University of Tokyo, Tokyo, Japan
| | - Michiko Hayashi
- Department of Cardiovascular Medicine, University of Tokyo, Tokyo, Japan
| | - Yujin Maru
- Department of Cardiovascular Medicine, University of Tokyo, Tokyo, Japan
| | - Eriko Hasumi
- Department of Cardiovascular Medicine, University of Tokyo, Tokyo, Japan
| | - Toshiya Kojima
- Department of Cardiovascular Medicine, University of Tokyo, Tokyo, Japan
| | - Soh Ishiguro
- School of Biomedical Engineering, Faculty of Applied Science and Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Yusuke Kijima
- School of Biomedical Engineering, Faculty of Applied Science and Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- Aquatic Bioscience, Graduate School of Agricultural and Life Sciences, University of Tokyo, Tokyo, Japan
| | - Nozomu Yachie
- School of Biomedical Engineering, Faculty of Applied Science and Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- Synthetic Biology Division, Research Center for Advanced Science and Technology, University of Tokyo, Tokyo, Japan
| | - Satoshi Yamazaki
- Division of Stem Cell Therapy, Center for Stem Cell Biology and Regenerative Medicine, Institute of Medical Science, University of Tokyo, Tokyo, Japan
- Laboratory of Stem Cell Therapy, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Ryo Yamamoto
- Institute for the Advanced Study of Human Biology, Kyoto University, Kyoto, Japan
| | - Fujimi Kudo
- Department of Systems Medicine, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Mio Nakanishi
- Department of Systems Medicine, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Atsushi Iwama
- Division of Stem Cell and Molecular Medicine, Center for Stem Cell Biology and Regenerative Medicine, Institute of Medical Science, University of Tokyo, Tokyo, Japan
| | - Ryoji Fujiki
- Department of Molecular Oncology, Graduate School of Medicine, Chiba University, Chiba, Japan
- Department of Applied Genomics, Kazusa DNA Research Institute, Chiba, Japan
| | - Atsushi Kaneda
- Department of Molecular Oncology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Osamu Ohara
- Department of Applied Genomics, Kazusa DNA Research Institute, Chiba, Japan
| | - Ryozo Nagai
- Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Ichiro Manabe
- Department of Systems Medicine, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Issei Komuro
- Department of Cardiovascular Medicine, University of Tokyo, Tokyo, Japan
- International University of Health and Welfare, Tokyo, Japan
- Department of Frontier Cardiovascular Science, Graduate School of Tokyo, University of Tokyo, Tokyo, Japan
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7
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Zhu J, Yang K, Liu W. Systolic and diastolic blood pressure time in target range and cardiovascular outcomes in patients with hypertension and pre-frailty or frailty status. J Clin Hypertens (Greenwich) 2024; 26:514-524. [PMID: 38552135 PMCID: PMC11088431 DOI: 10.1111/jch.14797] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 02/26/2024] [Accepted: 02/29/2024] [Indexed: 05/12/2024]
Abstract
In patients with hypertension and pre-frailty or frailty, the influence of systolic (SBP) and diastolic blood pressure (DBP) time in target range (TTR) on clinical outcomes is unclear. Thus, we conducted a post hoc analysis of the Systolic Blood Pressure Intervention Trial (SPRINT). Classifying 4208 participants into frail and non-frail groups using a frailty index, the study calculated blood pressure time in target range (BP-TTR) for the first three months using the Rosendaal method. The primary endpoint included a composite of nonfatal myocardial infarction (MI), acute coronary syndromes, stroke, acute decompensated heart failure (ADHF), and cardiovascular death. Relationships between BP-TTR and outcomes were analyzed using Kaplan-Meier curves, Cox models, and restricted cubic spline curves, with subgroup analysis for further insights. In a median follow-up of 3.17 years, primary outcomes occurred in 6.7% of participants. Kaplan-Meier analysis showed that a lower systolic blood pressure time in target range (SBP-TTR) (0%-25%) correlated with an increased cumulative incidence of the primary outcome (p < .001), nonfatal MI (P = .021), stroke (P = .004), and cardiovascular death (P = .002). A higher SBP-TTR (75%-<100%) was linked to a reduced risk of these outcomes. The restricted cubic spline (RCS) curve revealed a linear association between SBP-TTR and the primary outcome (non-linear P = .704). Similar patterns were observed for diastolic blood pressure time in target range (DBP-TTR). Subgroup analysis showed that the protective effect of higher SBP-TTR was less pronounced at low DBP-TTR levels (P for interaction = .023). In conclusion, this study highlights the importance of maintaining BP within the target range to mitigate cardiovascular risks in this population.
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Affiliation(s)
- Jiajia Zhu
- Cardiac Intensive Care UnitBeijing Anzhen HospitalCapital Medical UniversityBeijingChina
| | - Kun Yang
- Cardiac Intensive Care UnitBeijing Anzhen HospitalCapital Medical UniversityBeijingChina
| | - Wenxian Liu
- Cardiac Intensive Care UnitBeijing Anzhen HospitalCapital Medical UniversityBeijingChina
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8
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Yu BY, Hu XM, Matala R, Mo YH, Liu JL, Jin JG, Zhang SH, Ou YQ, Yang Y, Dong HJ. Association between trajectories of systolic blood pressure and frailty outcome in middle-aged and older adults. J Nutr Health Aging 2024; 28:100202. [PMID: 38460319 DOI: 10.1016/j.jnha.2024.100202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Revised: 02/06/2024] [Accepted: 02/11/2024] [Indexed: 03/11/2024]
Abstract
OBJECTIVES The association between blood pressure and frailty outcome in the middle-aged and older population remains controversial. This study aimed to examine the relationship between trajectories of systolic blood pressure (SBP) and new-onset frailty. DESIGN Cohort study with a 7-year follow-up. SETTING AND PARTICIPANTS Data were derived from 4 waves (2011, 2013, 2015 and 2018) of the China Health and Retirement Longitudinal Study and 6168 participants aged ≥45 years were included in the study. METHODS The frailty index (FI) was constructed based on 40 scored items, with FI ≥ 0.25 defined as frailty. We identified the 5-year trajectory of SBP by latent class trajectory modeling. The association between SBP trajectories and frailty was explored based on hazard ratios (HR) by four Cox proportional hazards models. Furthermore, we also investigated the relationship between mean SBP and systolic blood pressure variability (SBPV) and frailty. RESULTS 6168 participants were included in this study with a mean age of 59 years. We identified five trajectories based on SBP, which are maintained low-stable SBP (T0), moderate-stable SBP (T1), remitting then increasing SBP (T2), increasing then remitting SBP (T3), and remaining stable at high SBP levels (T4). During the 7-year follow-up period, frailty outcome occurred in 1415 participants. After adjusting for other confounders, the two trajectories labeled "T2" and "T4" were associated with a higher risk of frailty compared with T0. In addition, elevated SBP and increased SBPV were associated with risk of frailty. CONCLUSIONS Higher risk of frailty occurred in two trajectories, remitting then increasing and remaining stable at high SBP levels, were associated with a relatively higher risk of frailty.
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Affiliation(s)
- B Y Yu
- Department of Cardiology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, China
| | - X M Hu
- Department of Cardiology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, China
| | - R Matala
- Department of Environmental Health Sciences and Epidemiology and Biostatistics, University at Albany, One University Place, Rensselaer, NY, 12144
| | - Y H Mo
- Department of Cardiology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, China
| | - J L Liu
- Department of Cardiology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, China
| | - J G Jin
- Department of Cardiology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, China
| | - S H Zhang
- Department of Cardiology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, China
| | - Y Q Ou
- Department of Cardiology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, China
| | - Y Yang
- Department of Cardiology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, China.
| | - H J Dong
- Department of Cardiology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, China; Nyingchi People's Hospital, Nyingchi, 860000, Tibet, China.
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9
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Kim SE, Azarian M, Naik AD, Park C, Horstman MJ, Virani SS, Intrator O, Amos CI, Orkaby A, Razjouyan J. What is the additive value of nutritional deficiency to VA-FI in the risk assessment for heart failure patients? J Nutr Health Aging 2024; 28:100253. [PMID: 38692206 DOI: 10.1016/j.jnha.2024.100253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 04/19/2024] [Accepted: 04/20/2024] [Indexed: 05/03/2024]
Abstract
OBJECTIVES To assess the impact of adding the Prognostic Nutritional Index (PNI) to the U.S. Veterans Health Administration frailty index (VA-FI) for the prediction of time-to-death and other clinical outcomes in Veterans hospitalized with Heart Failure. METHODS A retrospective cohort study of veterans hospitalized for heart failure (HF) from October 2015 to October 2018. Veterans ≥50 years with albumin and lymphocyte counts, needed to calculate the PNI, in the year prior to hospitalization were included. We defined malnutrition as PNI ≤43.6, based on the Youden index. VA-FI was calculated from the year prior to the hospitalization and identified three groups: robust (≤0.1), prefrail (0.1-0.2), and frail (>0.2). Malnutrition was added to the VA-FI (VA-FI-Nutrition) as a 32nd deficit with the total number of deficits divided by 32. Frailty levels used the same cut-offs as the VA-FI. We compared categories based on VA-FI to those based on VA-FI-Nutrition and estimated the hazard ratio (HR) for post-discharge all-cause mortality over the study period as the primary outcome and other adverse events as secondary outcomes among patients with reduced or preserved ejection fraction in each VA-FI and VA-FI-Nutrition frailty groups. RESULTS We identified 37,601 Veterans hospitalized for HF (mean age: 73.4 ± 10.3 years, BMI: 31.3 ± 7.4 kg/m2). In general, VA-FI-Nutrition reclassified 1959 (18.6%) Veterans to a higher frailty level. The VA-FI identified 1,880 (5%) as robust, 8,644 (23%) as prefrail, and 27,077 (72%) as frail. The VA-FI-Nutrition reclassified 382 (20.3%) from robust to prefrail and 1577 (18.2%) from prefrail to frail creating the modified-prefrail and modified-frail categories based on the VA-FI-Nutrition. We observed shorter time-to-death among Veterans reclassified to a higher frailty status vs. those who remained in their original group (Median of 2.8 years (IQR:0.5,6.8) in modified-prefrail vs. 6.3 (IQR:1.8,6.8) years in robust, and 2.2 (IQR:0.7,5.7) years in modified-frail vs. 3.9 (IQR:1.4,6.8) years in prefrail). The adjusted HR in the reclassified groups was also significantly higher in the VA-FI-Nutrition frailty categories with a 38% increase in overall all-cause mortality among modified-prefrail and a 50% increase among modified-frails. Similar trends of increasing adverse events were also observed among reclassified groups for other clinical outcomes. CONCLUSION Adding PNI to VA-FI provides a more accurate and comprehensive assessment among Veterans hospitalized for HF. Clinicians should consider adding a specific nutrition algorithm to automated frailty tools to improve the validity of risk prediction in patients hospitalized with HF.
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Affiliation(s)
- Seulgi Erica Kim
- VA HSR&D, Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX 77030, USA; Baylor College of Medicine, Houston, TX, USA.
| | - Mehrnaz Azarian
- VA HSR&D, Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX 77030, USA; Baylor College of Medicine, Houston, TX, USA.
| | - Aanand D Naik
- VA HSR&D, Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX 77030, USA; Baylor College of Medicine, Houston, TX, USA; Big Data Scientist Training Enhancement Program, VA Office of Research and Development, Washington, DC, USA; University of Texas School of Public Health and UTHealth Consortium on Aging, Houston, TX, USA.
| | - Catherine Park
- VA HSR&D, Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX 77030, USA; Baylor College of Medicine, Houston, TX, USA; Big Data Scientist Training Enhancement Program, VA Office of Research and Development, Washington, DC, USA; Division of Digital Healthcare, Yonsei University, Wonju, 26493, South Korea.
| | - Molly J Horstman
- VA HSR&D, Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX 77030, USA; Baylor College of Medicine, Houston, TX, USA; Big Data Scientist Training Enhancement Program, VA Office of Research and Development, Washington, DC, USA.
| | - Salim S Virani
- VA HSR&D, Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX 77030, USA; Baylor College of Medicine, Houston, TX, USA
| | - Orna Intrator
- Geriatrics & Extended Care Data Analysis Center (GECDAC), Canandaigua VA Medical Center, Canandaigua, NY, USA; Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, USA.
| | | | - Ariela Orkaby
- New England Geriatrics Research, Education, and Clinical Center, Boston VA Health Care System, Boston, MA, USA; Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA.
| | - Javad Razjouyan
- VA HSR&D, Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX 77030, USA; Baylor College of Medicine, Houston, TX, USA; Big Data Scientist Training Enhancement Program, VA Office of Research and Development, Washington, DC, USA.
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10
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Maeda D, Fujimoto Y, Nakade T, Abe T, Ishihara S, Jujo K, Matsue Y. Frailty, Sarcopenia, Cachexia, and Malnutrition in Heart Failure. Korean Circ J 2024; 54:54.e51. [PMID: 38767446 DOI: 10.4070/kcj.2024.0089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Accepted: 04/10/2024] [Indexed: 05/22/2024] Open
Abstract
With global aging, the number of patients with heart failure has increased markedly. Heart failure is a complex condition intricately associated with aging, organ damage, frailty, and cognitive decline, resulting in a poor prognosis. The relationship among frailty, sarcopenia, cachexia, malnutrition, and heart failure has recently received considerable attention. Although these conditions are distinct, they often exhibit a remarkably close relationship. Overlapping diagnostic criteria have been observed in the recently proposed guidelines and position statements, suggesting that several of these conditions may coexist in patients with heart failure. Therefore, a comprehensive understanding of these conditions is essential, and interventions must not only target these conditions individually, but also provide comprehensive management strategies. This review article provides an overview of the epidemiology, diagnostic methods, overlap, and prognosis of frailty, sarcopenia, cachexia, and malnutrition in patients with heart failure, incorporating insights from the FRAGILE-HF study data. Additionally, based on existing literature, this article discusses the impact of these conditions on the effectiveness of guideline-directed medical therapy for patients with heart failure. While recognizing these conditions early and promptly implementing interventions may be advantageous, further data, particularly from well-powered, large-scale, randomized controlled trials, are necessary to refine personalized treatment strategies for patients with heart failure.
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Affiliation(s)
- Daichi Maeda
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Yudai Fujimoto
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Taisuke Nakade
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Takuro Abe
- Department of Cardiology, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Shiro Ishihara
- Department of Cardiology, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Kentaro Jujo
- Department of Cardiology, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Yuya Matsue
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan.
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Thompson L, Carr F, Rogers D, Lewis N, Charalampopoulos A, Fent G, Garg P, Swift AJ, Al-Mohammad A. Characterisation of the octogenarians presenting to the diagnostic heart failure clinic: SHEAF registry. Open Heart 2024; 11:e002584. [PMID: 38663890 PMCID: PMC11043696 DOI: 10.1136/openhrt-2023-002584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Accepted: 04/08/2024] [Indexed: 04/28/2024] Open
Abstract
INTRODUCTION Heart failure (HF) incidence is increasing in older adults with high hospitalisation and mortality rates. Treatment is complicated by side effects and comorbidities. We investigated the clinical characteristics of octogenarians presenting to the HF clinic. METHODS Data were collected on octogenarians (80-89 years) referred to the HF clinic in two periods. The data included demographics, HF phenotype, comorbidities, symptoms and treatment. We investigate the temporal changes in clinical characteristics using χ2 test. We aimed to determine the clinical characteristics which were associated with optimisation of HF pharmacological intervention in the clinic, conducting multivariate regression analysis. Statistical significance is determined at p<0.05. RESULTS Data were collected in April 2012 to January 2014 and in June 2021 to December 2022. In this cross-sectional study of temporal data, 571 octogenarians were referred to the clinic in the latter period, in whom the prevalence of HF was 68.48% (391 patients). HF with preserved ejection fraction (HFpEF) was the most common phenotype and increased significantly compared with the first period (46.3% and 29.2%, p<0.001). Frailty, chronic kidney disease and ischaemic heart disease increased significantly versus the first period (p<0.001). During the second period, and following the consultation, of the patients with HF with reduced ejection fraction (HFrEF), 86.4% and 82.7% were on a beta blocker and on an ACE inhibitor/angiotensin receptor blocker/angiotensin receptor-neprilysin inhibitor, respectively. Clinical characteristics associated with further optimisations of HF pharmacological therapy in the HF clinic were: New York Heart Association (NYHA) functional class III and the presence of HFrEF phenotype CONCLUSIONS: With a prevalence of HF at 68% among the octogenarians referred to the HF clinic, HFpEF incidence is rising. The decision to optimise HF pharmacological treatment in octogenarians is driven by NYHA functional class III and the presence of HFrEF phenotype.
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Affiliation(s)
- Luke Thompson
- Care of the Elderly, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Fiona Carr
- Department of Cardiology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
- Department of Geriatrics, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Dominic Rogers
- Department of Cardiology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Nigel Lewis
- Department of Cardiology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | | | - Graham Fent
- Department of Cardiology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Pankaj Garg
- University of East Anglia, Norwich, Norfolk, UK
| | - Andrew J Swift
- Division of Clinical Medicine, The University of Sheffield Faculty of Medicine Dentistry and Health, Sheffield, UK
| | - Abdallah Al-Mohammad
- Department of Cardiology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
- Division of Clinical Medicine, The University of Sheffield Faculty of Medicine Dentistry and Health, Sheffield, UK
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12
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Wang Z, Han S, Xiao Y, Zhang Y, Ge Y, Liu X, Gao J. Genetically supported causality between gut microbiota and frailty: a two-sample Mendelian randomization study. Front Microbiol 2024; 15:1324209. [PMID: 38741737 PMCID: PMC11089315 DOI: 10.3389/fmicb.2024.1324209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 03/25/2024] [Indexed: 05/16/2024] Open
Abstract
Background A mounting body of evidence suggests a strong connection between gut microbiota and the risk of frailty. However, the question of causality remains unanswered. In this study, we employed a Mendelian randomization (MR) approach to assess potential causal relationships between gut microbiota and the risk of frailty. Materials and methods Summary statistics for the gut microbiome were obtained from a genome wide association study (GWAS) meta-analysis of the MiBioGen consortium (N = 18,340). Summary statistics for frailty were obtained from a GWAS meta-analysis, including the UK Biobank and TwinGene (N = 175,226). Our primary analysis utilized the inverse variance weighted (IVW) method. To enhance the robustness of our results, we also applied weighted median methods, MR Egger regression, and MR pleiotropy residual sum and outlier test. Finally, we conducted reverse MR analysis to investigate the potential for reverse causality. Results IVW method identified 7 bacterial taxa nominally associated with the risk of FI. Class Bacteroidia (p = 0.033) and genus Eubacterium ruminantium group (p = 0.028) were protective against FI. In addition, class Betaproteobacteria (p = 0.042), genus Allisonella (p = 0.012), genus Bifidobacterium (p = 0.013), genus Clostridium innocuum group (p = 0.036) and genus Eubacterium coprostanoligenes group (p = 0.003) were associated with a higher risk of FI. No pleiotropy or heterogeneity were found. Conclusion The MR analysis indicates a causal relationship between specific gut microbiota and FI, offering new insights into the mechanisms underlying FI mediated by gut microbiota.
