1
|
Svahn S, Appelblad L, Lövheim H, Gustafson Y, Olofsson B, Gustafsson M. Prevalence of heart failure and trends in its pharmacological treatment between 2000 and 2017 among very old people. BMC Geriatr 2024; 24:701. [PMID: 39182036 PMCID: PMC11344298 DOI: 10.1186/s12877-024-05307-4] [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: 04/17/2024] [Accepted: 08/16/2024] [Indexed: 08/27/2024] Open
Abstract
PURPOSE The aim of this study was to describe a population of very old people with heart failure (HF), to analyse the use of cardiovascular drugs over time, and to explore factors influencing cardiovascular drug treatment for this group. METHODS All participants with information regarding HF diagnosis were selected from the Umeå 85+/Gerontological Regional Database (GERDA). The people in GERDA are all ≥85 years old. Trained investigators performed structured interviews and assessments. Information regarding medications and diagnoses was obtained from the participants and from medical records. Medical diagnoses were reviewed and confirmed by an experienced geriatrician. RESULTS In this very old population, the prevalence of HF was 29.6% among women and 30.7% among men. Between 2000 and 2017, there was an increase in the use of renin-angiotensin (RAS) inhibitors (odds ratio [OR] 1.107, 95% confidence interval [CI] 1.072-1.144) and beta-blockers (BBs) (OR 1.123, 95% CI 1.086-1.161) among persons with HF, whereas the prevalence of loop diuretics (OR 0.899, 95% CI 0.868-0.931) and digitalis (OR 0.864, 95% CI 0.828-0.901) decreased (p < 0.001 for all drug classes). Higher age was associated with lower use of RAS inhibitors and BBs. CONCLUSION In this HF population, the use of evidence-based medications for HF increased over time. This may be a sign of better awareness among prescribers regarding the under-prescribing of guidelines-recommended treatment to old people. Higher age associated with a lower prevalence of RAS inhibitors and BBs. This might indicate that further improvement is possible but could also represent a more cautious prescribing among frail very old individuals.
Collapse
Affiliation(s)
- Sofia Svahn
- Department of Medical and Translational Biology, Umeå University, Umeå, 901 87, Sweden.
| | - Leona Appelblad
- Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå University, Umeå, 901 87, Sweden
| | - Hugo Lövheim
- Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå University, Umeå, 901 87, Sweden
| | - Yngve Gustafson
- Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå University, Umeå, 901 87, Sweden
| | - Birgitta Olofsson
- Department of Nursing, Umeå University, Umeå, 901 87, Sweden
- Department of Diagnostics and Intervention, Orthopedics, Umeå University, Umeå, 901 87, Sweden
| | - Maria Gustafsson
- Department of Medical and Translational Biology, Umeå University, Umeå, 901 87, Sweden
| |
Collapse
|
2
|
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.
Collapse
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
| |
Collapse
|
3
|
Charkiewicz M, Wojszel ZB, Kasiukiewicz A, Magnuszewski L, Wojszel A. Association of Chronic Heart Failure with Frailty, Malnutrition, and Sarcopenia Parameters in Older Patients—A Cross-Sectional Study in a Geriatric Ward. J Clin Med 2023; 12:jcm12062305. [PMID: 36983305 PMCID: PMC10052656 DOI: 10.3390/jcm12062305] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 03/10/2023] [Accepted: 03/14/2023] [Indexed: 03/18/2023] Open
Abstract
The need to assess sarcopenia and frailty in patients with chronic heart failure (HF) has recently been raised. This cross-sectional study of 416 geriatric ward patients (median age (Me)—82 (IQR, 77–86) years, 77.4% female, 96.9% community dwelling) aimed to assess the prevalence of dynapenia, frailty syndrome, functional and nutritional health, and co-morbidity regarding their HF status. We collected data from comprehensive geriatric assessment. We observed HF in 162 (38.9%) patients, with 80 (49.4%) classified as New York Heart Association (NYHA) class III or IV. HF patients were significantly older, more frequently male, obese, hospitalized in the previous year, burdened with multimorbidity and polypharmacy, classified as frail, dependent on daily living activities, and physically non-active. Ischemic heart disease, atrial fibrillation, diabetes, peripheral arterial disease, anemia, chronic kidney disease, history of myocardial infarction, and stroke were found significantly more often in the HF group. A considerably higher percentage of HF patients had dynapenia (54.9% versus 41.9%, p = 0.02), but the difference was significant only in women. We found no significant difference between HF and no-HF groups regarding muscle performance, except for lower median gait speed in the HF group—0.53 m/s (0.35–0.89 m/s) versus 0.68 m/s (0.44–0.99 m/s), p = 0.02). HF patients significantly more often had low grip strength accompanied by slow gait, suggesting probable severe sarcopenia (40.4% vs. 29% in patients without HF, p = 0.046). In the regression analysis, significantly higher odds for HF were observed for lower mid-arm circumference (MAC) and dynapenia when controlling for age, sex, body mass index (BMI), calf circumference (CC), peripheral arterial disease, history of stroke, ischemic heart disease, atrial fibrillation, and diabetes mellitus. Conclusions: HF geriatric patients are often burdened with frailty, obesity, multimorbidity, and polypharmacy. As a result, they are more likely to present low muscle strength (potential sarcopenia), which is frequently accompanied by functional limitations (suggestive of more advanced stages of sarcopenia). This tendency is evident mainly in older women. Nevertheless, sarcopenia can be independently associated with HF in older patients with multimorbidity and disability who are hospitalized in a geriatric department, as a multivariable logistic regression analysis demonstrated.
