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Ayesta A, Valero-Masa MJ, Vidán MT, Segovia-Cubero J, García-Cosío MD, López-Ibor JV, Caravaca P, Luna-López R, Pérez-Gómez L, Nuche J, Martínez-Díaz J, Delgado J, Gómez-Bueno M, Fernández-Cordón C, López-Azor JC, Martínez-Sellés M. Frailty Is Common in Heart Transplant Candidates But Is Not Associated With Clinical Events and Is Reversible After Heart Transplantation. Am J Cardiol 2023; 205:28-34. [PMID: 37579657 DOI: 10.1016/j.amjcard.2023.07.110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 07/13/2023] [Accepted: 07/19/2023] [Indexed: 08/16/2023]
Abstract
Assessment of frailty before heart transplant (HT) is recommended but is not standard in most HT protocols. Our objective was to evaluate frailty at inclusion in HT list and during follow-up and to assess the influence of baseline frailty on prognosis. A prospective multicenter study in all adults included in the nonurgent HT waiting list. Frailty was defined as Fried's frailty phenotype score ≥3. Mean follow-up was 25.9 ± 1.2 months. Of 99 patients (mean age 54.8 [43.1 to 62.5] years, 70 men [70.7%]), 28 were frail (28.3%). A total of 85 patients received HT after 0.5 ± 0.01 years. Waiting time was shorter in frail patients (0.6 years [0.3 to 0.8] vs 0.2 years [0.1 to 0.4], p = 0.001) because of an increase in priority. Baseline frailty was not associated with overall mortality, (hazard ratio 0.99 [95% confidence interval 0.41 to 2.37, p = 0.98]). A total of 16 transplant recipients died (18.8%). Of the remaining 69 HT recipients, 65 underwent frailty evaluation during follow-up. Patients without baseline frailty (n = 49) did not develop it after HT. Of 16 patients with baseline frailty, only 2 were still frail at the end of follow-up. Frailty is common in HT candidates but is reversible in most cases after HT and is not associated with post-transplant mortality. Our results suggest that frailty should not be considered an exclusion criterion for HT.
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Affiliation(s)
- Ana Ayesta
- Heart Area, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | - María Jesús Valero-Masa
- Cardiology Department, Hospital General Universitario Gregorio Marañón, Centro de Investigación Biomédica en Red Cardiovascular (CIBERCV), Madrid, Spain; Universidad Complutense, Madrid, Spain
| | - María Teresa Vidán
- Universidad Complutense, Madrid, Spain; Geriatrics Department, Hospital General Universitario Gregorio Marañón, Centro de Investigación Biomédica en Red Fragilidad y Envejecimiento Saludable (CIBERFES), Madrid, Spain
| | - Javier Segovia-Cubero
- Cardiology Department, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain; Centro de Investigación Biomédica en Red Cardiovascular (CIBERCV), Madrid, Spain
| | - María Dolores García-Cosío
- Cardiology Department, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain; Centro de Investigación Biomédica en Red Cardiovascular (CIBERCV), Madrid, Spain
| | - Jorge V López-Ibor
- Cardiology Department, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain; Centro de Investigación Biomédica en Red Cardiovascular (CIBERCV), Madrid, Spain
| | - Pedro Caravaca
- Cardiology Department, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain; Centro de Investigación Biomédica en Red Cardiovascular (CIBERCV), Madrid, Spain
| | - Raquel Luna-López
- Cardiology Department, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain; Centro de Investigación Biomédica en Red Cardiovascular (CIBERCV), Madrid, Spain
| | - Laura Pérez-Gómez
- Cardiology Department, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain; Centro de Investigación Biomédica en Red Cardiovascular (CIBERCV), Madrid, Spain
| | - Jorge Nuche
- Universidad Complutense, Madrid, Spain; Cardiology Department, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain; Centro de Investigación Biomédica en Red Cardiovascular (CIBERCV), Madrid, Spain; Centro de Investigación Biomédica en Red Cardiovascular (CIBERCV), Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain
| | | | - Juan Delgado
- Universidad Complutense, Madrid, Spain; Cardiology Department, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain; Centro de Investigación Biomédica en Red Cardiovascular (CIBERCV), Madrid, Spain
| | - Manuel Gómez-Bueno
- Cardiology Department, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain; Centro de Investigación Biomédica en Red Cardiovascular (CIBERCV), Madrid, Spain
| | - Clara Fernández-Cordón
- Cardiology Department, Hospital General Universitario Gregorio Marañón, Centro de Investigación Biomédica en Red Cardiovascular (CIBERCV), Madrid, Spain; Universidad Complutense, Madrid, Spain
| | - Juan Carlos López-Azor
- Cardiology Department, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain; Centro de Investigación Biomédica en Red Cardiovascular (CIBERCV), Madrid, Spain
| | - Manuel Martínez-Sellés
- Cardiology Department, Hospital General Universitario Gregorio Marañón, Centro de Investigación Biomédica en Red Cardiovascular (CIBERCV), Madrid, Spain; Universidad Complutense, Madrid, Spain; Universidad Europea, Madrid, Spain.
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Macías-Valle A, Rodríguez-López C, González-Senac NM, Mayordomo-Cava J, Vidán MT, Cruz-Arnés ML, Jiménez-Gómez LM, Dujovne-Lindenbaum P, Pérez-Menéndez ME, Ortiz-Alonso J, Valenzuela PL, Rodríguez-Romo G, Serra-Rexach JA. Exercise effects on functional capacity and quality of life in older patients with colorectal cancer: study protocol for the ECOOL randomized controlled trial. BMC Geriatr 2023; 23:314. [PMID: 37211611 DOI: 10.1186/s12877-023-04026-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 05/08/2023] [Indexed: 05/23/2023] Open
Abstract
BACKGROUND Surgery and treatment for colorectal cancer (CRC) in the elderly patient increase the risk of developing post-operative complications, losing functional independence, and worsening health-related quality of life (HRQoL). There is a lack of high-quality randomized controlled trials evaluating the potential benefit of exercise as a countermeasure. The primary aim of this study is to evaluate the effectiveness of a home-based multicomponent exercise program for improving HRQoL and functional capacity in older adults undergoing CRC surgery and treatment. METHODS This randomized, controlled, observer-blinded, single-center trial aims to randomize 250 patients (>74 years) to either an intervention or a control group (i.e., usual care). The intervention group will perform an individualized home-based multicomponent exercise program with weekly telephone supervision from diagnosis until three months post-surgery. The primary outcomes will be HRQoL (EORTC QLQ-C30; CR29; and ELD14) and functional capacity (Barthel Index and Short Physical Performance Battery), which will be assessed at diagnosis, at discharge, and one, three, and six months after surgery. Secondary outcomes will be frailty, physical fitness, physical activity, inspiratory muscle function, sarcopenia and cachexia, anxiety and depression, ambulation ability, surgical complications, and hospital length of stay, readmission and mortality. DISCUSSION This study will examine the effects of an exercise program in older patients with CRC across a range of health-related outcomes. Expected findings are improvement in HRQoL and physical functioning. If proven effective, this simple exercise program may be applied in clinical practice to improve CRC care in older patients. TRIAL REGISTRATION ClinicalTrials.gov ID: NCT05448846.
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Affiliation(s)
- Angela Macías-Valle
- Faculty of Physical Activity and Sport Sciences (INEF), Universidad Politécnica de Madrid, Madrid, Spain
| | - Carlos Rodríguez-López
- Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (CIBERFES), Madrid, Spain.
- Department of Geriatrics, Hospital General Universitario Gregorio Marañón. Health Research Institute Gregorio Marañón (IiSGM), Dr.Esquerdo 46, 28007, Madrid, Spain.