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Affiliation(s)
- Zi Wang
- Yangzhou University Medical College, Yangzhou, China
- Department of Anesthesiology, Institute of Anesthesia, Emergency and Critical Care, Yangzhou University Affiliated Northern Jiangsu People’s Hospital, Yangzhou, China
| | - Shuai Han
- Yangzhou University Medical College, Yangzhou, China
- Department of Anesthesiology, Institute of Anesthesia, Emergency and Critical Care, Yangzhou University Affiliated Northern Jiangsu People’s Hospital, Yangzhou, China
| | - Yinggang Xiao
- Yangzhou University Medical College, Yangzhou, China
- Department of Anesthesiology, Institute of Anesthesia, Emergency and Critical Care, Yangzhou University Affiliated Northern Jiangsu People’s Hospital, Yangzhou, China
| | - Yang Zhang
- Department of Anesthesiology, Institute of Anesthesia, Emergency and Critical Care, Yangzhou University Affiliated Northern Jiangsu People’s Hospital, Yangzhou, China
| | - Yali Ge
- Department of Anesthesiology, Institute of Anesthesia, Emergency and Critical Care, Yangzhou University Affiliated Northern Jiangsu People’s Hospital, Yangzhou, China
| | - Xin Liu
- Department of Anesthesiology, Institute of Anesthesia, Emergency and Critical Care, Yangzhou University Affiliated Northern Jiangsu People’s Hospital, Yangzhou, China
| | - Ju Gao
- Department of Anesthesiology, Institute of Anesthesia, Emergency and Critical Care, Yangzhou University Affiliated Northern Jiangsu People’s Hospital, Yangzhou, China
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13
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DeGroot L, Pavlovic N, Perrin N, Gilotra NA, Miller H, Denfeld QE, McIlvennan CK, Dy SM, Davidson PM, Szanton SL, Abshire Saylor M. The Association of Unmet Palliative Care Needs and Physical Frailty With Clinical Outcomes: A Prospective Study of Adults With Heart Failure. J Cardiovasc Nurs 2024:00005082-990000000-00185. [PMID: 38635901 DOI: 10.1097/jcn.0000000000001087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/20/2024]
Abstract
BACKGROUND People with heart failure, particularly those who are physically frail, experience complex needs that can be addressed by palliative care (PC). However, we have a limited understanding of how the intersection of unmet PC needs and physical frailty contributes to health-related quality of life (HRQOL) and risk for hospitalization or mortality. OBJECTIVE In this study, we sought to examine the association of unmet PC needs and physical frailty with clinical outcomes (baseline HRQOL and hospitalizations or mortality at 6 months). METHODS We recruited a convenience sample of community-dwelling persons with heart failure from an urban hospital system who were older than 50 years and hospitalized in the last year. We measured physical frailty using the FRAIL scale (nonfrail, 0-2; frail, 3-5), PC needs using the Integrated Palliative Outcome Scale (range, 0-58; higher scores indicating higher needs), and HRQOL using the Kansas City Cardiomyopathy Questionnaire (range, 0-100; higher scores indicate higher HRQOL). We performed multivariable linear regression to test the relationships between physical frailty, PC needs, and HRQOL, and multivariable logistic regression for associations with all-cause 6-month hospitalization or mortality. We also performed an exploratory analysis of 4 PC needs/frailty groups (high PC needs/frail, high PC needs/nonfrail, low PC needs/frail, low PC needs/nonfrail) with outcomes. RESULTS In our overall sample (n = 298), mean (SD) age was 68 (9.8) years, 37% were women (n = 108), 28% identified as Black/African American (n = 84), and 65% had heart failure with preserved ejection fraction (n = 194). Mean PC needs score was 19.7, and frail participants (n = 130, 44%) had a significantly higher mean PC needs score than nonfrail participants (P < .001). Those with higher PC needs (Integrated Palliative Care Outcome Scale ≥ 20) had significantly worse HRQOL (P < .001) and increased odds of hospitalization or mortality (odds ratio, 2.5; P < .01) compared with those with lower PC needs, adjusting for covariates. Physically frail participants had significantly worse HRQOL (P < .001) and higher odds of hospitalization or mortality at 6 months (odds ratio, 2.6; P < .01) than nonfrail participants, adjusting for covariates. In an exploratory analysis, physically frail participants with high PC needs had the lowest HRQOL score, with an average score of 28.6 points lower (P < .001) and 4.6 times higher odds of hospitalization or mortality (95% confidence interval, 2.03-10.43; P < .001) than low-needs/nonfrail participants. CONCLUSION Higher unmet PC needs and physical frailty, separately and in combination, were associated with lower HRQOL and higher odds of hospitalization or mortality. Self-reported PC needs and physical frailty assessment in clinical settings may improve identification of patients at the highest risk for poor HRQOL and hospitalization or mortality amenable to PC intervention.
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14
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Li W, Wang Z, Hua C, Zhang H, Liu X, Zheng S, Lv Q, Jiang C, Dong J, Ma C, Du X. Body mass index, frailty, and outcomes in heart failure with preserved ejection fraction. ESC Heart Fail 2024; 11:709-718. [PMID: 38131256 DOI: 10.1002/ehf2.14595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 10/10/2023] [Accepted: 11/07/2023] [Indexed: 12/23/2023] Open
Abstract
AIMS Relationship between body mass index (BMI), frailty, and clinical adverse events remains unclear in patients with heart failure (HF) with preserved ejection fraction (HFpEF) in different patient populations. We aimed to compare the association of BMI, frailty, and clinical adverse events between a US cohort from the Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist (TOPCAT) study and a Chinese cohort from the Heart Failure Registry of Patient Outcomes (HERO) study. METHODS AND RESULTS We used data of 1715 participants enrolled from America in the TOPCAT study and 1487 patients with HFpEF in the Chinese registry study, the HERO. We evaluated the relationship between BMI and frailty using multivariate restricted cubic spline logistic regression. Association between frailty and BMI categories and primary outcomes including HF hospitalization, aborted sudden death, and cardiovascular death, all-cause mortality, and HF hospitalization were analysed by Cox proportional hazards models. The patients' mean age was 72 ± 11 years for both study populations, with 50% and 46% female for the TOPCAT study and the HERO study, respectively. Patients in the TOPCAT study had a higher mean BMI (33.9 vs. 24 kg/m2), with 72.3% vs. 52.9% defined as moderately to severely frail (frailty index > 0.3). In the TOPCAT study, risk of frailty rose as BMI increased, but not in the HERO study. Patients with frailty were at significant higher risk for the primary composite outcomes [hazard ratio (HR) 1.84 (95% confidence interval: 1.46-2.32)], all-cause mortality [HR 1.73 (1.34-2.25)], and HF hospitalization [HR 1.83 (1.40-2.40)] in the TOPCAT study. The corresponding numbers in the HERO study were 1.26 (1.01-1.57), 2.21 (1.45-3.35), and 1.15 (0.81-1.37), respectively. The association of frailty with clinical outcomes did not vary with BMI categories in the two studies. CONCLUSIONS BMI distribution and association between BMI and frailty risk were different between the two study populations. Frailty was associated with clinical adverse events and this association was consistent across different BMI categories in both studies.
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Affiliation(s)
- Wenjie Li
- Department of Cardiology, Anzhen Hospital, Beijing, China
| | - Zhiyan Wang
- Department of Cardiology, Anzhen Hospital, Beijing, China
| | - Chang Hua
- Department of Cardiology, Anzhen Hospital, Beijing, China
| | - Hao Zhang
- Department of Cardiology, Anzhen Hospital, Beijing, China
| | - Xinru Liu
- Department of Cardiology, Anzhen Hospital, Beijing, China
| | - Shiyue Zheng
- Department of Cardiology, Anzhen Hospital, Beijing, China
| | - Qiang Lv
- Department of Cardiology, Anzhen Hospital, Beijing, China
| | - Chao Jiang
- Department of Cardiology, Anzhen Hospital, Beijing, China
| | - Jianzeng Dong
- Department of Cardiology, Anzhen Hospital, Beijing, China
- Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Changsheng Ma
- Department of Cardiology, Anzhen Hospital, Beijing, China
| | - Xin Du
- Department of Cardiology, Anzhen Hospital, Beijing, China
- Heart Health Research Center (HHRC), Beijing, China
- The George Institute for Global Health (Australia), The University of New South Wales, Sydney, Australia
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15
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Marchegiani F, Recchioni R, Di Rosa M, Piacenza F, Marcheselli F, Bonfigli AR, Galeazzi R, Matacchione G, Cardelli M, Procopio AD, Corsonello A, Cherubini A, Antonicelli R, Lombardi G, Lattanzio F, Olivieri F. Low circulating levels of miR-17 and miR-126-3p are associated with increased mortality risk in geriatric hospitalized patients affected by cardiovascular multimorbidity. GeroScience 2024; 46:2531-2544. [PMID: 38008859 PMCID: PMC10828307 DOI: 10.1007/s11357-023-01010-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 11/03/2023] [Indexed: 11/28/2023] Open
Abstract
MultiMorbidity (MM), defined as the co-occurrence of two or more chronic conditions, is associated with poorer health outcomes, such as recurrent hospital readmission and mortality. As a group of conditions, cardiovascular disease (CVD) exemplifies several challenges of MM, and the identification of prognostic minimally invasive biomarkers to stratify mortality risk in patients affected by cardiovascular MM is a huge challenge. Circulating miRNAs associated to inflammaging and endothelial dysfunction, such as miR-17, miR-21-5p, and miR-126-3p, are expected to have prognostic relevance. We analyzed a composite profile of circulating biomarkers, including miR-17, miR-21-5p, and miR-126-3p, and routine laboratory biomarkers in a sample of 246 hospitalized geriatric patients selected for cardiovascular MM from the Report-AGE INRCA database and BioGER INRCA biobank, to evaluate the association with all-cause mortality during 31 days and 12 and 24 months follow-up. Circulating levels of miR-17, miR-126-3p, and some blood parameters, including neutrophil to lymphocyte ratio (NLR) and eGFR, were significantly associated with mortality in these patients. Overall, our results suggest that in a cohort of geriatric hospitalized patients affected by cardiovascular MM, lower circulating miR-17 and miR-126-3p levels could contribute to identify patients at higher risk of short- and medium-term mortality.
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Affiliation(s)
| | - Rina Recchioni
- Clinic of Laboratory and Precision Medicine, IRCCS INRCA, 60121, Ancona, Italy
| | - Mirko Di Rosa
- Unit of Geriatric Pharmacoepidemiology and Biostatistics, IRCCS INRCA, 60124, Ancona, Italy
| | - Francesco Piacenza
- Advanced Technology Center for Aging Research, IRCCS INRCA, 60121, Ancona, Italy
| | | | | | - Roberta Galeazzi
- Clinic of Laboratory and Precision Medicine, IRCCS INRCA, 60121, Ancona, Italy
| | | | - Maurizio Cardelli
- Advanced Technology Center for Aging Research, IRCCS INRCA, 60121, Ancona, Italy
| | - Antonio Domenico Procopio
- Clinic of Laboratory and Precision Medicine, IRCCS INRCA, 60121, Ancona, Italy
- Department of Clinical and Molecular Sciences, Università Politecnica Delle Marche, 60126, Ancona, Italy
| | - Andrea Corsonello
- Unit of Geriatric Medicine, IRCCS INRCA, 87100, Cosenza, Italy
- Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, 87036, Rende, Italy
| | - Antonio Cherubini
- Geriatria, Accettazione Geriatrica e Centro Di Ricerca Per L'invecchiamento, IRCCS INRCA, 60127, Ancona, Italy
| | | | - Giovanni Lombardi
- Laboratory of Experimental Biochemistry and Molecular Biology, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
- Department of Athletics, Strength and Conditioning, Poznań University of Physical Education, Poznań, Poland
| | | | - Fabiola Olivieri
- Clinic of Laboratory and Precision Medicine, IRCCS INRCA, 60121, Ancona, Italy
- Department of Clinical and Molecular Sciences, Università Politecnica Delle Marche, 60126, Ancona, Italy
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Prokopidis K, Ishiguchi H, Jordan C, Irlik K, Nabrdalik K, Formiga F, Sankaranarayanan R, Lip GYH, Isanejad M. Association between natriuretic peptides and C-reactive protein with frailty in heart failure: a systematic review and meta-analysis. Aging Clin Exp Res 2024; 36:57. [PMID: 38446241 PMCID: PMC10917829 DOI: 10.1007/s40520-024-02713-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 01/24/2024] [Indexed: 03/07/2024]
Abstract
BACKGROUND Heart failure (HF) and frailty are accompanied by a bidirectional relationship, sharing common risk factors including elevated levels of natriuretic peptides and inflammation. The aim of this study was to compare biomarkers associated with poor clinical outcomes, that is, plasma brain natriuretic peptide (BNP), N-terminal-pro B-type natriuretic peptide (NT-proBNP), and C-reactive protein (CRP) in patients with HF and frailty vs. patients with HF without frailty. METHODS From inception until July 2023, PubMed, Scopus, Web of Science, and Cochrane Library a systematic literature search was conducted. To evaluate whether frailty is linked with greater levels of BNP, NT-proBNP, and CRP, a meta-analysis using a random-effects model was used to calculate the pooled effects (CRD42023446607). RESULTS Fifty-three studies were included in this systematic review and meta-analysis. Patients with HF and frailty displayed significantly higher levels of BNP (k = 11; SMD: 0.53, 95%CI 0.30-0.76, I2 = 86%, P < 0.01), NT-proBNP (k = 23; SMD: 0.33, 95%CI 0.25-0.40, I2 = 72%, P < 0.01), and CRP (k = 8; SMD: 0.30, 95%CI 0.12-0.48, I2 = 62%, P < 0.01) vs. patients with HF without frailty. Using meta-regression, body mass index (BMI) and age were deemed potential moderators of these findings. CONCLUSIONS Frailty in HF is linked to increased concentrations of BNP, NT-proBNP, and CRP, which have been epidemiologically associated with adverse outcomes. The increased risk of NYHA III/IV classification further emphasizes the clinical impact of frailty in this population.
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Affiliation(s)
- Konstantinos Prokopidis
- Department of Musculoskeletal Ageing and Science, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK.
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart and Chest Hospital, Liverpool, UK.
| | - Hironori Ishiguchi
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart and Chest Hospital, Liverpool, UK
- Division of Cardiology, Department of Medicine and Clinical Science, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Cara Jordan
- School of Health and Life Sciences, Teesside University, Middlesbrough, UK
| | - Krzysztof Irlik
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart and Chest Hospital, Liverpool, UK
- Faculty of Medical Sciences in Zabrze, Students' Scientific Association By the Department of Internal Medicine, Diabetology and Nephrology in Zabrze, Medical University of Silesia, Katowice, Poland
- Doctoral School, Faculty of Medical Sciences in Zabrze, Department of Internal Medicine, Diabetology and Nephrology, Medical University of Silesia, Katowice, Poland
| | - Katarzyna Nabrdalik
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart and Chest Hospital, Liverpool, UK
- Faculty of Medical Sciences in Zabrze, Department of Internal Medicine, Diabetology and Nephrology, Medical University of Silesia, Katowice, Poland
| | - Francesc Formiga
- Servicio de Medicina Interna, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Rajiv Sankaranarayanan
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart and Chest Hospital, Liverpool, UK
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
- National Institute for Health and Care Research, Liverpool, UK
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart and Chest Hospital, Liverpool, UK
- Danish Center for Clinical Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Masoud Isanejad
- Department of Musculoskeletal Ageing and Science, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
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17
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Zhang M, Gao X, Liu M, Gao Z, Sun X, Huang L, Zou T, Guo Y, Chen L, Liu Y, Zhang X, Feng H, Wang Y, Sun Y. Correlation of preoperative frailty with postoperative delirium and one-year mortality in Chinese geriatric patients undergoing noncardiac surgery: Study protocol for a prospective observational cohort study. PLoS One 2024; 19:e0295500. [PMID: 38446754 PMCID: PMC10917300 DOI: 10.1371/journal.pone.0295500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 10/23/2023] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND To Frailty is associated with postoperative delirium (POD) but is rarely assessed in patients undergoing noncardiac surgery. In this study, the correlation between preoperative frailty and POD, one-year mortality will be investigated in noncardiac Chinese geriatric surgery patients. METHODS This study is a prospective, observational, cohort study conducted at a single center with Chinese geriatric patients. Patients who undergo noncardiac surgery and are older than 70 years will be included. A total of 536 noncardiac surgery patients will be recruited from the First Affiliated Hospital of Shandong First Medical University for this study. The Barthel Index (BI) rating will be used to assess the patient's ability to carry out everyday activities on the 1st preoperative day. The modified frailty index (mFI) will be used to assess frailty. Patients in the nonfrailty group will have an mFI < 0.21, and patients in the frailty group will have an mFI ≥ 0.21. The primary outcome is the incidence of POD. Three-Minute Diagnostic Interview for CAM-defined Delirium (3D-CAM) will be conducted twice daily during the 1st-7th postoperative days, or just before discharge. The secondary outcomes will include one-year mortality, in-hospital cardiopulmonary events, infections, acute renal injury, and cerebrovascular events. DISCUSSION This study will clarify the correlation of preoperative frailty with POD and one-year all-cause mortality in Chinese geriatric patients undergoing noncardiac surgery. Can preoperative frailty predict POD or one-year mortality? In the face of China's serious aging social problems, this result may have important clinical value for the surgical treatment of geriatric patients. TRIAL REGISTRATION This protocol has been registered with ClinicalTrials. Gov on 12 January 2022 (https://clinicaltrials.gov/ct2/show/NCT05189678).