Collapse
Affiliation(s)
- Miroslaw Charkiewicz
- Department of Cardiology, Hospital of the Ministry of Interior and Administration in Bialystok, 15-471 Bialystok, Poland
| | - Zyta Beata Wojszel
- Department of Geriatrics, Medical University of Bialystok, 15-471 Bialystok, Poland
- Department of Geriatrics, Hospital of the Ministry of Interior and Administration in Bialystok, 15-471 Bialystok, Poland
- Correspondence: ; Tel.: +48-47-710-4244
| | - Agnieszka Kasiukiewicz
- Department of Geriatrics, Medical University of Bialystok, 15-471 Bialystok, Poland
- Department of Geriatrics, Hospital of the Ministry of Interior and Administration in Bialystok, 15-471 Bialystok, Poland
| | - Lukasz Magnuszewski
- Department of Geriatrics, Medical University of Bialystok, 15-471 Bialystok, Poland
- Doctoral Studies, Faculty of Health Sciences, Medical University of Bialystok, 15-471 Bialystok, Poland
| | - Aleksandra Wojszel
- Interdisciplinary Student’s Scientific Society at the Department of Geriatrics, Faculty of Health Sciences, Medical University of Bialystok, 15-471 Bialystok, Poland
| |
Collapse
|
4
|
Already low drug dose antagonism of the renin-angiotensin aldosterone system decreases 1-year mortality and rehospitalization in old heart failure patients. Biomed Pharmacother 2022; 154:113615. [DOI: 10.1016/j.biopha.2022.113615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 08/24/2022] [Accepted: 08/25/2022] [Indexed: 11/24/2022] Open
|
5
|
Boureau A, Annweiler C, Belmin J, Bouleti C, Chacornac M, Chuzeville M, David J, Jourdain P, Krolak‐Salmon P, Lamblin N, Paccalin M, Sebbag L, Hanon O. Practical management of frailty in older patients with heart failure: Statement from a panel of multidisciplinary experts on behalf the Heart Failure Working Group of the French Society of Cardiology and on behalf French Society of Geriatrics and Gerontology. ESC Heart Fail 2022; 9:4053-4063. [PMID: 36039817 PMCID: PMC9773761 DOI: 10.1002/ehf2.14040] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 05/02/2022] [Accepted: 06/09/2022] [Indexed: 01/19/2023] Open
Abstract
AIMS The heart failure (HF) prognosis in older patients remains poor with a high 5-years mortality rate more frequently attributed to noncardiovascular causes. The complex interplay between frailty and heart failure contribute to poor health outcomes of older adults with HF independently of ejection fraction. The aim of this position paper is to propose a practical management of frailty in older patients with heart failure. METHODS A panel of multidisciplinary experts on behalf the Heart Failure Working Group of the French Society of Cardiology and on behalf French Society of Geriatrics and Gerontology conducted a systematic literature search on the interlink between frailty and HF, met to propose an early frailty screening by non-geriatricians and to propose ways to implement management plan of frailty. Statements were agreed by expert consensus. RESULTS Clinically relevant aspects of interlink between frailty and HF have been reported to identify the population eligible for screening and the most suitable screening test(s). The frailty screening program proposed focuses on frailty model defined by an accumulation of deficits including geriatric syndromes, comorbidities, for older patients with HF in different settings of care. The management plan of frailty includes optimization of HF pharmacological treatments and non-surgical device treatment as well as optimization of a global patient-centred biopsychosocial blended collaborative care pathway. CONCLUSION The current manuscript provides practical recommendations on how to screen and optimize frailty management in older patients with heart failure.