| | - Nicolas María González-Senac
- Department of Geriatrics, Hospital General Universitario Gregorio Marañón. Health Research Institute Gregorio Marañón (IiSGM), Dr.Esquerdo 46, 28007, Madrid, Spain
| | - Jennifer Mayordomo-Cava
- Department of Geriatrics, Hospital General Universitario Gregorio Marañón. Health Research Institute Gregorio Marañón (IiSGM), Dr.Esquerdo 46, 28007, Madrid, Spain
| | - María Teresa Vidán
- Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (CIBERFES), Madrid, Spain
- Department of Geriatrics, Hospital General Universitario Gregorio Marañón. Health Research Institute Gregorio Marañón (IiSGM), Dr.Esquerdo 46, 28007, Madrid, Spain
- School of Medicine, Department of Medicine, Universidad Complutense, Madrid, Spain
| | - María Luisa Cruz-Arnés
- Department of Geriatrics, Hospital General Universitario Gregorio Marañón. Health Research Institute Gregorio Marañón (IiSGM), Dr.Esquerdo 46, 28007, Madrid, Spain
| | - Luis Miguel Jiménez-Gómez
- Colorectal Surgery Unit - General Surgery Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Paula Dujovne-Lindenbaum
- Colorectal Surgery Unit - General Surgery Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Maria Elena Pérez-Menéndez
- Colorectal Surgery Unit - General Surgery Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Javier Ortiz-Alonso
- Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (CIBERFES), Madrid, Spain
- Department of Geriatrics, Hospital General Universitario Gregorio Marañón. Health Research Institute Gregorio Marañón (IiSGM), Dr.Esquerdo 46, 28007, Madrid, Spain
- School of Medicine, Department of Medicine, Universidad Complutense, Madrid, Spain
| | - Pedro L Valenzuela
- Physical Activity and Health Research Group (PaHerg), Research Institute of the Hospital Universitario 12 de Octubre ("Imas12"), Madrid, Spain
| | - Gabriel Rodríguez-Romo
- Faculty of Physical Activity and Sport Sciences (INEF), Universidad Politécnica de Madrid, Madrid, Spain
- Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (CIBERFES), Madrid, Spain
| | - Jose Antonio Serra-Rexach
- Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (CIBERFES), Madrid, Spain
- Department of Geriatrics, Hospital General Universitario Gregorio Marañón. Health Research Institute Gregorio Marañón (IiSGM), Dr.Esquerdo 46, 28007, Madrid, Spain
- School of Medicine, Department of Medicine, Universidad Complutense, Madrid, Spain
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Jiménez-Méndez C, Díez-Villanueva P, Bonanad C, Ortiz-Cortés C, Barge-Caballero E, Goirigolzarri J, Esteban-Fernández A, Pérez-Rivera Á, Cobo M, López J, Sanz-García A, Guerrero C, Pardo HG, Robles C, Iglesias D, Pinilla JMG, Rodríguez LL, Formiga F, Martín-Sánchez FJ, Vidán MT, Ariza A, Martínez-Sellés M, Alfonso F. Frailty and prognosis of older patients with chronic heart failure. Rev Esp Cardiol (Engl Ed) 2022; 75:1011-1019. [PMID: 35718066 DOI: 10.1016/j.rec.2022.04.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 04/21/2022] [Indexed: 06/15/2023]
Abstract
INTRODUCTION AND OBJECTIVES Heart failure (HF) is prevalent in advanced ages. Our objective was to assess the impact of frailty on 1-year mortality in older patients with ambulatory HF. METHODS Our data come from the FRAGIC study (Spanish acronym for "Study of the impact of frailty and other geriatric syndromes on the clinical management and prognosis of elderly outpatients with heart failure"), a multicenter prospective registry conducted in 16 Spanish hospitals including outpatients ≥ 75 years with HF followed up by cardiology services in Spain. RESULTS We included 499 patients with a mean age of 81.4±4.3 years, of whom 193 (38%) were women. A total of 268 (54%) had left ventricular ejection fraction <40%, and 84.6% was in NYHA II functional class. The FRAIL scale identified 244 (49%) pre-frail and 111 (22%) frail patients. Frail patients were significantly older, were more frequently female (both, P <.001), and had higher comorbidity according to the Charlson index (P=.017) and a higher prevalence of geriatric syndromes (P <.001). During a median follow-up of 371 [361-387] days, 58 patients (11.6%) died. On multivariate analysis (Cox regression model), frailty detected with the FRAIL scale was marginally associated with mortality (HR=2.35; 95%CI, 0.96-5.71; P=.059), while frailty identified by the visual mobility scale was an independent predictor of mortality (HR=2.26; 95%CI, 1.16-4.38; P=.015); this association was maintained after adjustment for confounding variables (HR=2.13; 95%CI, 1.08-4.20; P=.02). CONCLUSIONS In elderly outpatients with HF, frailty is independently associated with mortality at 1 year of follow-up. It is essential to identify frailty as part of the comprehensive approach to elderly patients with HF.
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Affiliation(s)
| | | | - Clara Bonanad
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - Carolina Ortiz-Cortés
- Servicio de Cardiología, Hospital Universitario San Pedro de Alcántara, Cáceres, Spain
| | - Eduardo Barge-Caballero
- Servicio de Cardiología, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Josebe Goirigolzarri
- Servicio de Cardiología, Hospital Clínico Universitario San Carlos, Madrid, Spain
| | | | - Ángel Pérez-Rivera
- Servicio de Cardiología, Hospital Universitario de Burgos, Burgos, Spain
| | - Marta Cobo
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - Javier López
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Ancor Sanz-García
- Unidad de Análisis de Datos, Instituto de Investigación Sanitaria del Hospital Universitario de La Princesa, Madrid, Spain
| | - Carmen Guerrero
- Servicio de Cardiología, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Héctor García Pardo
- Servicio de Cardiología, Hospital Universitario Río Hortega, Valladolid, Spain
| | - Carolina Robles
- Servicio de Cardiología, Complejo Hospitalario de Toledo, Toledo, Spain
| | - Diego Iglesias
- Servicio de Cardiología, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, Spain
| | - José Manuel García Pinilla
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Unidad de Insuficiencia Cardiaca y Cardiopatías Familiares, Hospital Universitario Virgen de la Victoria, IBIMA, Málaga, Spain
| | | | - Francesc Formiga
- Servicio de Medicina Interna, Hospital de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | | | - María Teresa Vidán
- Servicio de Geriatría, Hospital Universitario Gregorio Marañón, Universidad Complutense, Madrid, Spain; Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (CIBERFES), Spain
| | - Albert Ariza
- Servicio de Cardiología, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Manuel Martínez-Sellés
- Servicio de Cardiología, Hospital Universitario Gregorio Marañón, Universidad Europea, Universidad Complutense, Madrid, Spain
| | - Fernando Alfonso
- Servicio de Cardiología, Hospital Universitario de La Princesa, Madrid, Spain; Servicio de Cardiología, Hospital Universitario San Pedro de Alcántara, Cáceres, Spain
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4
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Ayesta A, Valero Masa MJ, Vidán MT, Luna-López R, Segovia-Cubero J, García-Cosío MD, Pérez Gómez L, Pérez PC, Vázquez López-Ibor J, Nuche J, Martínez-Sellés M. Prevalence and characterization of frailty, depression, and cognitive impairment in patients listed for heart transplantation: Results of the FELICITAR prospective registry. Clin Transplant 2021; 35:e14391. [PMID: 34159629 DOI: 10.1111/ctr.14391] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 06/01/2021] [Accepted: 06/07/2021] [Indexed: 02/06/2023]
Abstract
INTRODUCTION It is recommended to assess frailty prior to heart transplantation (HT). Our objective was to assess the prevalence of frailty in patients listed for HT. METHODS The FELICITAR registry (Frailty Evaluation after List Inclusion, Characteristics and Influence on TrAnsplantation And Results) is a prospective registry that includes patients listed for HT in three centers, from January 2017 to April 2019. We assessed the presence of frailty, depression, cognitive impairment, and quality of life when included. RESULTS Ninety-nine patients were included. Of this group, 30.6% were frail, 55 (56.1%) had depression (treated only in nine patients), and 51 (54.8%) had cognitive impairment. Compared with non-frail patients, frail patients were more frequently hospitalized when included in HT waiting list (P = .048), had a lower upper-arm circumference (P = .026), had a lower Barthel index (P = .001), more anemia (P = .010), higher rates of depression (P = .001), poorer quality of life (P = .001), and lower hand-grip strength (P < .001). In multivariate analysis hand-grip strength (odds ratio .91; 95% confidence interval .87-.96, P < .001) and Barthel index (odds ratio .90; 95% confidence interval .82-.99, P = .024) were associated with frailty. CONCLUSIONS Frailty, depression, and cognitive impairment are common in patients included in HT waiting list. Frailty is strongly associated with hand-grip strength.