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Affiliation(s)
- Min Zhang
- Department of Anesthesiology, Shandong Institute of Anesthesia and Respiratory Critical Medicine, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Xiaojun Gao
- Department of Anesthesiology, Shandong Institute of Anesthesia and Respiratory Critical Medicine, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Mengjie Liu
- Department of Anesthesiology, Shandong Institute of Anesthesia and Respiratory Critical Medicine, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Zhongquan Gao
- Department of Anesthesiology, Shandong Institute of Anesthesia and Respiratory Critical Medicine, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
- Department of Anesthesiology, Shandong First Medical University, Jinan, China
| | - Xiaxuan Sun
- Department of Anesthesiology, Shandong Institute of Anesthesia and Respiratory Critical Medicine, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
- Department of Anesthesiology, Shandong First Medical University, Jinan, China
| | - Linlin Huang
- Department of Nursing, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Ting Zou
- Department of Nursing, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Yongle Guo
- Department of Anesthesiology, Shandong Institute of Anesthesia and Respiratory Critical Medicine, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
- Department of Anesthesiology, Shandong First Medical University, Jinan, China
| | - Lina Chen
- Department of Anesthesiology, Shandong Institute of Anesthesia and Respiratory Critical Medicine, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Yang Liu
- Department of Anesthesiology, Shandong Institute of Anesthesia and Respiratory Critical Medicine, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Xiaoning Zhang
- Department of Anesthesiology, Shandong Institute of Anesthesia and Respiratory Critical Medicine, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Hai Feng
- Department of Anesthesiology, Shandong Institute of Anesthesia and Respiratory Critical Medicine, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Yuelan Wang
- Department of Anesthesiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University (Shandong Provincial Hospital), Jinan, China
| | - Yongtao Sun
- Department of Anesthesiology, Shandong Institute of Anesthesia and Respiratory Critical Medicine, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
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18
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Luo YF, Cheng ZJ, Wang YF, Jiang XY, Lei SF, Deng FY, Ren WY, Wu LF. Unraveling the relationship between high-sensitivity C-reactive protein and frailty: evidence from longitudinal cohort study and genetic analysis. BMC Geriatr 2024; 24:222. [PMID: 38439017 PMCID: PMC10913347 DOI: 10.1186/s12877-024-04836-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Accepted: 02/21/2024] [Indexed: 03/06/2024] Open
Abstract
BACKGROUND This study aimed to investigate the association of high-sensitivity C-reactive protein (hs-CRP) with incident frailty as well as its effects on pre-frailty progression and regression among middle-aged and older adults. METHODS Based on the frailty index (FI) calculated with 41 items, 6890 eligible participants without frailty at baseline from China Health and Retirement Longitudinal Study (CHARLS) were categorized into health, pre-frailty, and frailty groups. Logistic regression models were used to estimate the longitudinal association between baseline hs-CRP and incident frailty. Furthermore, a series of genetic approaches were conducted to confirm the causal relationship between CRP and frailty, including Linkage disequilibrium score regression (LDSC), pleiotropic analysis, and Mendelian randomization (MR). Finally, we evaluated the association of hs-CRP with pre-frailty progression and regression. RESULTS The risk of developing frailty was 1.18 times (95% CI: 1.03-1.34) higher in participants with high levels of hs-CRP at baseline than low levels of hs-CRP participants during the 3-year follow-up. MR analysis suggested that genetically determined hs-CRP was potentially positively associated with the risk of frailty (OR: 1.06, 95% CI: 1.03-1.08). Among 5241 participants with pre-frailty at baseline, we found pre-frailty participants with high levels of hs-CRP exhibit increased odds of progression to frailty (OR: 1.39, 95% CI: 1.09-1.79) and decreased odds of regression to health (OR: 0.84, 95% CI: 0.72-0.98) when compared with participants with low levels of hs-CRP. CONCLUSIONS Our results suggest that reducing systemic inflammation is significant for developing strategies for frailty prevention and pre-frailty reversion in the middle-aged and elderly population.
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Affiliation(s)
- Yu-Feng Luo
- Center for Genetic Epidemiology and Genomics, School of Public Health, Medical College of Soochow University, Suzhou, Jiangsu, People's Republic of China
- Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Soochow University, Suzhou, Jiangsu, People's Republic of China
- MOE Key Laboratory of Geriatric Diseases and Immunology, Soochow University, Suzhou, Jiangsu, People's Republic of China
| | - Zi-Jian Cheng
- Center for Genetic Epidemiology and Genomics, School of Public Health, Medical College of Soochow University, Suzhou, Jiangsu, People's Republic of China
- Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Soochow University, Suzhou, Jiangsu, People's Republic of China
- MOE Key Laboratory of Geriatric Diseases and Immunology, Soochow University, Suzhou, Jiangsu, People's Republic of China
| | - Yan-Fei Wang
- Center for Genetic Epidemiology and Genomics, School of Public Health, Medical College of Soochow University, Suzhou, Jiangsu, People's Republic of China
- Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Soochow University, Suzhou, Jiangsu, People's Republic of China
- MOE Key Laboratory of Geriatric Diseases and Immunology, Soochow University, Suzhou, Jiangsu, People's Republic of China
| | - Xi-Yuan Jiang
- Center of Osteoporosis, Kunshan Hospital of Traditional Chinese Medicine, Kunshan, Jiangsu, People's Republic of China
| | - Shu-Feng Lei
- Center for Genetic Epidemiology and Genomics, School of Public Health, Medical College of Soochow University, Suzhou, Jiangsu, People's Republic of China
- Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Soochow University, Suzhou, Jiangsu, People's Republic of China
- MOE Key Laboratory of Geriatric Diseases and Immunology, Soochow University, Suzhou, Jiangsu, People's Republic of China
| | - Fei-Yan Deng
- Center for Genetic Epidemiology and Genomics, School of Public Health, Medical College of Soochow University, Suzhou, Jiangsu, People's Republic of China
- Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Soochow University, Suzhou, Jiangsu, People's Republic of China
- MOE Key Laboratory of Geriatric Diseases and Immunology, Soochow University, Suzhou, Jiangsu, People's Republic of China
| | - Wen-Yan Ren
- Cambridge-Suda Genomic Resource Center, Jiangsu Key Laboratory of Neuropsychiatric Diseases, Medical College of Soochow University, Suzhou, Jiangsu, People's Republic of China.
| | - Long-Fei Wu
- Center for Genetic Epidemiology and Genomics, School of Public Health, Medical College of Soochow University, Suzhou, Jiangsu, People's Republic of China.
- Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Soochow University, Suzhou, Jiangsu, People's Republic of China.
- MOE Key Laboratory of Geriatric Diseases and Immunology, Soochow University, Suzhou, Jiangsu, People's Republic of China.
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19
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Raijmann RCMA, Koek HL, Emmelot-Vonk MH, Swaving JGE, Agema WRP, Kerckhoffs APM, Keijsers CJPW. Impact of geriatric co-management on outcomes in hospitalised cardiology patients aged 85 and over. Neth Heart J 2024; 32:76-83. [PMID: 37651030 PMCID: PMC10834903 DOI: 10.1007/s12471-023-01806-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2023] [Indexed: 09/01/2023] Open
Abstract
OBJECTIVE Cardiovascular disease and frailty are common among the population aged 85+. We hypothesised these patients might benefit from geriatric co-management, as has been shown in other frail patient populations. However, there is limited evidence supporting geriatric co-management in older, hospitalised cardiology patients. METHODS A retrospective cohort study was performed in a large teaching hospital in the Netherlands. We compared patients aged 85 and over admitted to the cardiology ward before (control group) and after the implementation of standard geriatric co-management (intervention group). Data on readmission, mortality, length of stay, number of consultations, delirium, and falls were analysed. RESULTS The data of 1163 patients were analysed (n = 542 control, n = 621 intervention). In the intervention group, 251 patients did not receive the intervention because of logistic reasons or the treating physician's decision. Baseline characteristics were comparable in the intervention and control groups. Patients in the intervention group had a shorter length of stay (-1 day, p = 0.01) and were more often discharged to a geriatric rehabilitation facility (odds ratio [OR] 1.97, 95% confidence interval [CI] 1.10-3.54, p = 0.02) compared with the control patients. Other outcomes were not significantly different between the groups. CONCLUSIONS After implementation of standard geriatric co-management for hospitalised cardiology patients aged 85 and over, the length of hospital stay shortened and the number of patients discharged to a geriatric rehabilitation facility increased. The adherence to geriatric team recommendations was high. Geriatric co-management would appear to optimise care for older hospitalised patients with cardiac disease.
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Affiliation(s)
- Renee C M A Raijmann
- Department of Geriatrics, Jeroen Bosch Ziekenhuis, 's-Hertogenbosch, The Netherlands.
- Department of Geriatrics, UMC Utrecht, Utrecht, The Netherlands.
| | | | | | | | - Willem R P Agema
- Department of Cardiology, Jeroen Bosch Ziekenhuis, 's-Hertogenbosch, The Netherlands
| | - Angèle P M Kerckhoffs
- Department of Geriatrics, Jeroen Bosch Ziekenhuis, 's-Hertogenbosch, The Netherlands
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Poco LC, Finkelstein E, Sim D, Malhotra C. Weak grip strength predicts higher unplanned healthcare utilization among patients with heart failure. ESC Heart Fail 2024; 11:306-314. [PMID: 37990632 PMCID: PMC10804178 DOI: 10.1002/ehf2.14573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 10/16/2023] [Accepted: 10/19/2023] [Indexed: 11/23/2023] Open
Abstract
AIMS Frailty increases healthcare utilization and costs for patients with heart failure but is challenging to assess in clinical settings. Hand grip strength (GS) is a single-item measure of frailty yet lacks evidence as a potential screening tool to identify patients at risk of higher unplanned events and related healthcare costs. We examined the association of baseline and longitudinal GS measurements with healthcare utilization and costs among patients with advanced heart failure. METHODS AND RESULTS Between July 2017 and April 2019, we enrolled 251 patients with symptoms of advanced heart failure (New York Heart Association class III or IV) in a prospective cohort study in Singapore. We measured GS at baseline and every 4 months for 2 years and linked patients' survey data with their medical and billing records. We categorized patients as having weak GS if their GS measurement was below the 5th percentile of the age- and gender-specific normative GS values in Singapore. We assessed the association between baseline GS and healthcare utilization (unplanned and planned events and healthcare costs, total costs, and length of inpatient stay) over the next 2 years using regression models. We investigated the association between longitudinal 4-monthly GS assessments and the ensuing 4 months of healthcare utilization and costs using mixed-effects logistic and two-part regression models. At baseline, 22.5% of patients had weak GS. Baseline and longitudinal GS measurements were significantly associated with longer length of inpatient stay, greater likelihood of unplanned events, and higher related costs. Patients with weak GS had higher odds of an unplanned event occurring by 8 percentage points [95% confidence interval (CI) (0.01, 0.14), P = 0.026], incurred longer inpatient stays by 4 days [95% CI (1.97, 6.79), P = 0.003], and additional SG$ 4792 [US$ ~ 3594, 95% CI (1894, 7689), P = 0.014] in unplanned healthcare costs over the next 4 months. CONCLUSIONS GS is a simple tool to identify and monitor heart failure patients at risk of unplanned events, longer inpatient stays, and higher related healthcare costs. Findings support its routine use in clinical settings.
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Affiliation(s)
- Louisa Camille Poco
- Lien Centre for Palliative CareDuke‐NUS Medical School8 College RdSingapore169857
| | - Eric Finkelstein
- Lien Centre for Palliative CareDuke‐NUS Medical School8 College RdSingapore169857
- Program in Health Services and Systems ResearchDuke‐NUS Medical SchoolSingapore
| | - David Sim
- National Heart Centre SingaporeSingapore
| | - Chetna Malhotra
- Lien Centre for Palliative CareDuke‐NUS Medical School8 College RdSingapore169857
- Program in Health Services and Systems ResearchDuke‐NUS Medical SchoolSingapore
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21
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Naito A, Nagatomo Y, Kawai A, Yukino-Iwashita M, Nakazawa R, Taruoka A, Takefuji A, Yasuda R, Toya T, Ikegami Y, Masaki N, Ido Y, Adachi T. The Safety and Efficacy of Sodium-Glucose Cotransporter-2 Inhibitors for Patients with Sarcopenia or Frailty: Double Edged Sword? J Pers Med 2024; 14:141. [PMID: 38392575 PMCID: PMC10890336 DOI: 10.3390/jpm14020141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 01/19/2024] [Accepted: 01/24/2024] [Indexed: 02/24/2024] Open
Abstract
Sodium-glucose cotransporter-2 inhibitors (SGLT-2is) show cardiovascular protective effects, regardless of the patient's history of diabetes mellitus (DM). SGLT2is suppressed cardiovascular adverse events in patients with type 2 DM, and furthermore, SGLT-2is reduced the risk of worsening heart failure (HF) events or cardiovascular death in patients with HF. Along with these research findings, SGLT-2is are recommended for patients with HF in the latest guidelines. Despite these benefits, the concern surrounding the increasing risk of body weight loss and other adverse events has not yet been resolved, especially for patients with sarcopenia or frailty. The DAPA-HF and DELIVER trials consistently showed the efficacy and safety of SGLT-2i for HF patients with frailty. However, the Rockwood frailty index that derived from a cumulative deficit model was employed for frailty assessment in these trials, which might not be suitable for the evaluation of physical frailty or sarcopenia alone. There is no fixed consensus on which evaluation tool to use or its cutoff value for the diagnosis and assessment of frailty in HF patients, or which patients can receive SGLT-2i safely. In this review, we summarize the methodology of frailty assessment and discuss the efficacy and safety of SGLT-2i for HF patients with sarcopenia or frailty.
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Affiliation(s)
- Ayami Naito
- Department of Cardiology, National Defense Medical College, Tokorozawa 359-8513, Japan
| | - Yuji Nagatomo
- Department of Cardiology, National Defense Medical College, Tokorozawa 359-8513, Japan
| | - Akane Kawai
- Department of Cardiology, National Defense Medical College, Tokorozawa 359-8513, Japan
| | | | - Ryota Nakazawa
- Department of Cardiology, National Defense Medical College, Tokorozawa 359-8513, Japan
| | - Akira Taruoka
- Department of Cardiology, National Defense Medical College, Tokorozawa 359-8513, Japan
| | - Asako Takefuji
- Department of Cardiology, National Defense Medical College, Tokorozawa 359-8513, Japan
| | - Risako Yasuda
- Department of Intensive Care, National Defense Medical College, Tokorozawa 359-8513, Japan
| | - Takumi Toya
- Department of Cardiology, National Defense Medical College, Tokorozawa 359-8513, Japan
| | - Yukinori Ikegami
- Department of Cardiology, National Defense Medical College, Tokorozawa 359-8513, Japan
| | - Nobuyuki Masaki
- Department of Intensive Care, National Defense Medical College, Tokorozawa 359-8513, Japan
| | - Yasuo Ido
- Department of Cardiology, National Defense Medical College, Tokorozawa 359-8513, Japan
| | - Takeshi Adachi
- Department of Cardiology, National Defense Medical College, Tokorozawa 359-8513, Japan
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22
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Eckerblad J, Klompstra L, Heinola L, Rojlén S, Waldréus N. What frail, older patients talk about when they talk about self-care-a qualitative study in heart failure care. BMC Geriatr 2023; 23:818. [PMID: 38062397 PMCID: PMC10704742 DOI: 10.1186/s12877-023-04538-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 11/30/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Self-care plays a crucial role in the management of heart failure (HF) and is especially important for older patients who are frail. However, there is limited knowledge about how frail, older patients with HF perceive and experience self-care. Therefore, the aim of this study was to describe the experiences of self-care among frail, older patients with HF. METHODS A qualitative descriptive design with semi-structured interviews with frail, older patients diagnosed with HF (n = 19; median age 82 years). Thematic analysis, guided by Braun and Clarke, was used to analyse the data. RESULTS Two main themes emerged from the analysis: 1) "To maintain my health," encompassing various aspects such as hygiene practices, engaging in physical activity, medication adherence, following a healthy diet, and ensuring adequate rest; and 2) "To maintain my well-being and happiness," highlighting the importance of hobbies, maintaining independence, participating in social activities, and creating a supportive environment. CONCLUSION This study provides valuable insights into the perspectives of frail, older patients with HF regarding self-care. It was observed that older patients often associate self-care with general well-being, hygiene, and happiness. Clear communication between healthcare providers and patients is essential to align different perspectives on self-care and ensure that self-care plans are tailored to individual needs. Moreover, addressing the emotional well-being and happiness of patients should be prioritized, as these factors play a significant role in promoting self-care adherence.
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Affiliation(s)
- Jeanette Eckerblad
- Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Stockholm, Sweden
| | - Leonie Klompstra
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Linda Heinola
- Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Stockholm, Sweden
| | - Sandra Rojlén
- Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Stockholm, Sweden
| | - Nana Waldréus
- Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Stockholm, Sweden.
- Theme Inflammation and Aging, Nursing Unit Aging, Karolinska University Hospital, Stockholm, Sweden.
- Theme Women's Health and Allied Health Professionals, Medical Unit Occupational Therapy & Physiotherapy, Karolinska University Hospital, Stockholm, Sweden.
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23
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Cazalbou S, Naccache L, Sourdet S, Cariou E, Fournier P, Nourhashemi F, Balardy L, Toulza O, Lairez O, Steinmeyer Z. Frailty in Older Patients with Transthyretin Cardiac Amyloidosis. J Clin Med 2023; 12:7507. [PMID: 38137576 PMCID: PMC10743850 DOI: 10.3390/jcm12247507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 11/22/2023] [Accepted: 11/30/2023] [Indexed: 12/24/2023] Open
Abstract
Background-Transthyretin cardiac amyloidosis (ATTR-CA) prevalence increases with age. The interplay between frailty and heart failure has been increasingly recognized. The objective of this study is to compare clinical, biological, and transthoracic echocardiography (TTE) characteristics of older ATTR-CA patients according to the G8 frailty screening tool. Methods-Patients over 75 years old with a confirmed diagnosis of ATTR-CA were included between January 2020 and April 2021. All patients underwent a routine blood test, TTE, and a functional assessment with a six-minute walking distance test (6MWD) or cardiopulmonary exercise testing (CPET), and the G8 score was calculated. Results-Fifty-two patients were included. Thirty-nine (75%) patients were frail and their mean NYHA stage was more severe (2.2 vs. 1.7; p = 0.004); 62% of them had a Gilmore stage of 2 or 3 (p = 0.05). Global left ventricular strain (GLS) was lower (-11.7% vs. -14.9%; p = 0.014) and the interventricular septum was thicker (18 ± 2 mm vs. 17 ± 2 mm; p = 0.033) in frail patients. There were no significant differences according to functional tests. Conclusion-The majority of older patients with ATTR-CA are frail according to the G8 score. They are more symptomatic and have an increased cardiac involvement and a poorer prognosis, requiring more personalized cardiac management.