Collapse
Affiliation(s)
- Anne‐Sophie Boureau
- Department of Geriatrics, University Hospital, Nantes, France; Institut du ThoraxUniversity HospitalNantesFrance
| | - Cédric Annweiler
- Department of Geriatric Medicine and Memory Clinic, Research Center on Autonomy and Longevity, University Hospital, Angers; UPRES EA 4638, University of Angers; Gérontopôle Autonomie Longévité des Pays de la Loire; Robarts Research Institute, Department of Medical Biophysics, Schulich School of Medicine and DentistryUniversity of Western OntarioLondonONCanada
| | - Joël Belmin
- Hôpital Charles Foix et Sorbonne UniversitéIvry‐sur‐SeineFrance
| | - Claire Bouleti
- Cardiology, University of Poitiers, Clinical Investigation Center (CIC) INSERM 1402Poitiers University HospitalPoitiersFrance
| | | | - Michel Chuzeville
- Geriatric Cardiology Department, Edouard Herriot HospitalHospices Civils de LyonLyonFrance
| | - Jean‐Philippe David
- INSERM‐ U955, IMRB, CEpiA team, Department of Geriatric Medicine, AP‐HP, Hôpitaux Henri‐MondorUniv Paris Est CreteilCreteilFrance
| | - Patrick Jourdain
- DMU COREVE, GHU Paris Saclay, APHP, Paris, France; INSERM UMR S 999IHU TORINO (thorax Innovation)TurinItaly
| | - Pierre Krolak‐Salmon
- Clinical and Research Memory Center of Lyon, Lyon Institute For Elderly, Hospices Civils de Lyon, Villeurbanne, France; University of Lyon, Lyon, France; Neuroscience Research Centre of Lyon, INSERM 1048CNRSLyonFrance
| | - Nicolas Lamblin
- Institut Cœur Poumon, CHU de Lille, Inserm U1167, Institut Pasteur de LilleUniversité de LilleLilleFrance
| | - Marc Paccalin
- Department of GeriatricsCHU La Milétrie, CIC‐1402PoitiersFrance
| | - Laurent Sebbag
- Service Insuffisance Cardiaque et Transplantation Hospices Civils de Lyon Hôpital Louis PradelBronFrance
| | - Olivier Hanon
- Department of GeriatricsUniversité de Paris, EA 4468, APHP, Hôpital BrocaParisFrance
| |
Collapse
|
6
|
Hacil A, Genet B, Assayag P, Jourdain P, Motiejunaite J, David JP, Verny C, Hanon O, Berthelot E. Management and prognosis of older patients with acute heart failure hospitalized in geriatrics and cardiology departments: The GERDICA study. J Am Geriatr Soc 2021; 70:1282-1284. [PMID: 34897658 DOI: 10.1111/jgs.17609] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 11/21/2021] [Indexed: 11/27/2022]
Affiliation(s)
- Abdelhakim Hacil
- Hôpital Broca, Service de gériatrie, Assistance Publique - Hôpitaux de Paris, Hôpitaux Universitaires Paris Centre, Paris, France
| | - Bastien Genet
- Université Paris Saclay, Le Kremlin-Bicêtre, France.,Department of Statistics and Methodology in Biomedical Research, Paris-Saclay University, Paris, France
| | - Patrick Assayag
- Université Paris Saclay, Le Kremlin-Bicêtre, France.,Université Paris-Saclay, AP-HP, Department of Cardiology, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | - Patrick Jourdain
- Université Paris Saclay, Le Kremlin-Bicêtre, France.,Université Paris-Saclay, AP-HP, Department of Cardiology, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | - Justina Motiejunaite
- Université Paris-Saclay, AP-HP, Department of Cardiology, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | - Jean Philippe David
- Department of Geriatrics, AP-HP, Henri Mondor Hospital, Creteil, France.,FR Univ Paris Est Creteil, INSERM, IMRB, Creteil, France
| | - Christiane Verny
- Université Paris-Saclay, AP-HP, Department of Geriatry, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | - Olivier Hanon
- Hôpital Broca, Service de Gérontologie, Assistance Publique - Hôpitaux de Paris and EA 4468, Université de Paris, Paris, France
| | - Emmanuelle Berthelot
- Université Paris-Saclay, AP-HP, Department of Cardiology, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
| |
Collapse
|
7
|
Putot S, Hacquin A, Manckoundia P, Putot A. Prognostic impact of systolic blood pressure in acute heart failure with preserved ejection fraction in older patients. ESC Heart Fail 2021; 8:5493-5500. [PMID: 34664426 PMCID: PMC8712845 DOI: 10.1002/ehf2.13650] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 09/07/2021] [Accepted: 09/23/2021] [Indexed: 12/28/2022] Open
Abstract