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Affiliation(s)
- Ana Ayesta
- Área del Corazón, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | - María Jesús Valero Masa
- Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Centro de Investigación Biomédica en Red Cardiovascular (CIBERCV), Madrid, Spain.,Universidad Complutense, Madrid, Spain
| | - María Teresa Vidán
- Universidad Complutense, Madrid, Spain.,Servicio de Geriatría, Hospital General Universitario Gregorio Marañón, CIBERFES, Madrid, Spain
| | - Raquel Luna-López
- Servicio de Cardiología, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain.,Centro de Investigación Biomédica en Red Cardiovascular (CIBERCV), Madrid, Spain
| | - Javier Segovia-Cubero
- Centro de Investigación Biomédica en Red Cardiovascular (CIBERCV), Madrid, Spain.,Servicio de Cardiología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - María Dolores García-Cosío
- Servicio de Cardiología, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain.,Centro de Investigación Biomédica en Red Cardiovascular (CIBERCV), Madrid, Spain
| | - Laura Pérez Gómez
- Centro de Investigación Biomédica en Red Cardiovascular (CIBERCV), Madrid, Spain.,Servicio de Cardiología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - Pedro Caravaca Pérez
- Servicio de Cardiología, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain.,Centro de Investigación Biomédica en Red Cardiovascular (CIBERCV), Madrid, Spain
| | - Jorge Vázquez López-Ibor
- Centro de Investigación Biomédica en Red Cardiovascular (CIBERCV), Madrid, Spain.,Servicio de Cardiología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - Jorge Nuche
- Universidad Complutense, Madrid, Spain.,Servicio de Cardiología, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain.,Centro de Investigación Biomédica en Red Cardiovascular (CIBERCV), Madrid, Spain.,Centro de Investigación Biomédica en Red Cardiovascular (CIBERCV), Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain
| | - Manuel Martínez-Sellés
- Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Centro de Investigación Biomédica en Red Cardiovascular (CIBERCV), Madrid, Spain.,Universidad Complutense, Madrid, Spain.,Servicio de Cardiología, Universidad Europea, Madrid, Spain
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Esteve-Pastor MA, Martín E, Alegre O, Formiga F, Sanchís J, López-Palop R, Martínez Sellés M, Vidán MT, Bueno H, Díez-Villanueva P, Abu Assi E, Ariza-Solé A, Marín F, Castillo Dominguez JC. Impact of frailty and atrial fibrillation in elderly patients with acute coronary syndromes. Eur J Clin Invest 2021; 51:e13505. [PMID: 33529346 DOI: 10.1111/eci.13505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 01/07/2021] [Accepted: 01/26/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND There is scarce information on the prognostic role of frailty and atrial fibrillation (AF) in elderly patients with acute coronary syndrome (ACS). METHODS The aim was to analyse the management of elderly patients with frailty and AF who suffered an ACS using data of the prospective multicentre LONGEVO-SCA registry. We evaluated the predictive performance of FRAIL, Charlson scores and AF status for adverse events at 6-month follow-up. RESULTS A total of 531 unselected patients with ACS and above 80 years old [mean age 84.4 (SD = 3.6) years; 322 (60.6%) male] were enrolled, of whom 128 (24.1%) with AF and 145 (27.3%) with frailty. Mutually exclusive number of patients were as follows: non-frail and sinus rhythm (SR) 304 (57.2%); frail and SR 99 (18.6%); non-frail and AF 82 (15.4%); and frail and AF 46 (8.7%). Frail and AF patients compared with non-frail and SR patients had higher risk of all-cause mortality [HR 2.61, (95% CI 1.28-5.31; P = .008)], readmissions [HR 2.28, (95%CI 1.37-3.80); P = .002)] and its composite [HR 2.28, (95% CI 1.44-3.60); P < .001)]. After multivariate adjustment, FRAIL score [HR 1.41, (95% CI 1.02-1.97); P = .040] and Charlson index [HR 1.32, (95% CI 1.09-1.59); P = .003] were significantly associated with mortality. AF status was not independently related with adverse events. CONCLUSIONS Frailty but not AF status was independently associated with follow-up adverse events. Frailty status and high Charlson index were independent conditions associated with adverse events during the follow-up. The impact of functional status has a bigger prognostic role over AF status in elderly patients with ACS.
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Affiliation(s)
- María Asunción Esteve-Pastor
- Department of Cardiology, Hospital Clínico Universitario Virgen de la Arrixaca, Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), CIBERCV, Spain
| | - Ernesto Martín
- Department of Cardiology, Hospital Universitario Reina Sofía, Córdoba, Spain
| | - Oriol Alegre
- Department of Cardiology, Hospital Universitario de Bellvitge, IDIBELL, Barcelona, Spain
| | - Francesc Formiga
- Internal Medicine Department, Hospital Universitario de Bellvitge, IDIBELL, Barcelona, Spain
| | - Juan Sanchís
- Department of Cardiology, Hospital Clínico Universitario de Valencia, INCLIVA, Universidad de Valencia, CIBERCV, Spain
| | - Ramón López-Palop
- Department of Cardiology, Hospital Clínico Universitario Virgen de la Arrixaca, Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), CIBERCV, Spain
| | - Manuel Martínez Sellés
- Hospital General Universitario Gregorio Marañón, Universidad Europea, Universidad Complutense de Madrid, CIBER-FES, Madrid, Spain
| | - María Teresa Vidán
- Hospital General Universitario Gregorio Marañón, Universidad Europea, Universidad Complutense de Madrid, CIBER-FES, Madrid, Spain
| | - Héctor Bueno
- Department of Cardiology, Hospital Universitario Doce de Octubre, Universidad Complutense de Madrid, Madrid, Spain.,Centro Nacional de Investigaciones Cardiovasculares, Universidad Complutense de Madrid, Madrid, Spain
| | | | - Emad Abu Assi
- Department of Cardiology, Hospital Álvaro Cunqueiro, Vigo, Spain
| | - Albert Ariza-Solé
- Department of Cardiology, Hospital Universitario de Bellvitge, CIBERCV, IDIBELL, Barcelona, Spain
| | - Francisco Marín
- Department of Cardiology, Hospital Clínico Universitario Virgen de la Arrixaca, Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), CIBERCV, Spain
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Tarazona-Santabalbina FJ, de la Cámara de las Heras JM, Vidán MT, García Navarro JA. [Coronavirus disease 2019 (COVID-19) and ageism: a narrative review of the literature]. Rev Esp Geriatr Gerontol 2021; 56:47-53. [PMID: 33077254 PMCID: PMC7476500 DOI: 10.1016/j.regg.2020.08.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 08/12/2020] [Indexed: 12/15/2022]
Abstract
Ageism is defined as stereotypes, prejudices and discrimination towards people due to their age. The present review analyzed the age-related attitudes, and the responses to them, produced during the COVID-19 pandemic. We searched for publications related to ageism during the COVID-19 pandemic in Pubmed, Medline, and Embase. Fourteen manuscripts were included. The works highlighted the civic and social sense of older adults, their capacity for help community, despite the risk of infection. This attitude contrasted with her vulnerability to illness and ageism. Specific interventions are necessary to support older adults during the pandemic, guaranteeing financial support, protection in the residential environment, access to information, and solving barriers to accessing health services. Likewise, chronological age should not be an independent criterion for clinical decision making.
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Affiliation(s)
| | | | - María Teresa Vidán
- Servicio de Geriatría, Hospital General Universitario Gregorio Marañón, Madrid, España
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Tarazona-Santabalbina FJ, Martínez-Velilla N, Vidán MT, García-Navarro JA. [COVID-19, older adults and ageism: Mistakes that should never happen again]. Rev Esp Geriatr Gerontol 2020; 55:191-192. [PMID: 32386947 PMCID: PMC7188650 DOI: 10.1016/j.regg.2020.04.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 04/22/2020] [Indexed: 11/30/2022]
Affiliation(s)
| | | | - María Teresa Vidán
- Servicio de Geriatría, Hospital General Universitario Gregorio Marañón, Madrid, España
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8
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González-Montalvo JI, Ramírez-Martín R, Menéndez Colino R, Alarcón T, Tarazona-Santabalbina FJ, Martínez-Velilla N, Vidán MT, Pi-Figueras Valls M, Formiga F, Rodríguez Couso M, Hormigo Sánchez AI, Vilches-Moraga A, Rodríguez-Pascual C, Gutiérrez Rodríguez J, Gómez-Pavón J, Sáez López P, Bermejo Boixareu C, Serra Rexach JA, Martínez Peromingo J, Sánchez Castellano C, González Guerrero JL, Martín-Sánchez FJ. [Cross-speciality geriatrics: A health-care challenge for the 21st century]. Rev Esp Geriatr Gerontol 2020; 55:84-97. [PMID: 31870507 DOI: 10.1016/j.regg.2019.10.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 10/25/2019] [Indexed: 06/10/2023]
Abstract
Increasing numbers of older persons are being treated by specialties other than Geriatric Medicine. Specialists turn to Geriatric Teams when they need to accurately stratify their patients' risk and prognosis, predict the potential impact of their, often, invasive interventions, optimise their clinical status, and contribute to discharge planning. Oncology and Haematology, Cardiology, General Surgery, and other surgical departments are examples where such collaborative working is already established, to a varying extent. The use of the term "Cross-speciality Geriatrics" is suggested when geriatric care is provided in clinical areas traditionally outside the reach of Geriatric Teams. The core principles of Geriatric Medicine (comprehensive geriatric assessment, patient-centred multidisciplinary targeted interventions, and input at point-of-care) are adapted to the specifics of each specialty and applied to frail older patients in order to deliver a holistic assessment/treatment, better patient/carer experience, and improved clinical outcomes. Using Comprehensive Geriatric Assessment methodology and Frailty scoring in such patients provides invaluable prognostic information, helps in decision making, and enables personalised treatment strategies. There is evidence that such an approach improves the efficiency of health care systems and patient outcomes. This article includes a review of these concepts, describes existing models of care, presents the most commonly used clinical tools, and offers examples of excellence in this new era of geriatric care. In an ever ageing population it is likely that teams will be asked to provide Cross-specialty Geriatrics across different Health Care systems. The fundamentals for its implementation are in place, but further evidence is required to guide future development and consolidation, making it one of the most important challenges for Geriatrics in the coming years.