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Affiliation(s)
- Stéphanie Cazalbou
- Department of Cardiology, University Hospital of Toulouse, 31400 Toulouse, France; (S.C.); (E.C.); (P.F.)
- Cardiac Imaging Center, University Hospital of Toulouse, 31059 Toulouse, France
| | - Louise Naccache
- Geriatrics Department, Internal Medicine and Cardiogeriatry Unit, Toulouse University Hospital, 31059 Toulouse, France; (L.N.); (S.S.); (F.N.); (L.B.); (O.T.); (Z.S.)
| | - Sandrine Sourdet
- Geriatrics Department, Internal Medicine and Cardiogeriatry Unit, Toulouse University Hospital, 31059 Toulouse, France; (L.N.); (S.S.); (F.N.); (L.B.); (O.T.); (Z.S.)
| | - Eve Cariou
- Department of Cardiology, University Hospital of Toulouse, 31400 Toulouse, France; (S.C.); (E.C.); (P.F.)
- Cardiac Imaging Center, University Hospital of Toulouse, 31059 Toulouse, France
| | - Pauline Fournier
- Department of Cardiology, University Hospital of Toulouse, 31400 Toulouse, France; (S.C.); (E.C.); (P.F.)
- Cardiac Imaging Center, University Hospital of Toulouse, 31059 Toulouse, France
| | - Fati Nourhashemi
- Geriatrics Department, Internal Medicine and Cardiogeriatry Unit, Toulouse University Hospital, 31059 Toulouse, France; (L.N.); (S.S.); (F.N.); (L.B.); (O.T.); (Z.S.)
- French National Institute of Health and Medical Research, Toulouse III Paul Sabatier University, 31062 Toulouse, France
- Medical School of Medicine, Toulouse III Paul Sabatier University, 31062 Toulouse, France
| | - Laurent Balardy
- Geriatrics Department, Internal Medicine and Cardiogeriatry Unit, Toulouse University Hospital, 31059 Toulouse, France; (L.N.); (S.S.); (F.N.); (L.B.); (O.T.); (Z.S.)
- French National Institute of Health and Medical Research, Toulouse III Paul Sabatier University, 31062 Toulouse, France
| | - Olivier Toulza
- Geriatrics Department, Internal Medicine and Cardiogeriatry Unit, Toulouse University Hospital, 31059 Toulouse, France; (L.N.); (S.S.); (F.N.); (L.B.); (O.T.); (Z.S.)
| | - Olivier Lairez
- Department of Cardiology, University Hospital of Toulouse, 31400 Toulouse, France; (S.C.); (E.C.); (P.F.)
- Cardiac Imaging Center, University Hospital of Toulouse, 31059 Toulouse, France
- Medical School of Medicine, Toulouse III Paul Sabatier University, 31062 Toulouse, France
- Department of Nuclear Medicine, University Hospital of Toulouse, 31059 Toulouse, France
| | - Zara Steinmeyer
- Geriatrics Department, Internal Medicine and Cardiogeriatry Unit, Toulouse University Hospital, 31059 Toulouse, France; (L.N.); (S.S.); (F.N.); (L.B.); (O.T.); (Z.S.)
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Cui G, Li S, Ye H, Yang Y, Jia X, Lin M, Chu Y, Feng Y, Wang Z, Shi Z, Zhang X. Gut microbiome and frailty: insight from genetic correlation and mendelian randomization. Gut Microbes 2023; 15:2282795. [PMID: 37990415 PMCID: PMC10730212 DOI: 10.1080/19490976.2023.2282795] [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] [Received: 03/30/2023] [Accepted: 11/08/2023] [Indexed: 11/23/2023] Open
Abstract
Observational studies have shown that the gut microbiome is associated with frailty. However, whether these associations underlie causal effects remains unknown. Thus, this study aimed to assess the genetic correlation and causal relationships between the genetically predicted gut microbiome and frailty using linkage disequilibrium score regression (LDSC) and Mendelian Randomization (MR). Summary statistics for the gut microbiome were obtained from a genome-wide association study (GWAS) meta-analysis of the MiBioGen consortium (N = 18,340). Summary statistics for frailty were obtained from a GWAS meta-analysis, including the UK Biobank and TwinGene (N = 175,226). We used LDSC and MR analyses to estimate the genetic correlation and causality between the genetically predicted gut microbiome and frailty. Our findings indicate a suggestive genetic correlation between Christensenellaceae R-7 and frailty. Moreover, we found evidence for suggestive causal effects of twelve genus-level gut microbes on frailty using at least two MR methods. There was no evidence of horizontal pleiotropy or heterogeneity in the MR analysis. This study provides suggestive evidence for a potential genetic correlation and causal association between several genetically predicted gut microbes and frailty. More population-based observational studies and animal experiments are required to clarify this association and the underlying mechanisms.
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Affiliation(s)
- Guanghui Cui
- Department of Integrated Traditional Chinese and Western Medicine, Peking University First Hospital; Institute of Integrated Traditional Chinese and Western Medicine, Peking University, Beijing, China
| | - Shaojie Li
- School of Public Health, Peking University, Beijing, China
- China Center for Health Development Studies, Peking University, Beijing, China
| | - Hui Ye
- Department of Integrated Traditional Chinese and Western Medicine, Peking University First Hospital; Institute of Integrated Traditional Chinese and Western Medicine, Peking University, Beijing, China
| | - Yao Yang
- Department of Integrated Traditional Chinese and Western Medicine, Peking University First Hospital; Institute of Integrated Traditional Chinese and Western Medicine, Peking University, Beijing, China
| | - Xiaofen Jia
- Department of Integrated Traditional Chinese and Western Medicine, Peking University First Hospital; Institute of Integrated Traditional Chinese and Western Medicine, Peking University, Beijing, China
| | - Miaomiao Lin
- Department of Integrated Traditional Chinese and Western Medicine, Peking University First Hospital; Institute of Integrated Traditional Chinese and Western Medicine, Peking University, Beijing, China
| | - Yingming Chu
- Department of Integrated Traditional Chinese and Western Medicine, Peking University First Hospital; Institute of Integrated Traditional Chinese and Western Medicine, Peking University, Beijing, China
| | - Yue Feng
- Department of Integrated Traditional Chinese and Western Medicine, Peking University First Hospital; Institute of Integrated Traditional Chinese and Western Medicine, Peking University, Beijing, China
| | - Zicheng Wang
- Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Zongming Shi
- Department of Integrated Traditional Chinese and Western Medicine, Peking University First Hospital; Institute of Integrated Traditional Chinese and Western Medicine, Peking University, Beijing, China
| | - Xuezhi Zhang
- Department of Integrated Traditional Chinese and Western Medicine, Peking University First Hospital; Institute of Integrated Traditional Chinese and Western Medicine, Peking University, Beijing, China
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Okoye C, Mazzarone T, Niccolai F, Bencivenga L, Pescatore G, Bianco MG, Guerrini C, Giusti A, Guarino D, Virdis A. Predicting mortality and re-hospitalization for heart failure: a machine-learning and cluster analysis on frailty and comorbidity. Aging Clin Exp Res 2023; 35:2919-2928. [PMID: 37848804 PMCID: PMC10721693 DOI: 10.1007/s40520-023-02566-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 09/13/2023] [Indexed: 10/19/2023]
Abstract
BACKGROUND Machine-learning techniques have been recently utilized to predict the probability of unfavorable outcomes among elderly patients suffering from heart failure (HF); yet none has integrated an assessment for frailty and comorbidity. This research seeks to determine which machine-learning-based phenogroups that incorporate frailty and comorbidity are most strongly correlated with death or readmission at hospital for HF within six months following discharge from hospital. METHODS In this single-center, prospective study of a tertiary care center, we included all patients aged 65 and older discharged for acute decompensated heart failure. Random forest analysis and a Cox multivariable regression were performed to determine the predictors of the composite endpoint. By k-means and hierarchical clustering, those predictors were utilized to phenomapping the cohort in four different clusters. RESULTS A total of 571 patients were included in the study. Cluster analysis identified four different clusters according to frailty, burden of comorbidities and BNP. As compared with Cluster 4, we found an increased 6-month risk of poor outcomes patients in Cluster 1 (very frail and comorbid; HR 3.53 [95% CI 2.30-5.39]), Cluster 2 (pre-frail with low levels of BNP; HR 2.59 [95% CI 1.66-4.07], and in Cluster 3 (pre-frail and comorbid with high levels of BNP; HR 3.75 [95% CI 2.25-6.27])). CONCLUSIONS In older patients discharged for ADHF, the cluster analysis identified four distinct phenotypes according to frailty degree, comorbidity, and BNP levels. Further studies are warranted to validate these phenogroups and to guide an appropriate selection of personalized, model of care.
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Affiliation(s)
- Chukwuma Okoye
- Geriatrics Unit, Department of Clinical and Experimental Medicine, University of Pisa, Via Paradisa, 2, 56124, Pisa, Italy
- Department of Neurobiology, Care Sciences and Society, Department of Geriatrics Aging Research Center, Karolinska Institutet, Stockholm University, Stockholm, Sweden
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Tessa Mazzarone
- Geriatrics Unit, Department of Clinical and Experimental Medicine, University of Pisa, Via Paradisa, 2, 56124, Pisa, Italy.
| | - Filippo Niccolai
- Geriatrics Unit, Department of Clinical and Experimental Medicine, University of Pisa, Via Paradisa, 2, 56124, Pisa, Italy
| | - Leonardo Bencivenga
- Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy
| | - Giulia Pescatore
- Geriatrics Unit, Department of Clinical and Experimental Medicine, University of Pisa, Via Paradisa, 2, 56124, Pisa, Italy
| | - Maria Giovanna Bianco
- Geriatrics Unit, Department of Clinical and Experimental Medicine, University of Pisa, Via Paradisa, 2, 56124, Pisa, Italy
| | - Cinzia Guerrini
- Geriatrics Unit, Department of Clinical and Experimental Medicine, University of Pisa, Via Paradisa, 2, 56124, Pisa, Italy
| | - Andrea Giusti
- Geriatrics Unit, Department of Clinical and Experimental Medicine, University of Pisa, Via Paradisa, 2, 56124, Pisa, Italy
| | - Daniela Guarino
- Geriatrics Unit, Department of Clinical and Experimental Medicine, University of Pisa, Via Paradisa, 2, 56124, Pisa, Italy
| | - Agostino Virdis
- Geriatrics Unit, Department of Clinical and Experimental Medicine, University of Pisa, Via Paradisa, 2, 56124, Pisa, Italy
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Li T, Jiang YL, Kang J, Song S, Du QF, Yi XD. Prevalence and risk factors of frailty in older patients with chronic heart failure: a systematic review and meta-analysis. Aging Clin Exp Res 2023; 35:2861-2871. [PMID: 37864762 DOI: 10.1007/s40520-023-02587-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 09/30/2023] [Indexed: 10/23/2023]
Abstract
AIM To provide a summary of the available evidence concerning prevalence and risk factors of frailty in elderly patients with CHF. METHODS PubMed, Embase, Web of Science, CINAHL, The Cochrane Library, China National Knowledge Infrastructure Database (CNKI), Chinese Biomedical Database (Sinomed), Weipu Database (VIP), and Wanfang database were searched from inception to July 2023. This study strictly followed the PRISMA guidelines. The quality of the included studies was rated by the Agency for Healthcare and Research and Quality and the Newcastle-Ottawa Scale. RESULTS A total of 21 original studies were included, involving 4,797 patients. Meta-analysis results showed that the prevalence of frailty in older patients with heart failure was 38% (95%CI: 0.32-0.44). Age, cardiac function grading, left atrial diameter, left ventricular ejection fraction, hemoglobin, polypharmacy, BNP, nutritional risk, and hospitalization day are the influential factors of frailty in older patients with CHF. CONCLUSION The prevalence of frailty in older patients with CHF is high, and clinical medical personnel should identify and intervene early to reduce or delay the frailty in older patients with CHF as much as possible.
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Affiliation(s)
- Tao Li
- Department of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, 610072, China
| | - Yun-Lan Jiang
- Affiliated Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, 610075, China.
| | - Jing Kang
- Department of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, 610072, China
| | - Shuang Song
- Department of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, 610072, China
| | - Qiu-Feng Du
- Department of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, 610072, China
| | - Xiao-Dong Yi
- Department of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, 610072, China
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27
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Chou YY, Lee YS, Lin CS, Chen JP, Kuo FH, Lin CF, Chen YM, Lin SY. Gender-specific linkages: frailty, polypharmacy, anti-cholinergic burden, and 5-year mortality risk-a real-world analysis. PeerJ 2023; 11:e16262. [PMID: 38025730 PMCID: PMC10668851 DOI: 10.7717/peerj.16262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 09/18/2023] [Indexed: 12/01/2023] Open
Abstract
Background With higher age, frailty escalates the risk of falls, unexpected physical dysfunction, hospitalization, and mortality. Polypharmacy in the older population is a major challenge that not only increases medical costs, but also may worsen the risk of hospitalization and death. More importantly, the properties of anti-cholinergic drugs contribute various negative effects. This study aimed to investigate the sex difference in the association of polypharmacy, anticholinergic burden, and frailty with mortality. Methods Participants older than 65 years who attended the geriatric outpatient clinic of the study center between January 2015 and July 2020 were invited to participate in this retrospective study. Comprehensive geriatric assessment data were collected and the phenotype of frailty was determined by Fried's criteria. Cox regression and the Kaplan-Meier curve were used to identify risk factors of 5-year survival along with intergroup differences in the risks. Results Of the 2,077 participants, 47.5% were female. The prevalence of frailty and the rate of polypharmacy were 44.7% and 60.6%, respectively. Higher age, male sex, low body mass index, low Mini-Mental State Examination scores, low activities of daily living, frailty status, polypharmacy, and a high Charlson Comorbidity Index score, and greater anticholinergic burden were significant risk factors that were associated with the 5-year all-cause mortality. Male patients with frailty exhibited the highest risks of mortality compared with male patients without frailty and female patients with or without frailty. Polypharmacy was significantly associated with a higher 5-year mortality rate in the frail male group compared with the non-frail male. In frail female group, individuals with a higher anticholinergic burden (as indicated by the Anticholinergic Cognitive Burden Scale) from drug usage exhibited an elevated 5-year mortality rate. Conclusions Polypharmacy and greater anticholinergic burden, synergistically interacted with frailty and intensified the 5-year mortality risk in a gender-specific manner. To mitigate mortality risks, clinicians should prudently identify polypharmacy and anticholinergic burden in the older population.
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Affiliation(s)
- Yin Yi Chou
- Center for Geriatrics & Gerontology, Taichung Veterans General Hospital, Taichung, Taiwan
- Division of Allergy, Immunology and Rheumatology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Yu Shan Lee
- Center for Geriatrics & Gerontology, Taichung Veterans General Hospital, Taichung, Taiwan
- Division of Neurology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Chu Sheng Lin
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan
- Department of Family Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Jun Peng Chen
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Fu-Hsuan Kuo
- Center for Geriatrics & Gerontology, Taichung Veterans General Hospital, Taichung, Taiwan
- Division of Neurology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Cheng-Fu Lin
- Center for Geriatrics & Gerontology, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Family Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
- Division of Occupational Medicine, Department of Emergency, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Yi-Ming Chen
- Division of Allergy, Immunology and Rheumatology, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan
- Institute of Biomedical Science and Rong-Hsing Research Center for Translational Medicine, Chung Hsing University, Taichung, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Shih-Yi Lin
- Center for Geriatrics & Gerontology, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
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28
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Talha KM, Greene SJ, Butler J, Khan MS. Frailty and Its Implications in Heart Failure with Reduced Ejection Fraction: Impact on Prognosis and Treatment. Cardiol Clin 2023; 41:525-536. [PMID: 37743075 DOI: 10.1016/j.ccl.2023.06.002] [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: 09/01/2023]
Abstract
Frailty affects half of all patients with heart failure with reduced ejection fraction (HFrEF) and carries a ∼2-fold increased risk of mortality. The relationship between frailty and HFrEF is bidirectional, with one condition exacerbating the other. Paradoxical to their higher clinical risk, frail patients with HFrEF are more often under-treated due to concerns over medication-related adverse clinical events. However, current evidence suggests consistent safety of HF medical therapies among older frail patients with HFrEF. A multidisciplinary effort is necessary for the appropriate management of these high-risk patients which focuses on the optimization of known beneficial therapies with a goal-directed effort toward improving quality of life.
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Affiliation(s)
- Khawaja M Talha
- Department of Medicine, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS 39216, USA
| | - Stephen J Greene
- Division of Cardiology, Department of Medicine, Duke University Hospital, 2301 Erwin Road, Durham, NC 27710, USA
| | - Javed Butler
- Department of Medicine, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS 39216, USA; Baylor Scott & White Research Institute, 3434 Live Oak Street Suite 501, Dallas, TX 75204, USA
| | - Muhammad Shahzeb Khan
- Division of Cardiology, Department of Medicine, Duke University Hospital, 2301 Erwin Road, Durham, NC 27710, USA.
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29
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Girerd N, Leclercq C, Hanon O, Bayés-Genís A, Januzzi JL, Damy T, Lequeux B, Meune C, Sabouret P, Roubille F. Optimisation of treatments for heart failure with reduced ejection fraction in routine practice: a position statement from a panel of experts. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2023; 76:813-820. [PMID: 36914024 DOI: 10.1016/j.rec.2023.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Accepted: 02/27/2023] [Indexed: 03/15/2023]
Abstract
Major international practice guidelines recommend the use of a combination of 4 medication classes in the treatment of patients with heart failure with reduced ejection fraction (HFrEF) but do not specify how these treatments should be introduced and up-titrated. Consequently, many patients with HFrEF do not receive an optimized treatment regimen. This review proposes a pragmatic algorithm for treatment optimization designed to be easily applied in routine practice. The first goal is to ensure that all 4 recommended medication classes are initiated as early as possible to establish effective therapy, even at a low dose. This is considered preferable to starting fewer medications at a maximum dose. The second goal is to ensure that the intervals between the introduction of different medications and between different titration steps are as short as possible to ensure patient safety. Specific proposals are made for older patients (> 75 years) who are frail, and for those with cardiac rhythm disorders. Application of this algorithm should allow an optimal treatment protocol to be achieved within 2-months in most patients, which should the treatment goal in HFrEF.