Aims Recent guidelines recommend a systolic blood pressure (SBP) target below 130 mmHg in heart failure patients with preserved ejection fraction (HFpEF), whatever their age. We investigated whether this intensive SBP control was associated with better survival in very old adults hospitalized for acute HFpEF. Methods and results We conducted an observational study in an acute geriatric unit: all consecutive patients discharged from hospital for acute heart failure from 1 March 2019 to 29 February 2020 with a diagnosis of HFpEF were included. Re‐hospitalization and all‐cause mortality at 1 year were compared according to the mean SBP at discharge (patients with a mean SBP < 130 mmHg vs. those with SBP ≥ 130 mmHg). We included 81 patients with a mean age of 89 years. Among them, 47 (58%) were re‐hospitalized and 37 (46%) died at 1 year. All‐cause mortality (hazard ratio [HR] [95% confidence interval]: 1.50 [0.75–2.98], P = 0.2) and re‐hospitalization rate (HR: 1.04 [0.58–1.86], P = 0.90) at 1 year did not significantly differ between patients with SBP ≥ 130 mmHg and those with SBP < 130 mmHg at discharge. However, a prescription for antihypertensive drugs at discharge was associated with a better long‐term prognosis (all‐cause mortality: HR: 0.42 [0.20–0.88], P = 0.02; re‐hospitalization rate: HR: 0.56 [0.28–1.10], P = 0.09). Conclusions Although SBP < 130 mmHg at discharge was not associated with a better prognosis among very old patients hospitalized for acute HFpEF, the prescription of antihypertensive drugs was associated with mortality and re‐hospitalization rates that were reduced by half. Future prospective studies are needed to assess target blood pressure in very elderly patients with HFpEF.
Collapse
Affiliation(s)
- Sophie Putot
- Geriatrics Internal Medicine Department, University Hospital of Dijon Bourgogne, Dijon CEDEX, 21079, France
| | - Arthur Hacquin
- Geriatrics Internal Medicine Department, University Hospital of Dijon Bourgogne, Dijon CEDEX, 21079, France.,Physiopathologie et Epidémiologie Cérébro-Cardiovasculaires (PEC2), EA 7460, Université de Bourgogne - Franche Comté, Dijon CEDEX, France
| | - Patrick Manckoundia
- Geriatrics Internal Medicine Department, University Hospital of Dijon Bourgogne, Dijon CEDEX, 21079, France
| | - Alain Putot
- Geriatrics Internal Medicine Department, University Hospital of Dijon Bourgogne, Dijon CEDEX, 21079, France.,Physiopathologie et Epidémiologie Cérébro-Cardiovasculaires (PEC2), EA 7460, Université de Bourgogne - Franche Comté, Dijon CEDEX, France
| |
Collapse
|
8
|
Damy T, Chouihed T, Delarche N, Berrut G, Cacoub P, Henry P, Lamblin N, Andrès E, Hanon O. Diagnosis and Management of Heart Failure in Elderly Patients from Hospital Admission to Discharge: Position Paper. J Clin Med 2021; 10:jcm10163519. [PMID: 34441815 PMCID: PMC8396904 DOI: 10.3390/jcm10163519] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 07/29/2021] [Accepted: 07/30/2021] [Indexed: 02/07/2023] Open
Abstract
Multidisciplinary management of worsening heart failure (HF) in the elderly improves survival. To ensure patients have access to adequate care, the current HF and French health authority guidelines advise establishing a clearly defined HF patient pathway. This pathway involves coordinating multiple disciplines to manage decompensating HF. Yet, recent registry data indicate that insufficient numbers of patients receive specialised cardiology care, which increases the risk of rehospitalisation and mortality. The patient pathway in France involves three key stages: presentation with decompensated HF, stabilisation within a hospital setting and transitional care back out into the community. In each of these three phases, HF diagnosis, severity and precipitating factors need to be promptly identified and managed. This is particularly pertinent in older, frail patients who may present with atypical symptoms or coexisting comorbidities and for whom geriatric evaluation may be needed or specific geriatric syndrome management implemented. In the transition phase, multi-professional post-discharge management must be coordinated with community health care professionals. When the patient is discharged, HF medication must be optimised, and patients educated about self-care and monitoring symptoms. This review provides practical guidance to clinicians managing worsening HF in the elderly.