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Affiliation(s)
- Juan Ignacio González-Montalvo
- Servicio de Geriatría, Hospital Universitario La Paz, IdiPAZ, Madrid, España; Facultad de Medicina, Universidad Autónoma de Madrid, Madrid, España.
| | | | | | - Teresa Alarcón
- Servicio de Geriatría, Hospital Universitario La Paz, IdiPAZ, Madrid, España; Facultad de Medicina, Universidad Autónoma de Madrid, Madrid, España
| | | | - Nicolás Martínez-Velilla
- Navarrabiomed, Complejo Hospitalario de Navarra (CHN), Universidad Pública de Navarra (UPNA), IDISNA, Pamplona, España
| | - María Teresa Vidán
- Servicio de Geriatría, Hospital General Universitario Gregorio Marañón, IiSGM, Facultad de Medicina, Universidad Complutense de Madrid, CIBERFES, Madrid, España
| | | | - Francesc Formiga
- Unidad de Geriatría, Servicio de Medicina Interna, IDIBELL, Hospital Universitario de Bellvitge, ĹHospitalet de Llobregat, Barcelona, España
| | | | - Ana Isabel Hormigo Sánchez
- Servicio de Geriatría, Hospital Universitario Fundación Jiménez Díaz, Madrid, España; Facultad de Medicina, Universidad Autónoma de Madrid, Madrid, España
| | - Arturo Vilches-Moraga
- Servicio de Geriatría, Salford Royal NHS Foundation Trust, Facultad de Medicina, Universidad de Manchester, Manchester, Inglaterra
| | | | - José Gutiérrez Rodríguez
- Área de Gestión Clínica de Geriatría, Hospital Monte Naranco, Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, España
| | - Javier Gómez-Pavón
- Servicio de Geriatría, Hospital Central de la Cruz Roja San José y Santa Adela, Facultad de Medicina, Universidad Alfonso X el Sabio, Madrid, España
| | - Pilar Sáez López
- Unidad de Geriatría, Hospital Universitario Fundación de Alcorcón, IdiPAZ, Alcorcón, Madrid, España
| | | | - José Antonio Serra Rexach
- Servicio de Geriatría, Hospital General Universitario Gregorio Marañón, IiSGM, Facultad de Medicina, Universidad Complutense de Madrid, CIBERFES, Madrid, España
| | | | | | - José Luis González Guerrero
- Servicio de Geriatría, Hospital San Pedro de Alcántara, Complejo Hospitalario Universitario de Cáceres, Cáceres, España
| | - Francisco Javier Martín-Sánchez
- Servicio de Urgencias, Hospital Universitario Clínico San Carlos, IdiSSC, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, España
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9
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Díez-Villanueva P, Salamanca J, Ariza-Solé A, Formiga F, Martín-Sánchez FJ, Bonanad Lozano C, Vidán MT, Martínez-Sellés M, Terres B, Jiménez Méndez C, Bueno H, Alfonso F. [Impact of frailty and other geriatric syndromes on the clinical management and prognosis of elderly ambulatory patients with heart failure. A prospective and multicentre study]. Rev Esp Geriatr Gerontol 2019; 55:29-33. [PMID: 31515087 DOI: 10.1016/j.regg.2019.08.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Revised: 07/22/2019] [Accepted: 08/06/2019] [Indexed: 12/31/2022]
Abstract
BACKGROUND AND OBJECTIVES Heart failure (HF) is a chronic disease that is often associated with ageing. There are predictive models based on variables that associate it with a poor prognosis, although those do not include common conditions in the elderly, such as frailty or comorbidity. The aim of this study is to determine the clinical and epidemiological characteristics of a cohort of elderly outpatients with HF followed-up by cardiologists. This will include a study of the prevalence of frailty and other geriatric syndromes, as well as their impact on the prognosis, and to evaluate whether these may improve predictive ability of such predictive models. MATERIAL AND METHODS Observational, prospective, and multicentre study that will include 400 patients ≥75years old with chronic HF followed-up in Spanish tertiary hospitals by cardiology specialists in HF. Patients will undergo a comprehensive geriatric assessment, and prediction of events will be performed based on MAGGIC (Meta-Analysis Global Group in Chronic Heart Failure) and Barcelona-Bio HF calculator scores. The primary endpoint is cardiovascular and overall mortality at 1 and 3years follow-up. RESULTS This study will assess both the characteristics and prognosis of elderly patients with HF followed-up by cardiologists in Spain and the applicability in the elderly population of scores used in the general population with chronic HF. CONCLUSION This is the first prospective study that will systematically assess frailty and other geriatric syndromes in the elderly outpatient with HF in Spain and followed-up by cardiologists, thus contributing to improve knowledge about both its prevalence and impact on our patients.
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Affiliation(s)
- Pablo Díez-Villanueva
- Servicio de Cardiología, Hospital Universitario La Princesa, Universidad Autónoma de Madrid, Madrid, España.
| | - Jorge Salamanca
- Servicio de Cardiología, Hospital Universitario La Princesa, Universidad Autónoma de Madrid, Madrid, España
| | - Albert Ariza-Solé
- Servicio de Cardiología, Área de Enfermedades del Corazón, Hospital Universitario de Bellvitge, Hospitalet de Llobregat, Barcelona, España
| | - Francesc Formiga
- Programa de Geriatría, Servicio de Medicina Interna, Instituto de Investigación Biomédica de Bellvitge (IDIBELL), Hospital Universitario de Bellvitge, Hospitalet de Llobregat, Barcelona, España
| | - Francisco Javier Martín-Sánchez
- Servicio de Urgencias, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria Hospital Clínico San Carlos (IdISSC), Universidad Complutense de Madrid, Madrid, España
| | - Clara Bonanad Lozano
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, Valencia, España
| | - María Teresa Vidán
- Servicio de Geriatría, Hospital General Universitario Gregorio Marañón (IiSGM), Universidad Complutense de Madrid, Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (CIBERFES), Madrid, España
| | - Manuel Martínez-Sellés
- Servicio de Cardiología, Hospital Universitario Gregorio Marañón, Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Universidad Complutense de Madrid, Universidad Europea de Madrid, Madrid, España
| | - Beatriz Terres
- Servicio de Cardiología, Hospital Universitario La Princesa, Universidad Autónoma de Madrid, Madrid, España
| | - César Jiménez Méndez
- Servicio de Cardiología, Hospital Universitario La Princesa, Universidad Autónoma de Madrid, Madrid, España
| | - Héctor Bueno
- Servicio de Cardiología, Hospital Universitario 12 de Octubre, CNIC, Madrid, España
| | - Fernando Alfonso
- Servicio de Cardiología, Hospital Universitario La Princesa, Universidad Autónoma de Madrid, Madrid, España
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10
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Martín-Sánchez FJ, Cuesta Triana F, Rossello X, Pardo García R, Llopis García G, Caimari F, Vidán MT, Ruiz Artacho P, González Del Castillo J, Llorens P, Herrero P, Jacob J, Gil V, Fernández Pérez C, Gil P, Bueno H, Miró Ò, Matía Martín P, Rodríguez Adrada E, Santos MC, Salgado L, Brizzi BN, Docavo ML, Del Mar Suárez-Cadenas M, Xipell C, Sánchez C, Aguiló S, Gaytan JM, Jerez A, Pérez-Durá MJ, Berrocal Gil P, López-Grima ML, Valero A, Aguirre A, Pedragosa MÀ, Piñera P, LázaroAragues P, Sánchez Nicolás JA, Rizzi MA, Herrera Mateo S, Alquezar A, Roset A, Ferrer C, Llopis F, Álvarez Pérez JM, López Diez MP, Richard F, Fernández-Cañadas JM, Carratalá JM, Javaloyes P, Andueza JA, Sevillano Fernández JA, Romero R, Merlo Loranca M, Álvarez Rodríguez V, Lorca MT, Calderón L, Soy Ferrer E, Manuel Garrido J, Martín Mojarro E. Effect of risk of malnutrition on 30-day mortality among older patients with acute heart failure in Emergency Departments. Eur J Intern Med 2019; 65:69-77. [PMID: 31076345 DOI: 10.1016/j.ejim.2019.04.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Revised: 03/19/2019] [Accepted: 04/23/2019] [Indexed: 01/04/2023]
Abstract
BACKGROUND Little is known about the prevalence and impact of risk of malnutrition on short-term mortality among seniors presenting with acute heart failure (AHF) in emergency setting. The objective was to determine the impact of risk of malnutrition on 30-day mortality risk among older patients who attended in Emergency Departments (EDs) for AHF. MATERIAL AND METHODS We performed a secondary analysis of the OAK-3 Registry including all consecutive patients ≥65 years attending in 16 Spanish EDs for AHF. Risk of malnutrition was defined by the Mini Nutritional Assessment Short Form (MNA-SF) < 12 points. Unadjusted and adjusted logistic regression models were used to assess the association between risk of malnutrition and 30-day mortality. RESULTS We included 749 patients (mean age: 85 (SD 6); 55.8% females). Risk of malnutrition was observed in 594 (79.3%) patients. The rate of 30-day mortality was 8.8%. After adjusting for MEESSI-AHF risk score clinical categories (model 1) and after adding all variables showing a significantly different distribution among groups (model 2), the risk of malnutrition was an independent factor associated with 30-day mortality (adjusted OR by model 1 = 3.4; 95%CI 1.2-9.7; p = .020 and adjusted OR by model 2 = 3.1; 95%CI 1.1-9.0; p = .033) compared to normal nutritional status. CONCLUSIONS The risk of malnutrition assessed by the MNA-SF is associated with 30-day mortality in older patients with AHF who were attended in EDs. Routine screening of risk of malnutrition may help emergency physicians in decision-making and establishing a care plan.