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Affiliation(s)
- Nicolas Girerd
- Centre d'Investigations Cliniques-Plurithématique (CIC-P) 14-33, Centre Hospitalier Régional Universitaire (CHRU) de Nancy, Institut National de la Santé et de la Recherche Médicale (INSERM), Université de Lorraine, Nancy, France; Cardiovascular and Renal Clinical Trialists network (INI-CRCT), French Clinical Research Infrastructure Network (F-CRIN).
| | - Christophe Leclercq
- Service de Cardiologie, Centre Hospitalier Universitaire de Rennes, Université Rennes 1, Rennes, France; Laboratoire Traitement du Signal et de l'Image (LTSI), Institut National de la Santé et de la Recherche Médicale (INSERM) U642, CIC-IT, 804, Rennes, France
| | - Olivier Hanon
- Service de Gériatrie, Hôpitaux Universitaires Paris Centre, Gérontopôle d'Île-de-France, Université de Paris Cité, Paris, France
| | - Antoni Bayés-Genís
- Servicio de Cardiología, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - James L Januzzi
- Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States; Heart Failure and Biomarker Research, Baim Institute for Clinical Research, Boston, Massachusetts, United States
| | - Thibaut Damy
- Service de Cardiologie, Centre Hospitalier Universitaire Henri Mondor AP-HP, Creteil, France
| | - Benoit Lequeux
- Service de Cardiologie, Centre Hospitalier Universitaire Poitiers, Poitiers, France
| | - Christophe Meune
- Service de Cardiologie, Centre Hospitalier Universitaire Avicenne, Université Paris 13, Bobigny, France
| | - Pierre Sabouret
- Service de Cardiologie, Institut de Cardiologie, Centre Hospitalier Universitaire La Pitié Salpetrière, Sorbonne Université, Paris, France
| | - François Roubille
- Service de Cardiologie, PhyMedExp, Université de Montpellier, Institut National de la Santé et de la Recherche Médicale (INSERM) U1046, Centre National de la Recherche Scientifique (CNRS) UMR 9214, Montpellier, France
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30
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Talha KM, Pandey A, Fudim M, Butler J, Anker SD, Khan MS. Frailty and heart failure: State-of-the-art review. J Cachexia Sarcopenia Muscle 2023; 14:1959-1972. [PMID: 37586848 PMCID: PMC10570089 DOI: 10.1002/jcsm.13306] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 06/16/2023] [Accepted: 07/11/2023] [Indexed: 08/18/2023] Open
Abstract
At least half of all patients with heart failure (HF) are affected by frailty, a syndrome that limits an individual ability to recover from acute stressors. While frailty affects up to 90% of patients with HF with preserved ejection fraction, it is also seen in ~30-60% of patients with HF with reduced ejection fraction, with ~26% higher prevalence in women compared with men. The relationship between frailty and HF is bidirectional, with both conditions exacerbating the other. Frailty is further complicated by a higher prevalence of sarcopenia (by ~20%) in HF patients compared with patients without HF, which negatively affects outcomes. Several frailty assessment methods have been employed historically including the Fried frailty phenotype and Rockwood Clinical Frailty Scale to classify HF patients based on the severity of frailty; however, a validated HF-specific frailty assessment tool does not currently exist. Frailty in HF is associated with a poor prognosis with a 1.5-fold to 2-fold higher risk of all-cause death and hospitalizations compared to non-frail patients. Frailty is also highly prevalent in patients with worsening HF, affecting >50% of patients hospitalized for HF. Such patients with multiple readmissions for decompensated HF have markedly poor outcomes compared to younger, non-frail cohorts, and it is hypothesized that it may be due to major physical and functional limitations that limit recovery from an acute episode of worsening HF, a care aspect that has not been addressed in HF guidelines. Frail patients are thought to confer less benefit from therapeutic interventions due to an increased risk of perceived harm, resulting in lower adherence to HF interventions, which may worsen outcomes. Multiple studies report that <40% of frail patients are on guideline-directed medical therapy for HF, of which most are on suboptimal doses of these medications. There is a lack of evidence generated from randomized trials in this incredibly vulnerable population, and most current practice is governed by post hoc analyses of trials, observational registry-based data and providers' clinical judgement. The current body of evidence suggests that the treatment effect of most guideline-based interventions, including medications, cardiac rehabilitation and device therapy, is consistent across all age groups and frailty subgroups and, in some cases, may be amplified in the older, more frail population. In this review, we discuss the characteristics, assessment tools, impact on prognosis and impact on therapeutic interventions of frailty in patients with HF.
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Affiliation(s)
- Khawaja M. Talha
- Department of MedicineUniversity of Mississippi Medical CenterJacksonMSUSA
| | - Ambarish Pandey
- Division of CardiologyUniversity of Texas Southwestern Medical CenterDallasTXUSA
| | - Marat Fudim
- Division of CardiologyDuke University Hospital, Duke University School of MedicineDurhamNCUSA
- Duke Clinical Research InstituteDurhamNCUSA
| | - Javed Butler
- Department of MedicineUniversity of Mississippi Medical CenterJacksonMSUSA
- Baylor Scott and White Research InstituteDallasTXUSA
| | - Stefan D. Anker
- Department of Cardiology (CVK) of German Heart Center CharitéInstitute of Health Center for Regenerative Therapies (BCRT), German Centre for Cardiovascular Research (DZHK) partner site Berlin, Charité UniversitätsmedizinBerlinGermany
- Institute of Heart DiseasesWroclaw Medical UniversityWroclawPoland
| | - Muhammad Shahzeb Khan
- Division of CardiologyDuke University Hospital, Duke University School of MedicineDurhamNCUSA
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31
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Díez-Villanueva P, Jiménez-Méndez C, López-Lluva MT, Wasniewski S, Solís J, Fernández-Friera L, Martínez-Sellés M. Heart Failure in the Elderly: the Role of Biological and Sociocultural Aspects Related to Sex. Curr Heart Fail Rep 2023; 20:321-332. [PMID: 37498496 DOI: 10.1007/s11897-023-00619-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/17/2023] [Indexed: 07/28/2023]
Abstract
PURPOSE OF REVIEW Heart failure (HF) entails poor prognosis, with high morbidity and mortality burden, particularly in elderly patients. Notably, important sex differences have been described between men and women with HF. In this regard, some biological and sociocultural aspects related to sex may play a key role in the different development and prognosis of HF in elderly men and women. RECENT FINDINGS Important differences between men and women with HF, especially in the elderly population, have been specifically addressed in recent studies. Consequently, specific differences in biological and sociocultural aspects have been found to associate differences in pathophysiology, baseline clinical profile, and prognosis according to sex. Moreover, differences in comorbidities and frailty and other geriatric conditions, frequent in elderly population with HF, have also been described. Biological and sociocultural differences related to sex are key in the different clinical presentation and prognosis of heart failure in elderly women. Further studies will be required to better understand some other underlying reasons that may differently impact prognosis in elderly patients with HF.
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Affiliation(s)
- Pablo Díez-Villanueva
- Cardiology Department, Hospital Universitario de La Princesa, Calle Diego de León 62, 28006, Madrid, Spain.
| | | | | | - Samantha Wasniewski
- Cardiac Imaging Unit, Hospital Universitario HM Montepríncipe-CIEC, Madrid, Spain
- Universidad Camilo José Cela, Madrid, Spain
- Atria Clinic, Madrid, Spain
| | - Jorge Solís
- Atria Clinic, Madrid, Spain
- Cardiology Department, Hospital Universitario 12 de Octubre, Madrid, Spain
- CIBER de enfermedades CardioVasculares (CIBERCV), Madrid, Spain
| | - Leticia Fernández-Friera
- Cardiac Imaging Unit, Hospital Universitario HM Montepríncipe-CIEC, Madrid, Spain
- Universidad Camilo José Cela, Madrid, Spain
- Atria Clinic, Madrid, Spain
- Cardiology Department, Hospital Universitario 12 de Octubre, Madrid, Spain
- CIBER de enfermedades CardioVasculares (CIBERCV), Madrid, Spain
| | - Manuel Martínez-Sellés
- Cardiology Department, Hospital Universitario Gregorio Marañón, Madrid, Spain
- Universidad Complutense and Universidad Europea de Madrid, Madrid, Spain
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32
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Li W, Huang G, Tang N, Lu P, Jiang L, Lv J, Qin Y, Lin Y, Xu F, Lei D. Association between co-exposure to phenols, phthalates, and polycyclic aromatic hydrocarbons with the risk of frailty. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2023; 30:105181-105193. [PMID: 37713077 DOI: 10.1007/s11356-023-29887-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 09/11/2023] [Indexed: 09/16/2023]
Abstract
The phenomenon of population aging has brought forth the challenge of frailty. Nevertheless, the contribution of environmental exposure to frailty remains ambiguous. Our objective was to investigate the association between phenols, phthalates (PAEs), and polycyclic aromatic hydrocarbons (PAHs) with frailty. We constructed a 48-item frailty index using data from the National Health and Nutrition Examination Survey (NHANES). The exposure levels of 20 organic contaminants were obtained from the survey circle between 2005 and 2016. The association between individual organic contaminants and the frailty index was assessed using negative binomial regression models. The combined effect of organic contaminants was examined using weighted quantile sum (WQS) regression. Dose-response patterns were modeled using generalized additive models (GAMs). Additionally, an interpretable machine learning approach was employed to develop a predictive model for the frailty index. A total of 1566 participants were included in the analysis. Positive associations were observed between exposure to MIB, P02, ECP, MBP, MHH, MOH, MZP, MC1, and P01 with the frailty index. WQS regression analysis revealed a significant increase in the frailty index with higher levels of the mixture of organic contaminants (aOR, 1.12; 95% CI, 1.05-1.20; p < 0.001), with MIB, ECP, COP, MBP, P02, and P01 identified as the major contributors. Dose-response relationships were observed between MIB, ECP, MBP, P02, and P01 exposure with an increased risk of frailty (both with p < 0.05). The developed predictive model based on organic contaminants exposure demonstrated high performance, with an R2 of 0.9634 and 0.9611 in the training and testing sets, respectively. Furthermore, the predictive model suggested potential synergistic effects in the MIB-MBP and P01-P02 pairs. Taken together, these findings suggest a significant association between exposure to phthalates and PAHs with an increased susceptibility to frailty.
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Affiliation(s)
- Wenxiang Li
- Department of Ophthalmology, the People's Hospital of Guangxi Zhuang Autonomous Region & Guangxi Key Laboratory of Eye Health & Guangxi Health Commission Key Laboratory of Ophthalmology and Related Systemic Diseases Artificial Intelligence Screening Technology & Institute of Ophthalmic Diseases, Guangxi Academy of Medical Sciences, Nanning, 530021, People's Republic of China
| | - Guangyi Huang
- Department of Ophthalmology, the People's Hospital of Guangxi Zhuang Autonomous Region & Guangxi Key Laboratory of Eye Health & Guangxi Health Commission Key Laboratory of Ophthalmology and Related Systemic Diseases Artificial Intelligence Screening Technology & Institute of Ophthalmic Diseases, Guangxi Academy of Medical Sciences, Nanning, 530021, People's Republic of China
| | - Ningning Tang
- Department of Ophthalmology, the People's Hospital of Guangxi Zhuang Autonomous Region & Guangxi Key Laboratory of Eye Health & Guangxi Health Commission Key Laboratory of Ophthalmology and Related Systemic Diseases Artificial Intelligence Screening Technology & Institute of Ophthalmic Diseases, Guangxi Academy of Medical Sciences, Nanning, 530021, People's Republic of China
| | - Peng Lu
- Department of Ophthalmology, the People's Hospital of Guangxi Zhuang Autonomous Region & Guangxi Key Laboratory of Eye Health & Guangxi Health Commission Key Laboratory of Ophthalmology and Related Systemic Diseases Artificial Intelligence Screening Technology & Institute of Ophthalmic Diseases, Guangxi Academy of Medical Sciences, Nanning, 530021, People's Republic of China
| | - Li Jiang
- Department of Ophthalmology, the People's Hospital of Guangxi Zhuang Autonomous Region & Guangxi Key Laboratory of Eye Health & Guangxi Health Commission Key Laboratory of Ophthalmology and Related Systemic Diseases Artificial Intelligence Screening Technology & Institute of Ophthalmic Diseases, Guangxi Academy of Medical Sciences, Nanning, 530021, People's Republic of China
| | - Jian Lv
- Department of Ophthalmology, the People's Hospital of Guangxi Zhuang Autonomous Region & Guangxi Key Laboratory of Eye Health & Guangxi Health Commission Key Laboratory of Ophthalmology and Related Systemic Diseases Artificial Intelligence Screening Technology & Institute of Ophthalmic Diseases, Guangxi Academy of Medical Sciences, Nanning, 530021, People's Republic of China
| | - Yuanjun Qin
- Department of Ophthalmology, the People's Hospital of Guangxi Zhuang Autonomous Region & Guangxi Key Laboratory of Eye Health & Guangxi Health Commission Key Laboratory of Ophthalmology and Related Systemic Diseases Artificial Intelligence Screening Technology & Institute of Ophthalmic Diseases, Guangxi Academy of Medical Sciences, Nanning, 530021, People's Republic of China
| | - Yunru Lin
- Department of Ophthalmology, the People's Hospital of Guangxi Zhuang Autonomous Region & Guangxi Key Laboratory of Eye Health & Guangxi Health Commission Key Laboratory of Ophthalmology and Related Systemic Diseases Artificial Intelligence Screening Technology & Institute of Ophthalmic Diseases, Guangxi Academy of Medical Sciences, Nanning, 530021, People's Republic of China
| | - Fan Xu
- Department of Ophthalmology, the People's Hospital of Guangxi Zhuang Autonomous Region & Guangxi Key Laboratory of Eye Health & Guangxi Health Commission Key Laboratory of Ophthalmology and Related Systemic Diseases Artificial Intelligence Screening Technology & Institute of Ophthalmic Diseases, Guangxi Academy of Medical Sciences, Nanning, 530021, People's Republic of China
| | - Daizai Lei
- Department of Ophthalmology, the People's Hospital of Guangxi Zhuang Autonomous Region & Guangxi Key Laboratory of Eye Health & Guangxi Health Commission Key Laboratory of Ophthalmology and Related Systemic Diseases Artificial Intelligence Screening Technology & Institute of Ophthalmic Diseases, Guangxi Academy of Medical Sciences, Nanning, 530021, People's Republic of China.
- Department of Ophthalmology, The People's Hospital of Guangxi Zhuang Autonomous Region, 6 Taoyuan Road, Qingxiu District, Nanning, 530000, China.
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Archer SH, Lee CS, Gupta N, Roberts Davis M, Hiatt SO, Purnell JQ, Tibbitts D, Winters-Stone K, Denfeld QE. Sex differences in the impact of physical frailty on outcomes in heart failure. Heart Lung 2023; 61:66-71. [PMID: 37156061 PMCID: PMC10524847 DOI: 10.1016/j.hrtlng.2023.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 04/25/2023] [Accepted: 04/27/2023] [Indexed: 05/10/2023]
Abstract
BACKGROUND Physical frailty is strongly related to adverse outcomes in heart failure (HF), and women are more likely to be physically frail than men; however, it is unknown if this sex difference affects outcomes. OBJECTIVES To determine if there are sex differences in the associations between physical frailty and health-related quality of life (HRQOL) and clinical outcomes in HF. METHODS We conducted a prospective study of adults with HF. Physical frailty was assessed using the Frailty Phenotype Criteria. HRQOL was assessed using the Minnesota Living with HF Questionnaire. One-year clinical events (all-cause death or cardiovascular hospitalization or emergency department visit) were ascertained. We used generalized linear modeling to quantify associations between physical frailty and HRQOL, and Cox proportional hazards modeling to quantify associations between physical frailty and clinical events, adjusting for Seattle HF Model scores. RESULTS The sample (n = 115) was 63.5 ± 15.7 years old and 49% women. Physical frailty was associated with significantly worse total HRQOL among women (p = 0.005) but not men (p = 0.141). Physical frailty was associated with worse physical HRQOL among both women (p < 0.001) and men (p = 0.043). There was a 46% higher clinical event risk for every one-point increase in physical frailty score among men (p = 0.047) but not women (p = 0.361). CONCLUSIONS Physical frailty is associated with worse overall HRQOL among women and higher clinical event risk among men, indicating a need to better understand contributors to sex-specific health differences associated with physical frailty in HF.
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Affiliation(s)
- Sara H Archer
- Oregon Health & Science University, Hillsboro Medical Center, Hillsboro, OR, United States
| | - Christopher S Lee
- Boston College, William F. Connell School of Nursing, Chestnut Hill, MA, United States; Australian Catholic University, Melbourne, Australia
| | - Nandita Gupta
- Oregon Health & Science University, Hillsboro Medical Center, Hillsboro, OR, United States; Knight Cardiovascular Institute, Oregon Health & Science University, Portland, OR, United States
| | - Mary Roberts Davis
- School of Nursing, Oregon Health & Science University, Portland, OR, United States
| | - Shirin O Hiatt
- School of Nursing, Oregon Health & Science University, Portland, OR, United States
| | - Jonathan Q Purnell
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, OR, United States
| | - Deanne Tibbitts
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR, United States
| | - Kerri Winters-Stone
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR, United States
| | - Quin E Denfeld
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, OR, United States; School of Nursing, Oregon Health & Science University, Portland, OR, United States.