Collapse
Affiliation(s)
- Thibaud Damy
- Service de Cardiologie, CHU H. Mondor, 94000 Créteil, France
- Correspondence:
| | - Tahar Chouihed
- Service des SAMU-SMUR-Urgences, Centre d’Investigations Cliniques-1433, INSERM UMR_S 1116, Université de Lorraine, CHRU Nancy, F-CRIN INI-CRCT, 541000 Nancy, France;
| | | | - Gilles Berrut
- CHU Nantes, Pôle Hospitalo-Universitiare de Gérontologie Clinique, 44000 Nantes, France;
| | - Patrice Cacoub
- Groupe Hospitalier Pitié-Salpêtrière, Department of Internal Medicine and Clinical Immunology, AP-HP, 75000 Paris, France;
| | - Patrick Henry
- Service de Cardiologie, APHP, Hôpital Lariboisière, 75000 Paris, France;
| | - Nicholas Lamblin
- Service de Cardiologie, Institut Pasteur de Lille, CHU de Lille, Université de Lille, U1167, 59000 Lille, France;
| | - Emmanuel Andrès
- Service Méd. Interne, Diabète, Maladies Métaboliques, Clinique Médicale B, CHU Strasbourg, 67000 Strasbourg, France;
| | - Olivier Hanon
- Service de Gériatrie, APHP, Hôpital Broca, Université de Paris, 54 Rue Pascal, 75013 Paris, France;
| |
Collapse
|
9
|
Nader V, Matta A, Canitrot R, Itier R, Salemeh P, Lairez O, Elbaz M, Galinier M, Azar R, Roncalli J. Evaluation of Mitral and Aortic Valvular Disease and Left Ventricular Dysfunction in a Lebanese Population: Retrospective Single-Center Experience. Med Sci Monit 2021; 27:e928218. [PMID: 33558450 PMCID: PMC7883403 DOI: 10.12659/msm.928218] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 10/21/2020] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Recently, new therapeutic approaches have revolutionized the management of left ventricular dysfunction (LVD) and valvular heart disease (VHD), which are a growing public health problem. In parallel, there are no available epidemiological data about LVD and VHD in developing countries, especially in the Mediterranean area. This retrospective study was conducted at a single center and aimed to evaluate the associations between mitral and aortic valvular disease and left ventricle systolic and diastolic dysfunction in the Lebanese population. MATERIAL AND METHODS A retrospective study was conducted of 4520 consecutive patients aged >18 years who were referred to the Cardiovascular Department of Notre Dame de Secours-University Hospital in Jbeil-Lebanon for transthoracic echocardiography between December 2016 and December 2019. The study population was divided into different groups based on types of LVD and VHD. Left ventricle systolic dysfunction was defined as a left ventricle ejection fraction (EF) ≤40%. Statistical analysis was carried out using SPSS software version 20. RESULTS VHD and systolic dysfunction were more common in men, whereas diastolic dysfunction was more common in women. Being older than age 65 years and smoking were significantly associated with heart failure with preserved EF, whereas female sex was a significant preventive factor against heart failure with reduced EF. Systemic hypertension was correlated with mitral stenosis and tricuspid regurgitation, whereas diabetes mellitus was associated with tricuspid regurgitation (TR). Smoking and older age also appeared to be associated with aortic stenosis. CONCLUSIONS Mitral valve disease (regurgitation and stenosis) was significantly correlated with systolic dysfunction, whereas aortic and mitral regurgitation were associated with diastolic dysfunction. Better monitoring of cardiovascular disease risk factors may lead to a reduced burden of LVD and VHD.