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Affiliation(s)
- Francisco Javier Martín-Sánchez
- Emergency Department, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria Hospital Clínico San Carlos (IdISSC), Madrid, Spain; Universidad Complutense de Madrid, Madrid, Spain; Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain.
| | - Federico Cuesta Triana
- Universidad Complutense de Madrid, Madrid, Spain; Department of Geriatric Medicine, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Xavier Rossello
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
| | | | - Guillermo Llopis García
- Emergency Department, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Francisca Caimari
- Department of Endocrinology, University College London, Hospitals NHS Foundation Trust, London, UK
| | - María Teresa Vidán
- Universidad Complutense de Madrid, Madrid, Spain; Department of Geriatric Medicine, Hospital General Universitario Gregorio Marañón, Instituto de Investigación IiSGM, Universidad Complutense de Madrid, Madrid, Spain
| | - Pedro Ruiz Artacho
- Department of Internal Medicine, Clínica Universitaria de Navarra, Madrid, Spain
| | - Juan González Del Castillo
- Emergency Department, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria Hospital Clínico San Carlos (IdISSC), Madrid, Spain; Universidad Complutense de Madrid, Madrid, Spain
| | - Pere Llorens
- Emergency Department-UCE-UHD, Hospital General Universitario de Alicante, Alicante, Spain
| | - Pablo Herrero
- Emergency Department, Hospital Central de Asturias, Oviedo, Asturias, Spain
| | - Javier Jacob
- Emergency Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Víctor Gil
- Emergency Department, Hospital Clínic, Institut de Recerca Biomédica August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
| | - Cristina Fernández Pérez
- Universidad Complutense de Madrid, Madrid, Spain; Preventive Department, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Pedro Gil
- Universidad Complutense de Madrid, Madrid, Spain; Department of Geriatric Medicine, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Héctor Bueno
- Universidad Complutense de Madrid, Madrid, Spain; Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; Department of Cardiology, Instituto de Investigación i+12, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Òscar Miró
- Emergency Department, Hospital Clínic, Institut de Recerca Biomédica August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
| | - Pilar Matía Martín
- Universidad Complutense de Madrid, Madrid, Spain; Department of Endocrinology and Nutrition, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Alex Roset
- Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Carles Ferrer
- Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Ferrán Llopis
- Hospital Universitari de Bellvitge, Barcelona, Spain
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Díez-Villanueva P, Arizá-Solé A, Vidán MT, Bonanad C, Formiga F, Sanchis J, Martín-Sánchez FJ, Ruiz Ros V, Sanmartín Fernández M, Bueno H, Martínez-Sellés M. Recomendaciones de la Sección de Cardiología Geriátrica de la Sociedad Española de Cardiología para la valoración de la fragilidad en el anciano con cardiopatía. Rev Esp Cardiol 2019. [DOI: 10.1016/j.recesp.2018.06.015] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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12
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Martín-Asenjo R, Bueno H, Vidán MT. [Anticoagulation in the elderly: is it all about guidelines or there room for the art of medicine?]. Rev Esp Geriatr Gerontol 2018; 53:314-316. [PMID: 30098832 DOI: 10.1016/j.regg.2018.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2018] [Revised: 07/03/2018] [Accepted: 07/05/2018] [Indexed: 06/08/2023]
Affiliation(s)
- Roberto Martín-Asenjo
- Servicio de Cardiología, Hospital Universitario 12 de Octubre, Madrid, España; Instituto de Investigación Sanitaria Hospital 12 de Octubre (i+12), Madrid, España.
| | - Héctor Bueno
- Servicio de Cardiología, Hospital Universitario 12 de Octubre, Madrid, España; Instituto de Investigación Sanitaria Hospital 12 de Octubre (i+12), Madrid, España; Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, España; Universidad Complutense de Madrid, Madrid, España
| | - María Teresa Vidán
- Universidad Complutense de Madrid, Madrid, España; Servicio de Geriatría, Hospital General Universitario Gregorio Marañón, Madrid, España
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Martín-Sánchez FJ, Díez-Villanueva P, Vidán MT. Authors' reply. Emergencias 2018; 30:363-364. [PMID: 30260131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- F Javier Martín-Sánchez
- Servicio de Urgencias, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria Hospital Clínico, Madrid, España
| | | | - María Teresa Vidán
- Servicio de Geriatría, Hospital General Universitario Gregorio Marañón,IisGM, Universidad Complutense de Madrid, CIBERFES (CIBER de Fragilidad y Envejecimiento Saludable), Madrid, España
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14
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Díez-Villanueva P, Arizá-Solé A, Vidán MT, Bonanad C, Formiga F, Sanchis J, Martín-Sánchez FJ, Ruiz Ros V, Sanmartín Fernández M, Bueno H, Martínez-Sellés M. Recommendations of the Geriatric Cardiology Section of the Spanish Society of Cardiology for the Assessment of Frailty in Elderly Patients With Heart Disease. ACTA ACUST UNITED AC 2018; 72:63-71. [PMID: 30269913 DOI: 10.1016/j.rec.2018.06.035] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 06/25/2018] [Indexed: 12/27/2022]
Abstract
Frailty is an age-associated clinical syndrome characterized by a decrease in physiological reserve in situations of stress, constituting a state of vulnerability that involves a higher risk of adverse events. Its prevalence in Spain is high, especially in elderly individuals with comorbidity and chronic diseases. In cardiovascular disease, frailty is associated worse clinical outcomes and higher morbidity and mortality in all scenarios, in both acute and chronic settings, and could consequently influence diagnosis and treatment. However, frailty is often not addressed or included when planning the management of elderly patients with heart disease. In this article, we review the available scientific evidence and highlight the most appropriate scales for the measurement and assessment of frailty, some of which are more useful and have better predictive capacity than others, depending on the clinical context. We also underline the importance of properly identifying and assessing frailty in order to include it in the treatment and care plan that best suits each patient.
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Affiliation(s)
| | - Albert Arizá-Solé
- Servicio de Cardiología, Área de Enfermedades del Corazón, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - María Teresa Vidán
- Servicio de Geriatría, Hospital General Universitario Gregorio Marañón (IiSGM), Universidad Complutense de Madrid, Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (CIBERFES), Madrid, Spain
| | - Clara Bonanad
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - Francesc Formiga
- Programa de Geriatría, Servicio de Medicina Interna, Instituto de Investigación Biomédica de Bellvitge (IDIBELL), Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Juan Sanchis
- Servei de Cardiologia, Hospital Clínic Universitari, INCLIVA, Universitat de València, Valencia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Valencia, Spain
| | - F Javier Martín-Sánchez
- Servicio de Urgencias, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria Hospital Clínico San Carlos (IdISSC), Universidad Complutense de Madrid, Madrid, Spain
| | - Vicente Ruiz Ros
- Servei de Cardiologia, Hospital Clínic Universitari, INCLIVA, Universitat de València, Valencia, Spain
| | | | - Héctor Bueno
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; Servicio de Cardiología, Hospital Universitario 12 de Octubre, Madrid, Spain; Instituto de Investigación Sanitaria Hospital 12 de Octubre (i+12), Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Manuel Martínez-Sellés
- Servicio de Cardiología, Hospital Universitario Gregorio Marañón, Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Universidad Complutense de Madrid, Universidad Europea de Madrid, Madrid, Spain
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15
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Martín-Sánchez FJ, Rodríguez-Adrada E, Vidán MT, Díez Villanueva P, Llopis García G, González Del Castillo J, Alberto Rizzi M, Alquézar A, Herrera Mateo S, Piñera P, Sánchez Nicolás JA, Lázaro Aragues P, Llorens P, Herrero P, Jacob J, Gil V, Fernández C, Bueno H, Miró Ò. Impact of geriatric assessment variables on 30-day mortality among older patients with acute heart failure. Emergencias 2018; 30:149-155. [PMID: 29687668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
OBJETIVE To study the impact of geriatric assessment variables on 30-day mortality among older patients with acute heart failure (AHF). METHODS Retrospective analysis of cases in the OAK Registry (Older Acute Heart Failure Key Data), a prospectively compiled database of consecutive patients aged 65 years or older treated for AHF in 3 Spanish emergency departments over a 4-month period (November-December 2011 and January-February 2014). The patients underwent a geriatric assessment adapted for emergency department use on weekdays between 8 AM and 10 PM. Demographic, clinical, laboratory, and geriatric assessment variables were recorded. The geriatric variables were concurrent diseases; polypharmacy; frailty; functional, social, and cognitive status at baseline; results of screening for confusional state, cognitive impairment, and depression; and nutritional status. The primary outcome was all-cause mortality at 30 days. RESULTS We included 565 patients with a mean (SD) age of 83 (7.1) years; 346 (61.6%) were women. Sixty-five (11.5%) died within 30 days. Independent factors associated with 30-day mortality were acute confusional state (adjusted odds ratio [aOR], 2.2; 95% CI, 1.0–4.8; P=.04), acute illness (aOR, 1.8; 95% CI, 0.9–3.4; P=.05), loss of appetite in the past 3 months (aOR, 1.8; 95% CI, 1.0–3.4; P=.04), frailty (aOR, 2.0, 95% CI, 1.0–4.1; P=.05), and severe disability (aOR, 4.4; 95% CI, 1.9–11.4; P=.01). CONCLUSIONS Certain geriatric variables should be considered when assessing short-term risk in older patients with AHF.