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Juanes A, Ruíz J, Puig M, Blázquez M, Gilabert A, López L, Baena MI, Guiu JM, Antònia Mangues M. The Effect of the Drug-Related Problems Prevention Bundle on Early Readmissions in Patients From the Emergency Department: A Randomized Clinical Trial. Ann Pharmacother 2023; 57:1025-1035. [PMID: 36539949 DOI: 10.1177/10600280221143237] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/10/2023] Open
Abstract
BACKGROUND Drug-related problems (DRPs) are prevalent and avoidable disease that patients experience due to drug use or nonuse. However, secondary prevention policies have not yet been systematized. OBJECTIVE To assess the clinical impact of a secondary prevention bundle for DRPs in patients who visited the emergency department (ED) for medicine-related problems. METHODS A single-center randomized clinical trial was conducted from August 28, 2019, to January 28, 2021, with 1-month follow-up. We included 769 adult patients who visited ED with a DRP associated with cardiovascular, alimentary tract, and metabolic system medications. For the intervention group, a DRP prevention bundle, consisting of a combined strategy initiated in the ED was applied. Patients in the control group received standard pharmaceutical care. Intervention was evaluated in terms of 30-day hospital readmission due to any cause. RESULTS Final analysis included 769 patients, of which 68 (8.8%) were readmitted within 30 days (control group, 40 of 386 [cumulative incidence: 10.4%]; intervention group, 28 of 383 [cumulative incidence, 7.3%]). After adjustment of the model for chronic heart failure, there was a lower incidence of hospital readmission among patients in the intervention group compared with those in the control group, odds ratio: 0.59 [95% confidence interval: 0.37-0.97]; number needed to treat (NNT) = 32. No significant differences in other outcomes were observed. CONCLUSION AND RELEVANCE In this clinical trial, DRP prevention bundle in adjusted analysis decreased the rate of 30-day hospital readmission for any cause in patients who visited ED for a DRP. TRIAL REGISTRATION ClinicalTrials.gov (Identifier: NCT03607097).
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Affiliation(s)
- Ana Juanes
- Department of Pharmacy, Sant Pau Biomedical Research Institute (IIB Sant Pau), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Autonomous University of Barcelona, Bellaterra, Spain
| | - Jesús Ruíz
- Department of Pharmacy, Sant Pau Biomedical Research Institute (IIB Sant Pau), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Autonomous University of Barcelona, Bellaterra, Spain
| | - Mireia Puig
- Autonomous University of Barcelona, Bellaterra, Spain
- Department of Emergency, Sant Pau Biomedical Research Institute (IIB Sant Pau), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Marta Blázquez
- Autonomous University of Barcelona, Bellaterra, Spain
- Department of Emergency, Sant Pau Biomedical Research Institute (IIB Sant Pau), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Antoni Gilabert
- Catalan Healthcare Consortium, Catalan Health Service, Barcelona, Spain
| | - Laia López
- Department of Pharmacy, Sant Pau Biomedical Research Institute (IIB Sant Pau), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Autonomous University of Barcelona, Bellaterra, Spain
| | - M Isabel Baena
- Pharmaceutical Care Research Group, University of Granada, Granada, Spain
| | - Josep M Guiu
- Catalan Healthcare Consortium, Catalan Health Service, Barcelona, Spain
| | - Maria Antònia Mangues
- Department of Pharmacy, Sant Pau Biomedical Research Institute (IIB Sant Pau), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Autonomous University of Barcelona, Bellaterra, Spain
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Son BK, Miura T, Yabu KI, Sumikawa Y, Kim D, Lyu W, Yang Y, Tanaka M, Tanaka T, Yoshizawa Y, Iijima K. The Co-Design/Co-Development and Evaluation of an Online Frailty Check Application for Older Adults: Participatory Action Research with Older Adults. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6101. [PMID: 37372688 DOI: 10.3390/ijerph20126101] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 06/04/2023] [Accepted: 06/08/2023] [Indexed: 06/29/2023]
Abstract
Frailty is an age-related condition characterized by a decline in physical capacity with an increased vulnerability to stressors. During the COVID-19 pandemic, there was considerable progression in frailty in older adults. Therefore, an online frailty check (FC) is required for continuous screening, especially acceptable to older adults. We aimed to co-design/co-develop an online FC application with FC supporters who were facilitators in a pre-existing onsite FC program in the community. It consisted of a self-assessment of sarcopenia and an 11-item questionnaire assessing dietary, physical, and social behaviors. Opinions obtained from FC supporters (median 74.0 years) were categorized and implemented. The usability was assessed using the system usability scale (SUS). For both FC supporters and participants (n = 43), the mean score was 70.2 ± 10.3 points, which implied a "marginally high" acceptability and a "good" adjective range. Multiple regression analysis showed that the SUS score was significantly correlated with onsite-online reliability, even after adjusting for age, sex, education level, and ICT proficiency (b = 0.400, 95% CI: 0.243-1.951, p = 0.013). We also validated the online FC score, which showed a significant association between onsite and online FC scores (R = 0.670, p = 0.001). In conclusion, the online FC application is an acceptable and reliable tool to check frailty for community-dwelling older adults.
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Affiliation(s)
- Bo-Kyung Son
- Institute of Gerontology, The University of Tokyo, Tokyo 113-8656, Japan
- Institute for Future Initiatives, The University of Tokyo, Tokyo 113-0033, Japan
- Department of Geriatric Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8655, Japan
| | - Takahiro Miura
- Institute of Gerontology, The University of Tokyo, Tokyo 113-8656, Japan
- Human Augmentation Research Center (HARC), National Institute of Advanced Industrial Science and Technology (AIST), Kashiwa 277-0882, Japan
| | - Ken-Ichiro Yabu
- Institute of Gerontology, The University of Tokyo, Tokyo 113-8656, Japan
- Research Center for Advanced Science and Technology (RCAST), The University of Tokyo, Tokyo 153-8904, Japan
| | - Yuka Sumikawa
- Division of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo 113-0033, Japan
| | - Dongyool Kim
- Department of Agribusiness Management, Faculty of International Agriculture and Food Studies, Tokyo University of Agriculture, Tokyo 156-8502, Japan
| | - Weida Lyu
- Institute of Gerontology, The University of Tokyo, Tokyo 113-8656, Japan
- Department of Geriatric Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8655, Japan
| | - Yingxue Yang
- Graduate School of Education, The University of Tokyo, Tokyo 113-0033, Japan
| | - Moeko Tanaka
- Division of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo 113-0033, Japan
| | - Tomoki Tanaka
- Institute of Gerontology, The University of Tokyo, Tokyo 113-8656, Japan
| | - Yasuyo Yoshizawa
- Institute of Gerontology, The University of Tokyo, Tokyo 113-8656, Japan
| | - Katsuya Iijima
- Institute of Gerontology, The University of Tokyo, Tokyo 113-8656, Japan
- Institute for Future Initiatives, The University of Tokyo, Tokyo 113-0033, Japan
- Department of Geriatric Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8655, Japan
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Dai KZ, Laber EB, Chen H, Mentz RJ, Malhotra C. Hand Grip Strength Predicts Mortality and Quality of Life in Heart Failure: Insights From the Singapore Cohort of Patients With Advanced Heart Failure. J Card Fail 2023; 29:911-918. [PMID: 36526216 DOI: 10.1016/j.cardfail.2022.11.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 10/25/2022] [Accepted: 11/08/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Frailty is prevalent among patients with heart failure (HF) and is associated with increased mortality rates and worse patient-centered outcomes. Hand grip strength (GS) has been proposed as a single-item marker of frailty and a potential screening tool to identify patients most likely to benefit from therapies that target frailty so as to improve quality of life (QoL) and clinical outcomes. We assessed the association of longitudinal decline in GS with all-cause mortality and QoL. Decline in GS is associated with increased risk of all-cause mortality and worse overall and domain-specific (physical, functional, emotional, social) QoL among patients with advanced HF. METHODS We used data from a prospective, observational cohort of patients with New York Heart Association class III or IV HF in Singapore. Patients' overall and domain-specific QoL were assessed, and GS was measured every 4 months. We constructed a Kaplan-Meier plot with GS at baseline dichotomized into categories of weak (≤ 5th percentile) and normal (> 5th percentile) based on the GS in a healthy Singapore population of the same sex and age. Missing GS measurements were imputed using chained equations. We jointly modeled longitudinal GS measurements and survival time, adjusting for comorbidities. We used mixed effects models to evaluate the associations between GS and QoL. RESULTS Among 251 patients (mean age 66.5 ± 12.0 years; 28.3% female), all-cause mortality occurred in 58 (23.1%) patients over a mean follow-up duration of 3.0 ± 1.3 years. Patients with weak GS had decreased survival rates compared to those with normal GS (log-rank P = 0.033). In the joint model of longitudinal GS and survival time, a decrease of 1 unit in GS was associated with a 12% increase in rate of mortality (hazard ratio: 1.12; 95% confidence interval: 1.05-1.20; P = < 0.001). Higher GS was associated with higher overall QoL (β (SE) = 0.36 (0.07); P = < 0.001) and higher domain-specific QoL, including physical (β [SE] = 0.13 [0.03]; P = < 0.001), functional (β [SE] = 0.12 [0.03]; P = < 0.001), and emotional QoL (β [SE] = 0.08 [0.02]; P = < 0.001). Higher GS was associated with higher social QoL, but this was not statistically significant (β [SE] = 0.04 [0.03]; P = 0.122). CONCLUSIONS Among patients with advanced HF, longitudinal decline in GS was associated with worse survival rates and QoL. Further studies are needed to evaluate whether incorporating GS into patient selection for HF therapies leads to improved survival rates and patient-centered outcomes.
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Affiliation(s)
- Kathy Z Dai
- Duke University School of Medicine, Durham, NC, USA
| | - Eric B Laber
- Department of Statistical Science, Trinity College of Arts & Sciences, Duke University, Durham, NC, USA; Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, USA
| | - Huaxuan Chen
- Department of Statistical Science, Trinity College of Arts & Sciences, Duke University, Durham, NC, USA
| | | | - Chetna Malhotra
- Duke-National University of Singapore Medical School, Singapore.
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Heaney C, Knisel A, Vuthoori R, Golombeck D, Fernandez H, Lima B, Taylor J, Davidson K, Kennedy K, Nursey V, Miller E, Maybaum S. Subjective Assessment Underestimates Fraility in Patients With Heart Failure Referred for Advanced Therapies. ASAIO J 2023; 69:588-594. [PMID: 36804288 DOI: 10.1097/mat.0000000000001894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023] Open
Abstract
Assessment of frailty is key for evaluation for advanced therapies (ATs). Most programs use a subjective provider assessment (SPA) or "eye-ball" test; however, objective measures exist. The modified five-item Fried Frailty Index (mFFI) is a validated tool to assess frailty. We compared SPA to mFFI testing in patients referred for AT. We also compared levels of macrophage migration inhibitory factor (MIF), an inflammatory biomarker associated with worse outcomes in heart failure, between frail and not frail subjects. Seventy-eight patients referred for evaluation for AT underwent both SPA and mFFI testing. Three cardiac surgeons independently assessed patients for frailty (SPA). SPA significantly underestimated frailty compared with mFFI testing and correlation between SPA and mFFI was not strong (κ = 0.02-0.14). Providers were correct 84% of the time designating a subject as frail, but only 40% of the time designating as not frail. Agreement between all three providers was robust (76%), which was primarily driven by designation as not frail. There was no significant difference in plasma MIF levels between frail and not frail subjects (47.6 ± 25.2 vs . 45.2 ± 18.9 ng/ml; p = 0.6). Clinicians significantly underestimate frailty but are usually correct when designating a patient as frail.
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Affiliation(s)
- Cassandra Heaney
- From the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell is in Manhasset, New York, USA
| | - Alexis Knisel
- From the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell is in Manhasset, New York, USA
| | - Ravi Vuthoori
- Department of Cardiovascular and Thoracic Surgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell is in Manhasset, New York, USA
| | - David Golombeck
- Department of Cardiovascular and Thoracic Surgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell is in Manhasset, New York, USA
| | - Harold Fernandez
- Department of Cardiovascular and Thoracic Surgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell is in Manhasset, New York, USA
| | - Brian Lima
- Department of Cardiovascular and Thoracic Surgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell is in Manhasset, New York, USA
| | - James Taylor
- Department of Cardiovascular and Thoracic Surgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell is in Manhasset, New York, USA
| | - Kathleen Davidson
- Department of Cardiovascular and Thoracic Surgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell is in Manhasset, New York, USA
| | - Kevin Kennedy
- Statistical Consultant for Northwell Health is in Kansas City, Missouri, USA
| | - Vishaan Nursey
- From the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell is in Manhasset, New York, USA
| | - Ed Miller
- RDS2 Solutions Research Division is in Stony Brook, New York, USA
| | - Simon Maybaum
- From the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell is in Manhasset, New York, USA
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Li L, Wang Y, Yang C, Huang C, Duan L, Zhou J, Lu Y, Zhao G. Frailty in hypertensive population and its association with all-cause mortality: data from the National Health and Nutrition Examination Survey. Front Cardiovasc Med 2023; 10:945468. [PMID: 37180794 PMCID: PMC10167047 DOI: 10.3389/fcvm.2023.945468] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 04/05/2023] [Indexed: 05/16/2023] Open
Abstract
Objectives This study aimed to investigate the relationship between frailty and all-cause mortality in hypertensive population. Methods We used data from the National Health and Nutrition Examination Survey (NHANES) 1999-2002 and mortality data from the National Death Index. Frailty was assessed using the revised version of the Fried frailty criteria (weakness, exhaustion, low physical activity, shrinking, and slowness). This study aimed to evaluate the association between frailty and all-cause mortality. Cox proportional hazard models were used to evaluate the association between frailty category and all-cause mortality, adjusted for age, sex, race, education, poverty-income ratio, smoking, alcohol, diabetes, arthritis, congestive heart failure, coronary heart disease, stroke, overweight, cancer or malignancy, chronic obstructive pulmonary disease, chronic kidney disease, and taking medicine for hypertension. Results We gathered data of 2,117 participants with hypertension; 17.81%, 28.77%, and 53.42% were classified as frail, pre-frail, and robust, respectively. We found that frail [hazard ratio (HR) = 2.76, 95% confidence interval (CI) = 2.33-3.27] and pre-frail (HR = 1.38, 95% CI = 1.19-1.59] were significantly associated with all-cause mortality after controlling for variables. We found that frail (HR = 3.02, 95% CI = 2.50-3.65) and pre-frail (HR = 1.35, 95% CI = 1.15-1.58) were associated with all-cause mortality in the age group ≥65 years. For the frailty components, weakness (HR = 1.77, 95% CI = 1.55-2.03), exhaustion (HR = 2.25, 95% CI = 1.92-2.65), low physical activity (HR = 2.25, 95% CI = 1.95-2.61), shrinking (HR = 1.48, 95% CI = 1.13-1.92), and slowness (HR = 1.44, 95% CI = 1.22-1.69) were associated with all-cause mortality. Conclusion This study demonstrated that frailty and pre-frailty were associated with an increased risk of all-cause mortality in patients with hypertension. More attention should be paid to frailty in hypertensive patients, and interventions to reduce the burden of frailty may improve outcomes in these patients.
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Affiliation(s)
- Li Li
- Department of Cardiovascular Surgery, The First Affliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yuge Wang
- Department of Medicine, Jinggangshan University, Ji'an, China
| | - Chunlei Yang
- Department of Cardiology, The First Affliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Chenhui Huang
- College of Nursing, Wenzhou Medical University, Wenzhou, China
| | - Lanzhi Duan
- Department of Medicine, Jinggangshan University, Ji'an, China
| | - Jianghua Zhou
- Department of Cardiology, The First Affliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yanyu Lu
- Department of Cardiology, The First Affliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Guojun Zhao
- Department of Cardiology, The First Affliated Hospital of Zhengzhou University, Zhengzhou, China
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Cano-Escalera G, Graña M, Irazusta J, Labayen I, Gonzalez-Pinto A, Besga A. Mortality Risks after Two Years in Frail and Pre-Frail Older Adults Admitted to Hospital. J Clin Med 2023; 12:jcm12093103. [PMID: 37176544 PMCID: PMC10179017 DOI: 10.3390/jcm12093103] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Revised: 03/11/2023] [Accepted: 04/06/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND Frailty is characterized by a progressive decline in the physiological functions of multiple body systems that lead to a more vulnerable condition, which is prone to the development of various adverse events, such as falls, hospitalization, and mortality. This study aims to determine whether frailty increases mortality compared to pre-frailty and to identify variables associated with a higher risk of mortality. MATERIALS Two cohorts, frail and pre-frail subjects, are evaluated according to the Fried phenotype. A complete examination of frailty, cognitive status, comorbidities and pharmacology was carried out at hospital admission and was extracted through electronic health record (EHR). Mortality was evaluated from the EHR. METHODS Kaplan-Meier estimates of survival probability functions were calculated at two years censoring time for frail and pre-frail cohorts. The log-rank test assessed significant differences between survival probability functions. Significant variables for frailty (p < 0-05) were extracted by independent sample t-test. Further selection was based on variable significance found in multivariate logistic regression discrimination between frail and pre-frail subjects. Cox regression over univariate t-test-selected variables was calculated to identify variables associated with higher proportional hazard risks (HR) at two years. RESULTS Frailty is associated with greater mortality at two years censoring time than pre-frailty (log-rank test, p < 0.0001). Variables with significant (p < 0.05) association with mortality identified in both cohorts (HR 95% (CI in the frail cohort) are male sex (0.44 (0.29-0.66)), age (1.05 (1.01-1.09)), weight (0.98 (0.96-1.00)), and use of proton-pump inhibitors (PPIs) (0.60 (0.41-0.87)). Specific high-risk factors in the frail cohort are readmission at 30 days (0.50 (0.33-0.74)), SPPB sit and stand (0.62 (0.45-0.85)), heart failure (0.67 (0.46-0.98)), use of antiplatelets (1.80 (1.19-2.71)), and quetiapine (0.31 (0.12-0.81)). Specific high-risk factors in the pre-frail cohort are Barthel's score (120 (7.7-1700)), Pfeiffer test (8.4; (2.3-31)), Mini Nutritional Assessment (MNA) (1200 (18-88,000)), constipation (0.025 (0.0027-0.24)), falls (18,000 (150-2,200,000)), deep venous thrombosis (8400 (19-3,700,000)), cerebrovascular disease (0.01 (0.00064-0.16)), diabetes (360 (3.4-39,000)), thyroid disease (0.00099 (0.000012-0.085)), and the use of PPIs (0.062 (0.0072-0.54)), Zolpidem (0.000014 (0.0000000021-0.092)), antidiabetics (0.00015 (0.00000042-0.051)), diuretics (0.0003 (0.000004-0.022)), and opiates (0.000069 (0.00000035-0.013)). CONCLUSIONS Frailty is associated with higher mortality at two years than pre-frailty. Frailty is recognized as a systemic syndrome with many links to older-age comorbidities, which are also found in our study. Polypharmacy is strongly associated with frailty, and several commonly prescribed drugs are strongly associated with increased mortality. It must be considered that frail patients need coordinated attention where the diverse specialist taking care of them jointly examines the interactions between the diversity of treatments prescribed.