Collapse
Affiliation(s)
- Vanessa Nader
- Department of Cardiology, Toulouse University Hospital, Toulouse, France
- Faculty of Pharmacy, Lebanese University, Beirut, Lebanon
| | - Anthony Matta
- Department of Cardiology, Toulouse University Hospital, Toulouse, France
- Faculty of medicine, Holy Spirit University of Kaslik, Kaslik, Lebanon
| | - Ronan Canitrot
- Department of Cardiology, Toulouse University Hospital, Toulouse, France
| | - Romain Itier
- Department of Cardiology, Toulouse University Hospital, Toulouse, France
| | | | - Olivier Lairez
- Department of Cardiology, Toulouse University Hospital, Toulouse, France
| | - Meyer Elbaz
- Department of Cardiology, Toulouse University Hospital, Toulouse, France
| | - Michel Galinier
- Department of Cardiology, Toulouse University Hospital, Toulouse, France
| | - Rania Azar
- Faculty of Pharmacy, Lebanese University, Beirut, Lebanon
| | - Jerome Roncalli
- Department of Cardiology, Toulouse University Hospital, Toulouse, France
| |
Collapse
|
10
|
Hanon O, Belmin J, Benetos A, Chassagne P, De Decker L, Jeandel C, Krolak-Salmon P, Nourhashemi F, Paccalin M. Consensus of experts from the French Society of Geriatrics and Gerontology on the management of heart failure in very old subjects. Arch Cardiovasc Dis 2021; 114:246-259. [PMID: 33455889 DOI: 10.1016/j.acvd.2020.12.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 11/26/2020] [Accepted: 12/01/2020] [Indexed: 02/08/2023]
Abstract
The prevalence of heart failure increases with age. In France, the 1-year mortality rate is 35% in subjects aged 80-89 years with heart failure, and 50% after the age of 90 years. In octogenarians, heart failure is associated with high rates of cardiovascular and non-cardiovascular events, and is one of the main causes of hospitalization and disability. The prevalence of frailty increases in elderly subjects with heart failure, and the co-occurrence of heart failure and frailty increases the risk of mortality in patients with heart failure. In the elderly, the presence of frailty must be evaluated using a comprehensive geriatric assessment to manage geriatric syndromes, such as cognitive disorders, malnutrition, falls, depression, polypharmacy, disability and social isolation. The objective of heart failure therapy in octogenarians is to reduce symptoms, mortality and hospitalizations, but also to improve quality of life. In the absence of specific studies involving very old subjects, most recommendations are extrapolated from evidence-based data from younger populations. Overall, the epidemiological studies in patients with heart failure aged>80 years highlight the underprescription of recommended drugs. This underprescription may be related to comorbidity, a fear of side-effects and the lack of specific recommendations for drug prescription in heart failure with preserved ejection fraction, which is common in this very old population. The benefit/risk ratio related to heart failure treatment and comorbidity should be carefully weighed and reassessed on a regular basis. Consideration of disease prognosis according to factors that predict mortality can help to better define the care plan and promote palliative and supportive care when needed.
Collapse
Affiliation(s)
- Olivier Hanon
- Service de gériatrie, hôpital Broca, AP-HP, 75013 Paris, France; EA 4468, gérontopôle d'Île-de-France, université de Paris, 75013 Paris, France.
| | - Joël Belmin
- Service de gériatrie, hôpital Charles-Foix, 94200 Ivry-sur-Seine, France; Faculté de médecine, Sorbonne université, 75103 Paris, France
| | - Athanase Benetos
- Service de médecine interne gériatrique, CHRU plurithématiques-Nancy, 54035 Nancy, France; UMR_S 1116, Inserm, université de Lorraine, 54500 Vandœuvre-lès-Nancy, France
| | - Philippe Chassagne
- Service de médecine interne gériatrique, CHU de Rouen, 76000 Rouen, France
| | - Laure De Decker
- Service de gérontologie clinique, CHU de Nantes, 44093 Nantes, France
| | - Claude Jeandel
- Centre Antonin-Balmès, CHU de Montpellier, 34090 Montpellier, France
| | - Pierre Krolak-Salmon
- Institut du vieillissement, hôpital des Charpennes, hospices civils de Lyon, 69002 Lyon, France; Inserm 1048, université de Lyon, 69675 Bron, France
| | - Fati Nourhashemi
- Gérontopôle, CHU de Toulouse, 31059 Toulouse, France; Inserm 1027, 31000 Toulouse, France
| | - Marc Paccalin
- Pôle de Gériatrie, CHU La Milétrie, 86021 Poitiers, France; CIC 1402, Inserm, centre hospitalier universitaire de Poitiers, université de Poitiers, 86000 Poitiers, France
| |
Collapse
|
11
|
Cui Z, Li N, Gao C, Fan Y, Zhuang X, Liu J, Zhang J, Tan Q. Precision implementation of early ambulation in elderly patients undergoing off-pump coronary artery bypass graft surgery: a randomized-controlled clinical trial. BMC Geriatr 2020; 20:404. [PMID: 33054724 PMCID: PMC7560239 DOI: 10.1186/s12877-020-01823-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 10/07/2020] [Indexed: 01/17/2023] Open
Abstract