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Affiliation(s)
- Francisco Javier Martín-Sánchez
- Servicio de Urgencias, Hospital Clínico San Carlos, Madrid, España. Instituto de Investigación Sanitaria Hospital Clínico San Carlos (IdISSC), Universidad Complutense, Madrid, España
| | - Esther Rodríguez-Adrada
- Instituto de Investigación Sanitaria Hospital Clínico San Carlos (IdISSC), Universidad Complutense, Madrid, España
| | - María Teresa Vidán
- Servicio de Geriatría, Hospital Gregorio Marañón, Instituto de Investigación IiSGM, Universidad Complutense de Madrid, España
| | | | | | - Juan González Del Castillo
- Servicio de Urgencias, Hospital Clínico San Carlos, Madrid, España. Instituto de Investigación Sanitaria Hospital Clínico San Carlos (IdISSC), Universidad Complutense, Madrid, España
| | - Miguel Alberto Rizzi
- Servicio de Urgencias, Hospital de la Santa Creu i Sant Pau, Universidad Autónoma de Barcelona, España
| | - Aitor Alquézar
- Servicio de Urgencias, Hospital de la Santa Creu i Sant Pau, Universidad Autónoma de Barcelona, España
| | - Sergio Herrera Mateo
- Servicio de Urgencias, Hospital de la Santa Creu i Sant Pau, Universidad Autónoma de Barcelona, España
| | - Pascual Piñera
- Servicio de Urgencias, Hospital Reina Sofia, Murcia, España
| | | | | | - Pere Llorens
- Servicio de Urgencias, Hospital General de Alicante; Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIALFundación FISABIO), Universidad Miguel Hernández de Alicante, España
| | - Pablo Herrero
- Servicio de Urgencias, Hospital Central de Asturias, Oviedo, España
| | - Javier Jacob
- Servicio de Urgencias, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España
| | - Víctor Gil
- Área de Urgencias, Hospital Clínic, Institut de Recerca Biomédica August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, España
| | - Cristina Fernández
- Instituto de Investigación Sanitaria Hospital Clínico San Carlos (IdISSC), Universidad Complutense, Madrid, España. Servicio de Medicina Preventiva, Hospital Clínico San Carlos, Madrid, España
| | - Héctor Bueno
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid; Instituto de Investigación i+12, Servicio de Cardiología, Hospital Universitario 12 de Octubre, Madrid; Universidad Complutense de Madrid, España
| | - Òscar Miró
- Área de Urgencias, Hospital Clínic, Institut de Recerca Biomédica August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, España
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Vicent L, Ayesta A, Vidán MT, Miguel-Yanes JMD, García J, Tamargo M, Gómez V, Véliz S, Fernández-Avilés F, Martínez-Sellés M. [Profile of heart failure according to the department of admission. Implications for multidisciplinary management]. Rev Esp Geriatr Gerontol 2017; 52:182-187. [PMID: 28010940 DOI: 10.1016/j.regg.2016.11.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2016] [Revised: 11/06/2016] [Accepted: 11/08/2016] [Indexed: 06/06/2023]
Abstract
INTRODUCTION Population aging has led to notable changes in heart failure admissions. The aim of this study was to analyse the characteristics, comorbidity, management, and outcomes of this patient population in three hospital departments. METHODS An analysis was made of a prospective register that included all patients admitted due to heart failure in Internal Medicine, Cardiology, and Geriatrics over a period of 45 days. RESULTS Of a total of 235 patients, 124 (52.7%) were admitted to Internal Medicine, 83 (35.3%) to Cardiology, and 28 (11.9%) to Geriatrics. Mean age was 77.0±20.2 years (Cardiology 71.5±13.5; Internal Medicine 79.2±21.1; Geriatrics 89.9±5.1; p<.001). Preserved ejection fraction was found in 121 (51.5%) patients, and this rate was higher in Internal Medicine (62.5%) and Geriatrics (70.0%) than in Cardiology (31.3%), p<.001. Comorbidity was frequent, especially atrial fibrillation (126; 53.6%), renal disease (89; 37.8%), and chronic obstructive pulmonary disease (65; 27.6%). Infections were the most common decompensating trigger in Internal Medicine (56; 45.2%), and there was often no trigger in Cardiology (45; 54.2%) and Geriatrics (14; 50.0%), p<.0001. The use of renin-angiotensin system inhibitors, beta-blockers, and spironolactone in patients with systolic dysfunction was higher in Cardiology. During the 45 days follow-up, 23 patients (9.9%) were readmitted, which was more frequent in Internal Medicine than in Cardiology (odds ratio 3.0 [95% confidence interval: 1.1 - 8.6], p=.03), with no other significant comparisons. CONCLUSIONS Patients admitted due to decompensated heart failure are elderly and often have comorbidities. There are major differences between departments as regards age and clinical profile.
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Affiliation(s)
- Lourdes Vicent
- Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Madrid, España. Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, España
| | - Ana Ayesta
- Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Madrid, España. Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, España
| | - María Teresa Vidán
- Servicio de Geriatría, Hospital General Universitario Gregorio Marañón, Madrid, España; Facultad de Medicina, Universidad Complutense, Madrid, España
| | | | - Jorge García
- Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Madrid, España. Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, España
| | - María Tamargo
- Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Madrid, España. Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, España
| | - Víctor Gómez
- Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Madrid, España. Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, España
| | - Samuel Véliz
- Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Madrid, España. Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, España
| | - Francisco Fernández-Avilés
- Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Madrid, España. Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, España; Facultad de Medicina, Universidad Complutense, Madrid, España
| | - Manuel Martínez-Sellés
- Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Madrid, España. Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, España; Facultad de Medicina, Universidad Complutense, Madrid, España; Facultad de Ciencias Biomédicas y de la Salud, Universidad Europea, Madrid, España.
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Martínez-Sellés M, Ariza-Solé A, Vidán MT, Formiga F. [Cardiogeriatrics: What do the current guidelines say about the elderly patient?]. Rev Esp Geriatr Gerontol 2017; 52:115-118. [PMID: 28222942 DOI: 10.1016/j.regg.2016.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2016] [Accepted: 12/12/2016] [Indexed: 06/06/2023]
Affiliation(s)
- Manuel Martínez-Sellés
- Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Universidad Complutense, Madrid, España; Universidad Europea, Madrid, España
| | - Albert Ariza-Solé
- Servicio de Cardiología, Hospital de Bellvitge, IDIBELL, L'Hospitalet de Llobregat (Barcelona), España
| | - María Teresa Vidán
- Servicio de Geriatría, Hospital General Universitario Gregorio Marañón, Universidad Complutense, Madrid, España. CIBER de Fragilidad y Envejecimiento Saludable (CIBERFES)
| | - Francesc Formiga
- Programa de Geriatría, Servicio de Medicina Interna, IDIBELL, Hospital de Bellvitge, L'Hospitalet de Llobregat (Barcelona), España.
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Martín‐Sánchez FJ, Rodríguez‐Adrada E, Mueller C, Vidán MT, Christ M, Frank Peacock W, Rizzi MA, Alquezar A, Piñera P, Aragues PL, Llorens P, Herrero P, Jacob J, Fernández C, Miró Ò. The Effect of Frailty on 30-day Mortality Risk in Older Patients With Acute Heart Failure Attended in the Emergency Department. Acad Emerg Med 2017; 24:298-307. [PMID: 27797432 DOI: 10.1111/acem.13124] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Revised: 10/14/2016] [Accepted: 10/17/2016] [Indexed: 12/18/2022]
Abstract
OBJECTIVE The objective was to determine the effect of frailty on risk of 30-day mortality in nonseverely disabled older patients with acute heart failure (AHF) attended in emergency departments (EDs). METHODOLOGY The Frailty-AHF Study is a retrospective analysis of a multicenter, observational, prospective, cohort study (Older-AHF Register). This study included consecutive patients ≥ 65 years of age without severe functional dependence or dementia attended for AHF in three Spanish EDs for 4 months. Frailty was defined by frailty phenotype as the presence of three or more domains. Baseline and episode characteristics and 30-day mortality were collected in all the patients. RESULTS A total of 465 patients with a mean (±SD) age of 82 (±7) years were included, 283 (61.0%) being female and 225 (51.3%) with severe comorbidity (Charlson index ≥ 3). Frailty was present in 169 (36.3%). The rate of 30-day mortality was 7.3%. Frailty adjusted for potential confounding factors was an independent factor associated with 30-day mortality (adjusted hazard ratio = 2.5; 95% confidence interval = 1.0 to 6.0; p = 0.047). CONCLUSION The presence of frailty is an independent risk factor of 30-day mortality in nonsevere dependent older patients attended with AHF in EDs.