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Affiliation(s)
- Guillermo Cano-Escalera
- Department of Computer Science and Artificial Intelligence, University of the Basque Country (UPV/EHU), 20018 Donostia-San Sebastian, Spain
- Computational Intelligence Group, University of the Basque Country (UPV/EHU), 20018 Donostia-San Sebastian, Spain
| | - Manuel Graña
- Department of Computer Science and Artificial Intelligence, University of the Basque Country (UPV/EHU), 20018 Donostia-San Sebastian, Spain
- Computational Intelligence Group, University of the Basque Country (UPV/EHU), 20018 Donostia-San Sebastian, Spain
| | - Jon Irazusta
- Department of Physiology, Faculty of Medicine and Nursing, University of the Basque Country (UPV/EHU), 48940 Bilbao, Spain
- BioCruces Health Research Institute, 48903 Barakaldo, Spain
| | - Idoia Labayen
- Institute for Innovation & Sustainable Development in Food Chain (IS-FOOD), Public University of Navarra, 31006 Pamplona, Spain
| | - Ana Gonzalez-Pinto
- BioAraba, Health Research Institute, Department of Medicine, Hospital Universitario de Araba, 01004 Vitoria, Spain
- Biomedical Research Centre in Mental Health Network (CIBERSAM), 28029 Madrid, Spain
| | - Ariadna Besga
- BioAraba, Health Research Institute, Department of Medicine, Hospital Universitario de Araba, 01004 Vitoria, Spain
- Biomedical Research Centre in Mental Health Network (CIBERSAM), 28029 Madrid, Spain
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Bart NK, Powell A, Macdonald PS. The role of frailty in advanced HF and cardiac transplantation. Front Cardiovasc Med 2023; 10:1082371. [PMID: 37077743 PMCID: PMC10106718 DOI: 10.3389/fcvm.2023.1082371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 03/14/2023] [Indexed: 04/05/2023] Open
Abstract
Frailty is a complex, multi-system condition often associated with multimorbidity. It has become an important prognostic maker across a range of conditions and is particularly relevant in patients with cardiovascular disease. Frailty encompasses a range of domains including, physical, psychological, and social. There are currently a range of validated tools available to measure frailty. It is an especially important measurement in advanced HF, because frailty occurs in up to 50% of HF patients and is potentially reversible with therapies such as mechanical circulatory support and transplantation. Moreover, frailty is dynamic, and therefore serial measurements are important. This review delves into the measurement of frailty, mechanisms, and its role in different cardiovascular cohorts. Understanding frailty will help determine patients that will benefit from therapies, as well as prognosticate outcomes.
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Affiliation(s)
- Nicole K. Bart
- Heart Transplant Program, St Vincent’s Hospital, Sydney, NSW, Australia
- School of Medicine, University of Notre Dame, Sydney, NSW, Australia
- School of Medicine, University of New South Wales, Sydney, NSW, Australia
- Infiltrative Cardiomyopathy Laboratory, Victor Chang Cardiac Research Institute, Sydney, NSW, Australia
- Correspondence: Nicole K. Bart
| | - Alice Powell
- Centre for Healthy Brain Ageing, School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
- Department of Neurology, Macquarie University Hospital, Sydney, NSW, Australia
| | - Peter S. Macdonald
- Heart Transplant Program, St Vincent’s Hospital, Sydney, NSW, Australia
- School of Medicine, University of New South Wales, Sydney, NSW, Australia
- Infiltrative Cardiomyopathy Laboratory, Victor Chang Cardiac Research Institute, Sydney, NSW, Australia
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Mėlinytė-Ankudavičė K, Ereminienė E, Mizarienė V, Šakalytė G, Plisienė J, Ankudavičius V, Dirsienė R, Žaliūnas R, Jurkevičius R. Relationships of Whole-Heart Myocardial Mechanics and Cardiac Morphometrics by Transthoracic Echocardiography with Main Prognostic Factors of Heart Failure in Non-Ischemic Dilated Cardiomyopathy. J Clin Med 2023; 12:2272. [PMID: 36983273 PMCID: PMC10058858 DOI: 10.3390/jcm12062272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 03/11/2023] [Accepted: 03/13/2023] [Indexed: 03/17/2023] Open
Abstract
BACKGROUND there are many prognostic factors of heart failure (HF) based on their evaluation from imaging, to laboratory tests. In clinical practice, it is crucial to use widely available, cheap, and easy-to-use prognostic factors, such as left ventricular ejection fraction (LVEF), New York Heart Association (NYHA) functional class, 6 min walk test (6MWT), B-type natriuretic peptide (BNP), etc. We sought to evaluate the relationships between whole-heart myocardial mechanics and cardiac morphometrics with the main commonly used prognostic factors of HF in patients with non-ischemic dilated cardiomyopathy (NIDCM). METHODS AND RESULTS two-dimensional (2D) echocardiography for myocardial mechanics (global longitudinal, radial, and circumferential strains of the left ventricle; right ventricular longitudinal strain; strain values of reservoir, conduit, and contraction function of both atria) and cardiac morphometric (diameters and volumes of both atria and ventricles) parameters were performed, and the HF main traditional prognostic factors were identified. We assessed 109 patients (68.8% male; 49.7 ± 10.5 years) with newly diagnosed NIDCM. Myocardial mechanics and morphometrics were weakly correlated with the patient's age, gender, and smoking (R = 0.2, p < 0.05). Stronger relationships were observed with NYHA class, 6MWT, and BNP (the strongest correlations were with LVEF: R = -0.499, R 0.462, R = -0.461, p < 0.001, respectively). There were moderately strong correlations with LVEF and other whole-heart myocardial mechanics or morphometrics. Moreover, LVEF with global regurgitation volume (GRV) and right ventricle free wall longitudinal strain (RVFWLS) were the most usually detected parameters in multivariate analysis to be associated with changes in HF prognostic factors. CONCLUSIONS in NIDCM patients, the main prognostic factors of HF are correlated with whole-heart myocardial mechanics and morphometrics. However, LVEF, GRV, and RVFWLS are the most usually found 2D echocardiographic factors associated with changes in HF prognostic factors.
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Affiliation(s)
- Karolina Mėlinytė-Ankudavičė
- Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, LT-44307 Kaunas, Lithuania
- Institute of Cardiology, Lithuanian University of Health Sciences, LT-50162 Kaunas, Lithuania
| | - Eglė Ereminienė
- Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, LT-44307 Kaunas, Lithuania
- Institute of Cardiology, Lithuanian University of Health Sciences, LT-50162 Kaunas, Lithuania
| | - Vaida Mizarienė
- Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, LT-44307 Kaunas, Lithuania
| | - Gintarė Šakalytė
- Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, LT-44307 Kaunas, Lithuania
- Institute of Cardiology, Lithuanian University of Health Sciences, LT-50162 Kaunas, Lithuania
| | - Jurgita Plisienė
- Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, LT-44307 Kaunas, Lithuania
| | - Vytautas Ankudavičius
- Department of Pulmonology, Medical Academy, Lithuanian University of Health Sciences, LT-44307 Kaunas, Lithuania
| | - Rūta Dirsienė
- Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, LT-44307 Kaunas, Lithuania
| | - Remigijus Žaliūnas
- Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, LT-44307 Kaunas, Lithuania
| | - Renaldas Jurkevičius
- Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, LT-44307 Kaunas, Lithuania
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Zhang X, Kang Y, Luo Z, Chen Q, Yang M, Zeng J, Yu P, Zhang Q. Feasibility and safety of 1-min sit-to-stand test in acute decompensated heart failure confirmed by lung ultrasound. Front Cardiovasc Med 2023; 10:1103247. [PMID: 36970350 PMCID: PMC10030608 DOI: 10.3389/fcvm.2023.1103247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 02/14/2023] [Indexed: 03/11/2023] Open
Abstract
AimThis study innovatively proposed the 1-min sit-to-stand test (1-min STST) as an assessment tool for functional capacity in acute decompensated heart failure (ADHF), in which its feasibility and safety were investigated.MethodsThis was a prospective, single-center cohort study. The 1-min STST was performed after the first 48 h of admission when vital signs and Borg score were collected. Lung ultrasound was used to measure pulmonary edema by B-lines before and after the test.ResultsSeventy-five patients were enrolled in the study, of whom 40% were in functional class IV on admission. The mean age was 58.3 ± 15.7 years and 40% of the patients were male. 95% patients accomplished the test and the average number of repetitions was 18 ± 7. No adverse event was recorded during or after the 1-min STST. Blood pressure, heart rate, and degree of dyspnea were increased after the test (all p < 0.001), while oxygen saturation was slightly decreased (97.0 ± 1.6 vs. 96.3 ± 2.0%, p = 0.003). The degree of pulmonary edema (χ2 = 8.300, p = 0.081) was not significantly changed, while there was a reduction in the absolute number of B-lines [9 (3, 16) vs. 7 (3, 13), p = 0.008].ConclusionThe application of the 1-min STST in early stage of ADHF appeared to be safe and feasible, which induce neither adverse event nor pulmonary edema. It may serve as a new tool of functional capacity assessment, as well as a reference of exercise rehabilitation.
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Affiliation(s)
- Xiu Zhang
- Department of Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu, China
| | - Yu Kang
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Zeruxin Luo
- Department of Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu, China
| | - Qiaowei Chen
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Mengxuan Yang
- Department of Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu, China
| | - Jijuan Zeng
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Pengming Yu
- Department of Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu, China
- *Correspondence: Pengming Yu,
| | - Qing Zhang
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
- Qing Zhang,
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43
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Ahmad F, Karim A, Khan J, Qaisar R. Plasma Galectin-3 and H-FABP correlate with poor physical performance in patients with congestive heart failure. Exp Biol Med (Maywood) 2023; 248:532-540. [PMID: 36803120 PMCID: PMC10281532 DOI: 10.1177/15353702231151980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 12/26/2022] [Indexed: 02/22/2023] Open
Abstract
Heart failure (HF) is often associated with compromised physical capacity in patients. However, it is unclear if established HF markers correlate with the physical performance of patients with congestive HF (CHF). We assessed the left ventricular end-systolic dimension (LVESD) and ejection fraction (LVEF) and, physical performance parameters, including short physical performance battery (SPPB), gait speed (GS), and handgrip strength (HGS) in 80 patients with CHF along with 59 healthy controls. Furthermore, levels of plasma HF markers galectin-3 and heart-specific fatty acid binding protein (H-FABP) were measured in relation to the severity of HF and physical performance. Irrespective of etiology, significantly greater LVESD and lower LVEF were observed in HF patients versus controls. As expected, the levels of HF markers galectin-3 and H-FABP were upregulated in the CHF patients which were accompanied by significantly elevated levels of plasma zonulin and inflammatory marker C-reactive protein (CRP). The SPPB scores, GS, and HGS were significantly lower in the ischemic and non-ischemic HF patients than controls. The level of galectin-3 was inversely correlated with SPPB scores (r2 = 0.089, P = 0.01) and HGS (r2 = 0.078, P = 0.01). Similarly, H-FABP levels were also inversely correlated with SPPB scores (r2 = 0.06, P = 0.03) and HGS (r2 = 0.109, P = 0.004) in the patients with CHF. Taken together, CHF adversely affects physical performance, and galectin-3 and H-FABP may serve as biomarkers of physical disability in patients with CHF. The robust correlations of galectin-3 and H-FABP with the physical performance parameters and CRP in CHF patients suggest that the poor physical performance may partly be caused due to systemic inflammation.
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Affiliation(s)
- Firdos Ahmad
- Basic Medical Sciences, College of Medicine, University of Sharjah, Sharjah 27272, United Arab Emirates
- Department of Biomedical Sciences, College of Health Sciences, Abu Dhabi University, Abu Dhabi, 59911 United Arab Emirates
| | - Asima Karim
- Basic Medical Sciences, College of Medicine, University of Sharjah, Sharjah 27272, United Arab Emirates
| | - Javaidullah Khan
- Department of Cardiology, Post Graduate Medical Institute, Hayatabad Medical Complex, Peshawar 25120, Pakistan
| | - Rizwan Qaisar
- Basic Medical Sciences, College of Medicine, University of Sharjah, Sharjah 27272, United Arab Emirates
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Henning T, Kochlik B, Ara I, González-Gross M, Fiorillo E, Marongiu M, Cucca F, Rodriguez-Artalejo F, Carnicero Carreño JA, Rodriguez-Mañas L, Grune T, Weber D. Patterns of Dietary Blood Markers Are Related to Frailty Status in the FRAILOMIC Validation Phase. Nutrients 2023; 15:nu15051142. [PMID: 36904142 PMCID: PMC10005398 DOI: 10.3390/nu15051142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 02/17/2023] [Accepted: 02/22/2023] [Indexed: 02/26/2023] Open
Abstract
The influence of nutritional factors on frailty syndrome is still poorly understood. Thus, we aimed to confirm cross-sectional associations of diet-related blood biomarker patterns with frailty and pre-frailty statuses in 1271 older adults from four European cohorts. Principal component analysis (PCA) was performed based on plasma levels of α-carotene, β-carotene, lycopene, lutein + zeaxanthin, β-cryptoxanthin, α-tocopherol, γ-tocopherol and retinol. Cross-sectional associations between biomarker patterns and frailty status, according to Fried's frailty criteria, were assessed by using general linear models and multinomial logistic regression models as appropriate with adjustments for the main potential confounders. Robust subjects had higher concentrations of total carotenoids, β-carotene and β-cryptoxanthin than frail and pre-frail subjects and had higher lutein + zeaxanthin concentrations than frail subjects. No associations between 25-Hydroxyvitamin D3 and frailty status were observed. Two distinct biomarker patterns were identified in the PCA results. The principal component 1 (PC1) pattern was characterized by overall higher plasma levels of carotenoids, tocopherols and retinol, and the PC2 pattern was characterized by higher loadings for tocopherols, retinol and lycopene together and lower loadings for other carotenoids. Analyses revealed inverse associations between PC1 and prevalent frailty. Compared to participants in the lowest quartile of PC1, those in the highest quartile were less likely to be frail (odds ratio: 0.45, 95% CI: 0.25-0.80, p = 0.006). In addition, those in the highest quartile of PC2 showed higher odds for prevalent frailty (2.48, 1.28-4.80, p = 0.007) than those in the lowest quartile. Our findings strengthen the results from the first phase of the FRAILOMIC project, indicating carotenoids are suitable components for future biomarker-based frailty indices.
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Affiliation(s)
- Thorsten Henning
- Department of Molecular Toxicology, German Institute of Human Nutrition Potsdam-Rehbruecke (DIfE), 14558 Nuthetal, Germany
- Food4Future (F4F), c/o Leibniz Institute of Vegetable and Ornamental Crops (IGZ), Theodor-Echtermeyer-Weg 1, 14979 Grossbeeren, Germany
- NutriAct-Competence Cluster Nutrition Research Berlin-Potsdam, 14558 Nuthetal, Germany
- Institute of Nutritional Science, University of Potsdam, 14469 Potsdam, Germany
| | - Bastian Kochlik
- Department of Molecular Toxicology, German Institute of Human Nutrition Potsdam-Rehbruecke (DIfE), 14558 Nuthetal, Germany
- Food4Future (F4F), c/o Leibniz Institute of Vegetable and Ornamental Crops (IGZ), Theodor-Echtermeyer-Weg 1, 14979 Grossbeeren, Germany
- NutriAct-Competence Cluster Nutrition Research Berlin-Potsdam, 14558 Nuthetal, Germany
- Department of Nutrition and Gerontology, German Institute of Human Nutrition Potsdam-Rehbruecke (DIfE), 14558 Nuthetal, Germany
| | - Ignacio Ara
- GENUD Toledo Research Group, Universidad de Castilla-La Mancha, 45071 Toledo, Spain
- CIBER of Frailty and Healthy Aging, CIBERFES, Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Marcela González-Gross
- ImFINE Research Group, Department of Health and Human Performance, Universidad Politécnica de Madrid, 28040 Madrid, Spain
- CIBER on Physiopathology of Obesity and Nutrition, CIBEROBN, Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Edoardo Fiorillo
- Institute for Genetic and Biomedical Research, National Research Council (CNR), 09042 Monserrato, Italy
| | - Michele Marongiu
- Institute for Genetic and Biomedical Research, National Research Council (CNR), 09042 Monserrato, Italy
| | - Francesco Cucca
- Institute for Genetic and Biomedical Research, National Research Council (CNR), 09042 Monserrato, Italy
- Department of Biomedical Sciences, University of Sassari, 07100 Sassari, Italy
| | - Fernando Rodriguez-Artalejo
- Department of Preventive Medicine and Public Health, CIBERESP and IMDEA-Food Institute, Universidad Autonoma de Madrid, CEI UAM + CSIC, 28029 Madrid, Spain
| | - Jose Antonio Carnicero Carreño
- CIBER of Frailty and Healthy Aging, CIBERFES, Instituto de Salud Carlos III, 28029 Madrid, Spain
- Biomedical Research Foundation, Getafe University Hospital, 28905 Getafe, Spain
| | - Leocadio Rodriguez-Mañas
- CIBER of Frailty and Healthy Aging, CIBERFES, Instituto de Salud Carlos III, 28029 Madrid, Spain
- Division of Geriatrics, Hospital Universitario de Getafe, 28905 Getafe, Spain
| | - Tilman Grune
- Department of Molecular Toxicology, German Institute of Human Nutrition Potsdam-Rehbruecke (DIfE), 14558 Nuthetal, Germany
- Food4Future (F4F), c/o Leibniz Institute of Vegetable and Ornamental Crops (IGZ), Theodor-Echtermeyer-Weg 1, 14979 Grossbeeren, Germany
- NutriAct-Competence Cluster Nutrition Research Berlin-Potsdam, 14558 Nuthetal, Germany
- Institute of Nutritional Science, University of Potsdam, 14469 Potsdam, Germany
| | - Daniela Weber
- Department of Molecular Toxicology, German Institute of Human Nutrition Potsdam-Rehbruecke (DIfE), 14558 Nuthetal, Germany
- Food4Future (F4F), c/o Leibniz Institute of Vegetable and Ornamental Crops (IGZ), Theodor-Echtermeyer-Weg 1, 14979 Grossbeeren, Germany
- NutriAct-Competence Cluster Nutrition Research Berlin-Potsdam, 14558 Nuthetal, Germany
- Correspondence:
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Codina P, Zamora E, Bayes-Genis A. Reply to 'The frail patient and the frailing heart'. Eur J Heart Fail 2023; 25:441-442. [PMID: 36789582 DOI: 10.1002/ejhf.2799] [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: 02/06/2023] [Accepted: 02/10/2023] [Indexed: 02/16/2023] Open
Affiliation(s)
- Pau Codina
- Heart Failure Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Spain.,Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain
| | - Elisabet Zamora
- Heart Failure Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Spain.,Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain.,CIBERCV, Instituto de Salud Carlos III, Madrid, Spain
| | - Antoni Bayes-Genis
- Heart Failure Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Spain.,Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain.,CIBERCV, Instituto de Salud Carlos III, Madrid, Spain
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Meng C, Chai K, Li YY, Luo Y, Wang H, Yang JF. Prevalence and prognosis of frailty in older patients with stage B heart failure with preserved ejection fraction. ESC Heart Fail 2023; 10:1133-1143. [PMID: 36601690 PMCID: PMC10053163 DOI: 10.1002/ehf2.14274] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 11/15/2022] [Accepted: 12/07/2022] [Indexed: 01/06/2023] Open
Abstract
AIMS Frailty in older patients with stage B heart failure with preserved ejection fraction (HFpEF) has not been fully explored. We evaluated the prevalence and prognostic significance of frailty in older patients diagnosed with stage B HFpEF. METHODS Our prospective cohort study included inpatients aged ≥65 years who were followed up for 3 years. Stage B HFpEF was defined as cardiac structural or functional abnormalities with a left ventricular ejection fraction (LVEF) ≥ 50% without signs or symptoms. Frailty was assessed using the Fried phenotype. The primary outcome was 3-year all-cause mortality or readmission. RESULTS Overall, 520 older inpatients diagnosed with stage B HFpEF [mean ± standard deviation age: 75.5 ± 6.25 years, male: 222 (42.7%)] were included in the study. Of these, 145 (27.9%) were frail. Frail patients were older (78.5 ± 6.23 vs. 74.3 ± 6.22 years, P < 0.001), with a lower body mass index (24.6 ± 3.60 vs. 25.7 ± 3.27 kg/m2 , P = 0.001), higher level of N-terminal pro-B-type natriuretic peptide [279 (interquartile range: 112.4, 596) vs. 140 (67.1, 266) pg/mL, P < 0.001], longer timed up-and-go test result (19.9 ± 9.71 vs. 13.3 ± 5.08 s, P < 0.001), and poorer performance in the short physical performance battery (4.1 ± 3.26 vs. 8.2 ± 2.62, P < 0.001), basic activities of daily living (BADL, 4.7 ± 1.71 vs. 5.7 ± 0.57, P < 0.001), and instrumental activities of daily living (IADL, 4.4 ± 2.73 vs. 7.4 ± 1.33, P < 0.001). Frail patients were more likely to have a Mini-Mental State Examination (MMSE) score <24 (55.9% vs. 28.8%, P < 0.001) and take more than five medications (64.1% vs. 47.2%, P = 0.001). Frail patients had a higher incidence of all-cause mortality or readmission (62.8% vs. 47.7%, P = 0.002), all-cause readmission (56.6% vs. 45.9%, P = 0.029), and readmission for non-heart failure (55.2% vs. 41.3%, P = 0.004) during the 3-year follow-up, with a 1.53-fold (95%CI 1.11-2.11, P = 0.009) higher risk of all-cause mortality or readmission, a 1.52-fold (95%CI 1.09-2.11, P = 0.014) higher risk of all-cause readmission, and a 1.70-fold (95%CI 1.21-2.38, P = 0.002) higher risk of readmission for non-clinical heart failure, adjusted for sex, age, polypharmacy, Athens Insomnia Scale, MMSE, LVEF, BADL, and IADL. CONCLUSIONS Frailty is common in elderly patients with stage B HFpEF. Physical frailty, particularly low physical activity, can independently predict the long-term prognosis in these patients.