Background Although early ambulation (EA) is associated with improved outcomes in post-operative patients, implementation of EA in elderly patients is still a challenge. In this study, we aimed to design and assess a precision early ambulation program for cardiac rehabilitation. Methods We conducted a single-center, randomized and controlled clinical trial in elderly patients aged over 60 years after off-pump coronary artery bypass graft (OPCABG) surgery. Patients were randomly assigned to a precision early ambulation (PEA) group or a routine ambulation (Control) group. Age-predicted maximal heart rate (APMHR) and maximal oxygen uptake (VO2max) were used as a reference to formulate and monitor the PEA regimen. The primary end-point was the postoperative length of stay in hospital (PLOS). The secondary end-points included 90-day mortality, incidence of early discharge, laboratory tests, length of ICU stay, the incidence of multiple organ complications and post-traumatic stress disorder (PTSD). Ambulation outcomes were also recorded. Results In total, 178 patients were enrolled (n = 89 per group). In the intent-to-treat analysis, PLOS in the PEA group was shorter than that in the Control group (9.04 ± 3.08 versus 10.09 ± 3.32 days, respectively. Mean difference 1.045 days; 95% confidence interval [CI] 0.098–1.992; P = 0.031 in the unadjusted model; mean difference 0.957 days; CI 0.007–1.907; P = 0.048 in adjusted model). The incidence of early discharge differed significantly between the PEA and control groups (41[46.1%] versus 24[27.0%] patients, respectively. Odds ratio [OR] 0.432; CI 0.231–0.809; P = 0.009 in unadjusted model; OR 0.466; CI 0.244–0.889, P = 0.02 in adjusted model). The time of first bowel movement, partial pressure O2 and post-traumatic stress disorder score in the PEA group were better than those in the Control group. Participants walked much longer distances on day 3 in the PEA group than those in the Control group (76.12 ± 29.02 versus 56.80 ± 24.40 m, respectively, P < 0.001). Conclusion APMHR and VO2max are valuable for implementation of PEA according to an established security threshold. PEA after OPCAPG surgery is safe and reliable for elderly patients, not only reducing the hospital stay, but also improving their physiological and psychological symptoms. Trial registration This study is a component of a protocol retrospectively registered: Application of ERAS in cardiovascular surgery. Trial registration number: ChiCTR1800018167. Date of registration: 3rd September, 2018. URL of trial registry record: http://www.chictr.org.cn/index.aspx
Collapse
Affiliation(s)
- Zhaomei Cui
- Intensive Care Unit (ICU), Department of Cardiac Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, Shandong, China
| | - Na Li
- Department of Gynecology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, Shandong, China
| | - Chaonan Gao
- Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, Shandong, China
| | - Yiou Fan
- Department of Toxicological and Functional Test, Centers for Disease Control and Prevention of Shandong, Jinan, 250014, China
| | - Xin Zhuang
- Intensive Care Unit (ICU), Department of Cardiac Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, Shandong, China
| | - Jing Liu
- Intensive Care Unit (ICU), Department of Cardiac Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, Shandong, China
| | - Jie Zhang
- Intensive Care Unit (ICU), Department of Cardiac Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, Shandong, China
| | - Qi Tan
- Intensive Care Unit (ICU), Department of Cardiac Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, Shandong, China. .,Intensive Care Unit (ICU), Department of Cardiac Surgery, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250021, Shandong, China.
| |
Collapse
|
12
|
Lelli D, Pedone C, Leosco D, Onder G, Antonelli Incalzi R. Management of heart failure: an Italian national survey on fellows/specialists in geriatrics. Aging Clin Exp Res 2020; 32:2049-2055. [PMID: 32383033 DOI: 10.1007/s40520-020-01577-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 04/25/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Heart failure (HF) is often managed by geriatricians. Few data are available on their knowledge and attitudes about this condition. AIMS To compare perceptions and knowledge on HF of specialists/fellows in geriatrics working in Italy. METHODS This nation-wide survey carried out by the Italian Society of Gerontology and Geriatrics in May-June 2019 enrolled 283 specialists/fellows in geriatrics in Italy. Results were stratified by qualification (specialist/fellow) and performance (lower/higher quartile of correct answers). RESULTS About half (55.5%) of the participants worked in acute care wards, 190 were residents, and 93 specialists. The overall proportion of correct answers was 70.8%, with no differences between specialists and fellows. There was a poor knowledge, with no differences between groups, about the target doses of ACE-inhibitors (36% of correct answers), the pharmacological treatment of HF with preserved ejection fraction (HFpEF) (37% of correct answers), and the inotropes indicated in acute HF (35% of correct answers). Compared to specialists, fellows performed better on indication (88% vs 76%, P = 0.019) and mechanism of action (93% vs 84%, P = 0.023) of sacubitril/valsartan, and on therapeutic indications of patients with atrial fibrillation (92% vs 75%, P < 0.001). CONCLUSIONS Globally, there was a good knowledge of the latest guidelines on the diagnosis and management of HF. However, for some important topics, such as HFpEF, that is the most common HF manifestation in older adults, the observed performance was relatively poor, indicating the need for focused educational campaigns.