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Affiliation(s)
- Francisco Javier Martín‐Sánchez
- Emergency Department Hospital Clínico San Carlos Instituto de Investigación Sanitaria Hospital Clínico San Carlos (IdISSC) Madrid Spain
| | - Esther Rodríguez‐Adrada
- Emergency Department Hospital Clínico San Carlos Instituto de Investigación Sanitaria Hospital Clínico San Carlos (IdISSC) Madrid Spain
| | - Christian Mueller
- Department of Cardiology and Cardiovascular Research Institute Basel University Hospital Basel Basel Switzerland
| | - María Teresa Vidán
- Department of Geriatric Medicine Hospital General Universitario Gregorio Marañón Instituto de Investigación IiSGM Universidad Complutense de Madrid Madrid Spain
| | - Michael Christ
- Department of Emergency and Critical Care Medicine Paracelsus Medical University Nürnberg Germany
| | - W. Frank Peacock
- Department of Emergency Medicine Baylor College of Medicine Houston TX
| | - Miguel Alberto Rizzi
- Emergency Department Hospital de la Santa Creu i Sant Pau Universidad Autónoma de Barcelona Barcelona Spain
| | - Aitor Alquezar
- Emergency Department Hospital de la Santa Creu i Sant Pau Universidad Autónoma de Barcelona Barcelona Spain
| | | | | | - Pere Llorens
- Emergency Department Short Unit Stay and Hospital at Home Hospital General de Alicante Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL‐Fundación FISABIO) Universidad Miguel Hernández Alicante Alicante Spain
| | - Pablo Herrero
- Emergency Department Hospital Central de Asturias Oviedo Asturias Spain
| | - Javier Jacob
- Emergency Department Hospital Universitari de Bellvitge L'Hospitalet de Llobregat Barcelona Spain
| | - Cristina Fernández
- Department of Preventive Medicine Hospital Clínico San Carlos Instituto de Investigación Sanitaria Hospital Clínico San Carlos (IdISSC) Universidad Complutense de Madrid Madrid Spain
| | - Òscar Miró
- Emergency Department Hospital Clínic, and Institut de Recerca Biomàdica August Pi i Sunyer (IDIBAPS) Barcelona CataloniaSpain
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Formiga F, Vidán MT, Ariza-Solé A, Martínez-Sellés M. Reflections on the Importance of Frailty in the Assessment of Cardiovascular Risk in the Elderly. Rev Esp Cardiol (Engl Ed) 2016; 69:1008-1010. [PMID: 27426969 DOI: 10.1016/j.rec.2016.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Accepted: 05/05/2016] [Indexed: 06/06/2023]
Affiliation(s)
- Francesc Formiga
- Programa de Geriatría, Servicio de Medicina Interna, Instituto de Investigación Biomédica de Bellvitge (IDIBELL), Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain.
| | - María Teresa Vidán
- Servicio de Geriatría, Hospital General Universitario Gregorio Marañón, Universidad Complutense, Madrid, Spain
| | - Albert Ariza-Solé
- Servicio de Cardiología, Instituto de Investigación Biomédica de Bellvitge (IDIBELL), Hospital Universitari de Bellvitge, ĹHospitalet de Llobregat, Barcelona, Spain
| | - Manuel Martínez-Sellés
- Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Universidad Complutense and Universidad Europea, Madrid, Spain
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Martínez-Sellés M, Gómez Huelgas R, Abu-Assi E, Calderón A, Vidán MT. Chronic Ischemic Heart Disease in the Elderly. Consensus Document of the Spanish Societies of Cardiology, Internal Medicine, Primary Care, and Geriatrics. Rev Esp Cardiol (Engl Ed) 2016; 69:710-711. [PMID: 27267382 DOI: 10.1016/j.rec.2016.02.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Accepted: 02/25/2016] [Indexed: 06/06/2023]
Affiliation(s)
- Manuel Martínez-Sellés
- Sociedad Española de Cardiología (SEC), Sección de Cardiología Geriátrica, Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Universidad Europea y Universidad Complutense, Madrid, Spain.
| | - Ricardo Gómez Huelgas
- Sociedad Española de Medicina Interna (SEMI), Departamento de Medicina Interna, Hospital Universitario Regional de Málaga, FIMABIS, Málaga, Spain
| | - Emad Abu-Assi
- Sociedad Española de Cardiología (SEC), Sección de Cardiopatía Isquémica y Cuidados Agudos Cardiovasculares, Servicio de Cardiología, Hospital Clínico Universitario Álvaro Cunqueiro, Vigo, Pontevedra, Spain
| | - Alberto Calderón
- Sociedad Española de Médicos de Atención Primaria (SEMERGEN), Centro de Salud Rosa Luxemburgo, San Sebastián de los Reyes, Madrid, Spain
| | - María Teresa Vidán
- Sociedad Española de Geriatría y Gerontología, Servicio de Geriatría, Hospital General Universitario Gregorio Marañón, Universidad Complutense, Madrid, Spain
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Martínez-Sellés M, Gómez Huelgas R, Abu-Assi E, Calderón A, Vidán MT. [Chronic ischaemic heart disease in the elderly]. Rev Esp Geriatr Gerontol 2016; 51:170-179. [PMID: 27102136 DOI: 10.1016/j.regg.2016.01.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Accepted: 01/21/2016] [Indexed: 06/05/2023]
Abstract
It is the aim of this manuscript to take into account the peculiarities and specific characteristics of elderly patients with chronic ischaemic heart disease from a multidisciplinary perspective, with the participation of the Spanish Society of Cardiology (sections of Geriatric Cardiology and Ischaemic Heart Disease/Acute Cardiovascular Care), the Spanish Society of Internal Medicine, the Spanish Society of Primary Care Physicians and the Spanish Society of Geriatrics and Gerontology. This consensus document shows that in order to adequately address these elderly patients a comprehensive assessment is needed, which includes comorbidity, frailty, functional status, polypharmacy and drug interactions. We conclude that in most patients medical treatment is the best option and that this treatment must take into account the above factors and the biological changes associated with aging.
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Affiliation(s)
- Manuel Martínez-Sellés
- Sociedad Española de Cardiología (SEC), Sección de Cardiología Geriátrica, Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Universidad Europea y Universidad Complutense, Madrid, España.
| | - Ricardo Gómez Huelgas
- Sociedad Española de Medicina Interna (SEMI), Departamento de Medicina Interna, Hospital Universitario Regional de Málaga, Fundación Pública Andaluza para la Investigación de Málaga en Biomedicina y Salud (FIMABIS), Málaga, España
| | - Emad Abu-Assi
- Sociedad Española de Cardiología (SEC), Sección de Cardiopatía Isquémica y Cuidados Agudos Cardiovasculares, Servicio de Cardiología y Unidad Coronaria, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, España
| | - Alberto Calderón
- Sociedad Española de Médicos de Atención Primaria (SEMERGEN), Centro de Salud Rosa Luxemburgo, San Sebastián de los Reyes, Madrid, España
| | - María Teresa Vidán
- Sociedad Española de Geriatría y Gerontología (SEGG), Servicio de Geriatría, Hospital General Universitario Gregorio Marañón, Universidad Complutense, Madrid, España
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Martínez-Sellés M, Gómez Huelgas R, Abu-Assi E, Calderón A, Vidán MT. Cardiopatía isquémica crónica en el anciano. Med Clin (Barc) 2016; 146:372.e1-372.e10. [DOI: 10.1016/j.medcli.2016.01.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Revised: 01/14/2016] [Accepted: 01/21/2016] [Indexed: 12/12/2022]
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Martínez-Sellés M, Massó-van Roessel A, Álvarez-García J, García de la Villa B, Cruz-Jentoft AJ, Vidán MT, López Díaz J, Felix Redondo FJ, Durán Guerrero JM, Bayes-Genis A, Bayes de Luna A. Interatrial block and atrial arrhythmias in centenarians: Prevalence, associations, and clinical implications. Heart Rhythm 2016; 13:645-51. [PMID: 26520207 DOI: 10.1016/j.hrthm.2015.10.034] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Indexed: 12/18/2022]
Abstract
BACKGROUND Data are lacking on the characteristics of atrial activity in centenarians, including interatrial block (IAB). OBJECTIVE The aim of this study was to describe the prevalence of IAB and auricular arrhythmias in subjects older than 100 years and to elucidate their clinical implications. METHODS We studied 80 centenarians (mean age 101.4 ± 1.5 years; 21 men) with follow-ups of 6-34 months. Of these 80 centenarians, 71 subjects (88.8%) underwent echocardiography. The control group comprised 269 septuagenarians. RESULTS A total of 23 subjects (28.8%) had normal P wave, 16 (20%) had partial IAB, 21 (26%) had advanced IAB, and 20 (25.0%) had atrial fibrillation/flutter. The IAB groups exhibited premature atrial beats more frequently than did the normal P wave group (35.1% vs 17.4%; P < .001); also, other measurements in the IAB groups frequently fell between values observed in the normal P wave and the atrial fibrillation/flutter groups. These measurements included sex preponderance, mental status and dementia, perceived health status, significant mitral regurgitation, and mortality. The IAB group had a higher previous stroke rate (24.3%) than did other groups. Compared with septuagenarians, centenarians less frequently presented a normal P wave (28.8% vs 53.5%) and more frequently presented advanced IAB (26.3% vs 8.2%), atrial fibrillation/flutter (25.0% vs 10.0%), and premature atrial beats (28.3 vs 7.0%) (P < .01). CONCLUSION Relatively few centenarians (<30%) had a normal P wave, and nearly half had IAB. Our data suggested that IAB, particularly advanced IAB, is a pre-atrial fibrillation condition associated with premature atrial beats. Atrial arrhythmias and IAB occurred more frequently in centenarians than in septuagenarians.