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Affiliation(s)
- Chen Meng
- Peking University Fifth School of Clinical Medicine, Beijing, China, 100730.,Department of Cardiology, Beijing Hospital; National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China, 100730
| | - Ke Chai
- Department of Cardiology, Beijing Hospital; National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China, 100730
| | - Ying-Ying Li
- Department of Cardiology, Beijing Hospital; National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China, 100730
| | - Yao Luo
- Department of Cardiology, Beijing Hospital; National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China, 100730
| | - Hua Wang
- Peking University Fifth School of Clinical Medicine, Beijing, China, 100730.,Department of Cardiology, Beijing Hospital; National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China, 100730
| | - Jie-Fu Yang
- Peking University Fifth School of Clinical Medicine, Beijing, China, 100730.,Department of Cardiology, Beijing Hospital; National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China, 100730
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Zhu J, Qiu X, Ji C, Wang F, Tao A, Chen L. Frailty as a predictor of neurosurgical outcomes in brain tumor patients: A systematic review and meta-analysis. Front Psychiatry 2023; 14:1126123. [PMID: 36873196 PMCID: PMC9982160 DOI: 10.3389/fpsyt.2023.1126123] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Accepted: 01/23/2023] [Indexed: 02/19/2023] Open
Abstract
BACKGROUND Patients with frailty are at a high risk of poor health outcomes, and frailty has been explored as a predictor of adverse events, such as perioperative complications, readmissions, falls, disability, and mortality in the neurosurgical literature. However, the precise relationship between frailty and neurosurgical outcomes in patients with brain tumor has not been established, and thus evidence-based advancements in neurosurgical management. The objectives of this study are to describe existing evidence and conduct the first systematic review and meta-analysis of the relationship between frailty and neurosurgical outcomes among brain tumor patients. METHODS Seven English databases and four Chinese databases were searched to identify neurosurgical outcomes and the prevalence of frailty among patients with a brain tumor, with no restrictions on the publication period. According to the Joanna Briggs Institute (JBI) Manual for Evidence Synthesis and the Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) guidelines, two independent reviewers employed the Newcastle-Ottawa scale in cohort studies and JBI Critical Appraisal Checklist for Cross-sectional Studies to evaluate the methodological quality of each study. Then random-effects or fixed-effects meta-analysis was used in combining odds ratio (OR) or hazard ratio (RR) for the categorical data and continuous data of neurosurgical outcomes. The primary outcomes are mortality and postoperative complications, and secondary outcomes include readmission, discharge disposition, length of stay (LOS), and hospitalization costs. RESULTS A total of 13 papers were included in the systematic review, and the prevalence of frailty ranged from 1.48 to 57%. Frailty was significantly associated with increased risk of mortality (OR = 1.63; CI = 1.33-1.98; p < 0.001), postoperative complications (OR = 1.48; CI = 1.40-1.55; p < 0.001; I 2 = 33%), nonroutine discharge disposition to a facility other than home (OR = 1.72; CI = 1.41-2.11; p < 0.001), prolonged LOS (OR = 1.25; CI = 1.09-1.43; p = 0.001), and high hospitalization costs among brain tumor patients. However, frailty was not independently associated with readmission (OR = 0.99; CI = 0.96-1.03; p = 0.74). CONCLUSION Frailty is an independent predictor of mortality, postoperative complications, nonroutine discharge disposition, LOS, and hospitalization costs among brain tumor patients. In addition, frailty plays a significant potential role in risk stratification, preoperative shared decision making, and perioperative management. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42021248424.
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Affiliation(s)
- Jinfeng Zhu
- Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China.,Medical School of Nanjing University, Nanjing, Jiangsu, China
| | - Xichenhui Qiu
- Health Science Center, Shenzhen University, Shenzhen, China
| | - Cuiling Ji
- Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China
| | - Fang Wang
- Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China
| | - An Tao
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Lu Chen
- Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China
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48
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Hwang AC, Chen LY, Tang TC, Peng LN, Lin MH, Chou YJ, Hsiao FY, Chen LK. Transitions in Frailty and 4-Year Mortality Risk in Taiwan Longitudinal Study on Aging. J Am Med Dir Assoc 2023; 24:48-56.e5. [PMID: 36370752 DOI: 10.1016/j.jamda.2022.10.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 10/07/2022] [Accepted: 10/11/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVES To explore the associations of (1) the frailty phenotype or frailty index transition with cause-specific mortality, and (2) different combinations of transition in frailty phenotype and frailty index with all-cause mortality. DESIGN Retrospective cohort study. SETTING AND PARTICIPANTS Data from 3529 respondents aged >50 years who completed the 1999 and 2003 surveys of the Taiwan Longitudinal Study on Aging were analyzed. METHODS Cox regression and subdistribution hazard models were constructed to investigate frailty phenotype or frailty index transitions (by categories of frailty phenotype, absolute and percentage changes in frailty index, and combined categories of the 2 measurements) and subsequent 4-year all-cause and cause-specific mortality, respectively. RESULTS Among the frailty phenotype transition groups, the improved frailty group had overall mortality risk comparable to that of the maintained robustness/prefrailty group [hazard ratio (HR): 0.9; 95% CI: 0.7-1.2] and lower risk of mortality due to organ failure (HR: 0.4; 95% CI: 0.2-0.8; P = .015), whereas the worsened frailty group had the highest risk of all-cause mortality and death from infection, malignancy, cardiometabolic/cerebrovascular diseases, and other causes (HR: 1.8-3.7; all P < .03). The rapidly increased frailty index group had significantly higher all-cause and every cause-specific mortality than the decreased frailty index group (HR: 1.8-7.7; all P < .05). When frailty phenotype and frailty index transition groups were combined, participants with worsened frailty/rapidly increased frailty index had increased risk under the same frailty index/frailty phenotype transition condition, particularly for large changes in each factor (HR: 1.5-2.2; P < .01 for worsened frailty; 1.7-4.5, P < .03 for rapidly increased frailty index). CONCLUSIONS AND IMPLICATIONS We found that considering both frailty phenotype and frailty index provided best mortality prediction. These associations were independent of baseline frailty status and comorbidities. Nevertheless, even capturing transitions in frailty phenotype or frailty index only can provide good mortality prediction, which supported adopting these approaches in different clinical settings.
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Affiliation(s)
- An-Chun Hwang
- Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Geriatric Medicine, National Yang Ming Chiao Tung University, School of Medicine, Taipei, Taiwan; Institute of Public Health, National Yang Ming Chiao Tung University, Taipei, Taiwan; Center for Healthy Longevity and Aging Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Liang-Yu Chen
- Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Geriatric Medicine, National Yang Ming Chiao Tung University, School of Medicine, Taipei, Taiwan; Center for Healthy Longevity and Aging Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Ting-Ching Tang
- Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Geriatric Medicine, National Yang Ming Chiao Tung University, School of Medicine, Taipei, Taiwan
| | - Li-Ning Peng
- Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Geriatric Medicine, National Yang Ming Chiao Tung University, School of Medicine, Taipei, Taiwan; Center for Healthy Longevity and Aging Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Ming-Hsien Lin
- Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Geriatric Medicine, National Yang Ming Chiao Tung University, School of Medicine, Taipei, Taiwan; Center for Healthy Longevity and Aging Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yiing-Jenq Chou
- Institute of Public Health, National Yang Ming Chiao Tung University, Taipei, Taiwan; Office of the Deputy Superintendent, National Yang Ming Chiao Tung University Hospital, Yilan County, Taiwan.
| | - Fei-Yuan Hsiao
- Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan; School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan
| | - Liang-Kung Chen
- Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Geriatric Medicine, National Yang Ming Chiao Tung University, School of Medicine, Taipei, Taiwan; Center for Healthy Longevity and Aging Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan; Taipei Municipal Gan-Dau Hospital (Managed by Taipei Veterans General Hospital), Taipei, Taiwan.
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Bartosch P, Malmgren L. Can frailty in conjunction with FRAX identify additional women at risk of fracture - a longitudinal cohort study of community dwelling older women. BMC Geriatr 2022; 22:951. [PMID: 36494774 PMCID: PMC9733205 DOI: 10.1186/s12877-022-03639-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 11/21/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Fracture risk assessment is still far from perfect within the geriatric population. The overall aim of this study is to better identify older women at risk for fractures, using a quantitative measure of frailty in conjunction with the web-based Fracture Risk Assessment Tool (FRAX®). METHODS This study was performed in the Osteoporosis Risk Assessment (OPRA) cohort of n = 1023, 75-year-old women followed for 10-years. A frailty index (FI) of 'deficits in health' was created, and FRAX 10-year probability for major osteoporotic and hip fractures was calculated and bone mineral density measured. Incident fractures were continuously registered for 10-years. Receiver Operating Characteristic (ROC) curves were used to compare FI, FRAX and the combination FI + FRAX as instruments for risk prediction. Discriminative ability was estimated by comparing Area Under the Curve (AUC). In addition, using guidelines from the Swedish Osteoporosis Foundation, a category of low risk women who would not have been recommended for pharmacological treatment (non-treatment group) was identified, categorized by frailty status and for relative risk analysis, hazard ratios (HR) and 95% confidence intervals were calculated using Cox proportional hazard regressions. RESULTS For hip fracture, FRAX and frailty performed almost equally (HIP AUC 10y: 0.566 vs. 0.567, p = 0.015 and p = 0.013). Next, FI was used in conjunction with FRAX; proving marginally better than either score alone (AUC 10y: 0.584, p = 0.002). Comparable results were observed for osteoporotic fracture. In the non-treatment group (564 women), being frail was associated with higher 10y hip fracture risk (HR 2.01 (1.13-3.57)), although failing to reach statistical significance for osteoporotic fracture (HR 1.40 (0.97-2.01). The utility of measuring frailty was also demonstrated when using T-score as an index of bone density to define fracture risk. Among n = 678 non-osteoporotic women, frailty added to the 10-year fracture risk (Hip; HR 2.22 (1.35-3.71); Osteoporotic fracture; HR 1.57 (1.15-2.14)). CONCLUSIONS While the addition of frailty to FRAX marginally improved fracture prediction, applying a frailty measurement to a group of 'low risk' women, identified a set of individuals with high actual hip fracture risk that would not be prioritized for pharmacological treatment. Further cost-benefit analysis studies are needed to formally test potential benefit.
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Affiliation(s)
- Patrik Bartosch
- grid.4514.40000 0001 0930 2361Department of Clinical Sciences Malmö, Clinical and Molecular Osteoporosis Research Unit, Lund University, 214 28 Malmö, Sweden ,grid.411843.b0000 0004 0623 9987Department of Orthopaedics, Skåne University Hospital, Malmö, Sweden
| | - Linnea Malmgren
- grid.4514.40000 0001 0930 2361Department of Clinical Sciences Malmö, Clinical and Molecular Osteoporosis Research Unit, Lund University, 214 28 Malmö, Sweden ,grid.411843.b0000 0004 0623 9987Department of Geriatrics, Skåne University Hospital, 205 02 Malmö, Sweden
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50
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Locatelli G, Zeffiro V, Occhino G, Rebora P, Caggianelli G, Ausili D, Alvaro R, Riegel B, Vellone E. Effectiveness of Motivational Interviewing on contribution to self-care, self-efficacy, and preparedness in caregivers of patients with heart failure: a secondary outcome analysis of the MOTIVATE-HF randomized controlled trial. Eur J Cardiovasc Nurs 2022; 21:801-811. [PMID: 35290454 DOI: 10.1093/eurjcn/zvac013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 12/23/2021] [Accepted: 02/25/2022] [Indexed: 12/29/2022]
Abstract
AIMS Caregiver characteristics and behaviours are associated with patients' and caregivers' outcomes. However, there is scarce evidence on interventions aimed at improving caregiver contribution (CC) to patient self-care, caregiver self-efficacy, and caregiver preparedness in heart failure (HF). This study aims to evaluate the effect of Motivational Interviewing (MI) on CC to patient self-care, caregiver self-efficacy, and caregiver preparedness in HF. METHODS AND RESULTS This is a secondary outcome analysis of MOTIVATE-HF randomized controlled trial. Caregivers of patients with HF were randomized into three arms: Arm 1 (MI for patients), Arm 2 (MI for patients and caregivers), and Arm 3 (standard care). The intervention consisted of one MI session plus three telephone contacts. Data were collected at baseline and after 3, 6, 9, and 12 months. A total of 510 patient and caregiver (median age 54 years, 76% females) dyads were enrolled, 235 caregivers and 238 patients completed the study until 12 months. Caregiver contribution to self-care maintenance and management and caregiver preparedness significantly improved over time, but without significant differences among the three arms. At 9 months, caregiver self-efficacy improved more in Arm 2 than Arm 3 [difference: 8.36, 95% confidence interval (CI) (3.13; 13.59), P = 0.001]. This improvement remained significant also at linear mixed model [β^ = 1.39, 95% CI (0.02; 2.75), P = 0.046]. CONCLUSION Motivational Interviewing did not improve CC to patient self-care and caregiver preparedness. However, it increased caregiver self-efficacy, which is known to be a powerful mediator of CC to self-care. REGISTRATION Clinicaltrials.gov: NCT02894502.
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Affiliation(s)
- Giulia Locatelli
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Via Montpellier, 1., 00133 Rome, Italy.,School of Nursing, Midwifery and Paramedicine, Faculty of Health Sciences, Australian Catholic University, 115 Victoria Parade, Fitzroy, Victoria 3065, Australia
| | - Valentina Zeffiro
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Via Montpellier, 1., 00133 Rome, Italy
| | - Giuseppe Occhino
- Bicocca Bioinformatics, Biostatistics and Bioimaging Centre-B4, School of Medicine and Surgery, University of Milano-Bicocca, Via Cadore, 48., 20900 Monza, Italy
| | - Paola Rebora
- Bicocca Bioinformatics, Biostatistics and Bioimaging Centre-B4, School of Medicine and Surgery, University of Milano-Bicocca, Via Cadore, 48., 20900 Monza, Italy
| | - Gabriele Caggianelli
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Via Montpellier, 1., 00133 Rome, Italy
| | - Davide Ausili
- Department of Medicine and Surgery, University of Milano Bicocca, Via Cadore 48, 20900 Monza, Italy
| | - Rosaria Alvaro
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Via Montpellier, 1., 00133 Rome, Italy
| | - Barbara Riegel
- School of Nursing, Midwifery and Paramedicine, Faculty of Health Sciences, Australian Catholic University, 115 Victoria Parade, Fitzroy, Victoria 3065, Australia.,School of Nursing, University of Pennsylvania, 418 Curie Boulevard, Philadelphia, PA 19104-4217, USA
| | - Ercole Vellone
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Via Montpellier, 1., 00133 Rome, Italy
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