Collapse
Affiliation(s)
- Diana Lelli
- Area di Geriatria, Università Campus Bio-Medico di Roma, via Alvaro del Portillo 21, 00128, Rome, Italy.
| | - Claudio Pedone
- Area di Geriatria, Università Campus Bio-Medico di Roma, via Alvaro del Portillo 21, 00128, Rome, Italy
| | - Dario Leosco
- Dipartimento di Scienze Mediche Traslazionali, Università Degli Studi di Napoli "Federico II", Via Pansini 5, 80131, Naples, Italy
| | - Graziano Onder
- Dipartimento di Malattie Cardiovascolari, endocrino-metaboliche ed invecchiamento, Istituto Superiore di Sanità, viale Regina Elena 299, 00161, Rome, Italy
| | | |
Collapse
|
13
|
Huerta-Preciado J, Franco J, Formiga F, Iborra PL, Epelde F, Franco ÁG, Ormaechea G, Manzano L, Cepeda-Rodrigo JM, Montero-Pérez-Barquero M. Differential characteristics of acute heart failure in very elderly patients: the prospective RICA study. Aging Clin Exp Res 2020; 32:1789-1799. [PMID: 31621036 DOI: 10.1007/s40520-019-01363-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Accepted: 09/21/2019] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Acute heart failure (AHF) is a frequent epidemic in geriatrics. The main aim of this study was to evaluate the clinical and prognostic differences of very elderly patients with AHF compared to the rest, and evaluate the factors associated with 90-day mortality. METHODS We analyzed 3828 patients hospitalized for AHF with an age of ≥ 70 years. The population was divided into three groups: 70-79, 80-89 and ≥ 90 years old (nonagenarians). The baseline characteristics of patients nonagenarians were compared with the rest. In the group of nonagenarians, their clinical characteristics were analyzed according to the left ventricular ejection fraction (LVEF) and the factors associated with mortality at 90 days of follow-up. RESULTS Nonagenarians showed higher comorbidity and cognitive deterioration, worse basal functional status, and preserved LVEF. Alternatively, they presented a lower rate of diabetes mellitus, lower incidence of de novo AHF, and lower prescription of angiotensin-converting-enzyme inhibitors, aldosterone blockers, anticoagulants, and statins at hospital discharge. Of the total, 334 patients (9.3%) had died by 90 days. The 90-day mortality rate was highest in nonagenarians (7.1% vs 9.8% vs 17%; p = 0.001). Multivariate analysis showed that renal failure, New York Heart Association (NYHA) functional classifications of III-IV, and a more advanced functional deterioration at baseline are predictors of mortality within 90 days. CONCLUSIONS The AHF in patients nonagenarians has a different clinical profile compared to younger patients and a higher mortality. In this subgroup of patients having a worse baseline functional status, higher NYHA classification (III-IV), and renal failure are predictors of 90-day mortality.
Collapse
Affiliation(s)
- Jorge Huerta-Preciado
- Department of Internal Medicine, Hospital Universitario Quirón Dexeus, Barcelona, Spain.
| | - Jonathan Franco
- Department of Internal Medicine, Hospital Universitario Quirón Dexeus, Barcelona, Spain
| | - Francesc Formiga
- Department of Internal Medicine, Hospital Universitario Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
| | - Pau Llácer Iborra
- Department of Internal Medicine, Hospital de Manises, Manises, Spain
| | - Francisco Epelde
- Short-Stay Unit, Hospital Universitari Parc Taulí, Sabadell, Spain
| | - Álvaro González Franco
- Department of Internal Medicine, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Gabriela Ormaechea
- Multidisciplinary Unit on Heart Failure, Hospital de Clínicas Dr. Manuel Quintela, Montevideo, Uruguay
| | - Luis Manzano
- Department of Internal Medicine, Hospital Universitario Ramón y Cajal, Universidad de Alcalá/IRYCIS, Madrid, Spain
| | | | | |
Collapse
|