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Affiliation(s)
- Manuel Martínez-Sellés
- Hospital General Universitario Gregorio Marañón y Universidad Europea y Universidad Complutense, Madrid, Spain.
| | | | - Jesús Álvarez-García
- Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | | | - María Teresa Vidán
- Hospital General Universitario Gregorio Marañón, Universidad Complutense, Madrid, Spain
| | | | | | | | - Antoni Bayes-Genis
- Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Barcelona, Spain
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Datino T, Rexach L, Vidán MT, Alonso A, Gándara Á, Ruiz-García J, Fontecha B, Martínez-Sellés M. [Guidelines on the management of implantable cardioverter defibrillators at the end of life]. Rev Esp Geriatr Gerontol 2013; 49:29-34. [PMID: 24331838 DOI: 10.1016/j.regg.2013.09.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Accepted: 09/16/2013] [Indexed: 11/17/2022]
Abstract
This article is a joint document of the Spanish Society of Geriatrics and Gerontology, the Spanish Society of Palliative Care and the Section of Geriatric Cardiology of the Spanish Society of Cardiology. Its aim is to address the huge gap that exists in Spain with regard to the management of implantable cardioverter defibrillators (ICDs) in the final stages of life. It is increasingly common to find patients carrying these devices that are in the terminal stage of an advanced disease. This occurs in patients with advanced heart disease and subsequent heart failure refractory to treatment but also in a patient with an ICD who develops cancer disease, organ failure or other neurodegenerative diseases with poor short-term prognosis. The vast majority of these patients are over 65, so the paper focuses particularly on the elderly who are in this situation, but the decision-making process is similar in younger patients with ICDs who are in the final phase of their life.
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Affiliation(s)
- T Datino
- Unidad de Arritmias y Electrofisiología, Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - L Rexach
- Unidad de Cuidados Paliativos, Hospital Universitario Ramón y Cajal, Madrid, España
| | - M T Vidán
- Servicio de Geriatría, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - A Alonso
- Unidad de Cuidados Paliativos, Hospital Universitario La Paz, Madrid, España
| | - Á Gándara
- Unidad del Dolor y Cuidados Paliativos, Clínica Ruber, Madrid, España
| | - J Ruiz-García
- Servicio de Cardiología, Hospital Universitario La Paz, Madrid, España
| | - B Fontecha
- Servicio de Geriatría y Cuidados Paliativos, Consorci Sanitari Integral L'Hospitalet de Llobregat, Barcelona, España
| | - M Martínez-Sellés
- Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Madrid, España; Universidad Europea de Madrid, Madrid, España.
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Vidán MT. [Research into health care models in geriatrics: proposals for the future]. Rev Esp Geriatr Gerontol 2010; 45:311-3. [PMID: 21075487 DOI: 10.1016/j.regg.2010.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2010] [Accepted: 07/11/2010] [Indexed: 11/24/2022]
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Martínez-Sellés M, Teresa Vidán M, López-Palop R, Rexach L, Sánchez E, Datino T, Cornide M, Carrillo P, Ribera JM, Díaz-Castro Ó, Bañuelos C. El anciano con cardiopatía terminal. Rev Esp Cardiol 2009. [DOI: 10.1016/s0300-8932(09)70898-x] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Martínez-Sellés M, Teresa Vidán M, López-Palop R, Rexach L, Sánchez E, Datino T, Cornide M, Carrillo P, Ribera JM, Díaz-Castro Ó, Bañuelos C. End-Stage Heart Disease in the Elderly. ACTA ACUST UNITED AC 2009; 62:409-21. [DOI: 10.1016/s1885-5857(09)71668-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Abstract
This case report describes an atypical case of duodenal leishmaniasis in an elderly patient not infected with human immunodeficiency virus. Investigation of this 84 year old woman with a constitutional syndrome and dysphagia revealed anaemia of chronic disorder, a high erythrocyte sedimentation rate, and polyclonal hypergammaglobulinaemia. Abdominal ultrasonography revealed thickening of the stomach wall, which was seen to be inflamed during gastroscopy. Duodenal histology revealed numerous leishmania amastigotes within macrophages. This was confirmed by bone marrow biopsy and leishmania serology. This case report stresses the importance of atypical symptoms and the unusual location of visceral leishmaniasis, not only in immunodepressed patients, but also in elderly immunocompetent patients.
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Affiliation(s)
- M L Alvarez-Nebreda
- Geriatrics Department, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain.
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Fernández-Gutiérrez B, Jover JA, De Miguel S, Hernández-García C, Vidán MT, Ribera JM, Bañares A, Serra JA. Early lymphocyte activation in elderly humans: impaired T and T-dependent B cell responses. Exp Gerontol 1999; 34:217-29. [PMID: 10363788 DOI: 10.1016/s0531-5565(98)00068-0] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Immunosenescence is characterized by an increase in autoantibody production. Because both T and B cell stimulation are key events for producing antibodies, we investigated early T and B cell activation by means of CD23 and CD40L (two very early activation antigens). PBMC from elderly humans (EH) were studied following culture with either medium, anti-CD3mAb, rIL-4, or PMA + ionomycin. CD23 expression on elderly B cells after anti-CD3 challenge of PBMC, a reflect of T-dependent B cell activation, was clearly defective. Conversely, CD23 expression on EH B cells following activation with soluble factors as rIL-4 was preserved. CD40L expression was also impaired in EH T cells following anti-CD3 challenge. However, activation by means of PMA and/or ionomycin was preserved both in T cells (CD40L expression) and in B cells (CD23 expression). These results indicate that a defective T-dependent B cell activation related to defective T cell activation located between surface membrane and PKC/ionomycin function is an intrinsic characteristic of immunosenescence. We have not found intrinsic B-cell defects, and we conclude that the characteristically impaired early B cell activation in EH is mostly due to T cell defects.
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Vidán MT, Fernández-Gutiérrez B, Hernández-García C, Serra JA, Ribera JM, Pérez-Blas M, Regueiro JR, Bañares A, Jover JA. Functional integrity of the CD28 co-stimulatory pathway in T lymphocytes from elderly subjects. Age Ageing 1999; 28:221-7. [PMID: 10350423 DOI: 10.1093/ageing/28.2.221] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION the antigen CD28, expressed in most T cells, has co-stimulatory properties and plays a pivotal role in clonal T cell anergy mechanisms. METHODS we have compared proliferative T cell responses after anti-CD3 or in phorbol myristate acetate activation with concomitant CD28 signal in peripheral blood mononuclear cells from healthy donors aged over 65 [elderly donors; ED] and young healthy donors (YD); mean age 30+/-2.7 years). RESULTS no proliferative responses were observed in ED and YD with anti-CD28 monoclonal antibody alone. These responses both were defective in ED, particularly after anti-CD3 monoclonal antibody stimulus (7604 compared with 12,438 c.p.m. in YD, P=0.001) and were corrected when anti-CD28 monoclonal antibody was added to the culture (17,216 vs 18,536, not significant). Functional integrity of the CD28 co-stimulatory pathway was demonstrated by analysis of CD25 expression, interleukin-2 secretion and interleukin-2 gene expression on T cells from ED and YD. Age-associated phenotypic T cell changes were not crucial for an adequate CD28 response. CONCLUSION these experiments demonstrate the integrity of the CD28 pathway in elderly people, and suggest that ageing does not affect different T cell activation pathways equally.
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Affiliation(s)
- M T Vidán
- Services of Geriatrics, Hospital Clínico San Carlos, Madrid, Spain
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Abstract
BACKGROUND Sex seems to affect the course of acute myocardial infarction (AMI) in the general population. Although the epidemiological importance of female sex among patients with AMI is more important from the sixth decade of life, little is known about the impact of sex on the outcome of AMI in the elderly. METHODS AND RESULTS To determine the differences between sexes in the outcome of AMI in the elderly, we compared the clinical history and evolution of 204 consecutive patients (99 men, 105 women) > or = 75 years of age admitted with a first AMI. Women had a higher prevalence (P < .01) of hypertension (60% versus 32%) and diabetes (41% versus 18%), whereas men were more frequently smokers (41% versus 4%, P < .0001); these factors were associated with higher rates of congestive heart failure. Women showed lower ejection fractions and higher rates of congestive heart failure (odds ratio [OR], 2.32; 95% CI, 1.32 to 4.12) and shock (OR, 2.78; 95% CI, 1.29 to 6.40). Mortality rate was higher in women (40% versus 23%, P = .01; OR, 2.29; 95% CI, 1.26 to 4.26); however, sex was excluded as an independent predictor of in-hospital mortality in every regression model tested (OR, 0.75; 95% CI, 0.25 to 2.21). CONCLUSIONS After a first AMI, elderly women experience a more complicated hospital course than men. The increase in mortality risk seems to be related to the impact of cardiovascular risk factors on left ventricular function more than to sex itself.
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Affiliation(s)
- H Bueno
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
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