Application of machine learning in predicting frailty syndrome in patients with heart failure

Prevention and diagnosis of frailty syndrome (FS) in patients with heart failure (HF) require innovative systems to help medical personnel tailor and optimize their treatment and care. Traditional methods of diagnosing FS in patients could be more satisfactory. Healthcare personnel in clinical settings use a combination of tests and self-reporting to diagnose patients and those at risk of frailty, which is time-consuming and costly. Modern medicine uses artificial intelligence (AI) to study the physical and psychosocial domains of frailty in cardiac patients with HF. This paper aims to present the potential of using the AI approach, emphasizing machine learning (ML) in predicting frailty in patients with HF. Our team reviewed the literature on ML applications for FS and reviewed frailty measurements applied to modern clinical practice. Our approach analysis resulted in recommendations of ML algorithms for predicting frailty in patients. We also present the exemplary application of ML for FS in patients with HF based on the Tilburg Frailty Indicator (TFI) questionnaire, taking into account psychosocial variables.

The Impact of Rationing Nursing Care on Patient Safety: A Systematic Review

BACKGROUND Rationing of nursing care (RONC) has been associated with poor patient outcomes and is a growing concern in healthcare. The aim of this systematic study was to investigate the connection between patient safety and the RONC. MATERIAL AND METHODS A thorough search of electronic databases was done to find research that examined the relationship between restricting nurse services and patient safety. The systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Two reviewers (M.L. and A.P.) independently screened the titles and abstracts, and full-text articles were assessed for eligibility. Data were extracted, and a quality assessment was performed using appropriate techniques. RESULTS A total of 15 studies met the inclusion criteria. The studies included in the review demonstrated a correlation between rationing of nursing care and patient safety. The results of these studies revealed that there is an inverse relationship between rationing of nursing care and patient safety. The review found that when nursing care is rationed, there is a higher incidence of falls, medication errors, pressure ulcers, infections, and readmissions. In addition, the review identified that the work characteristics of nurses, such as workload, staffing levels, and experience, were associated with RONC. CONCLUSIONS RONC has a negative impact on patient safety outcomes. It is essential for healthcare organizations to implement effective strategies to prevent the RONC. Improving staffing levels, workload management, and communication amo0ng healthcare providers are some of the strategies that can support this.

A patient with heart failure, who is frail: How does this affect therapeutic decisions?

Patients with heart failure (HF) are heterogeneous, not only related to comorbidities but also in the presentation of frailty syndrome. Frailty syndrome also affects patients with HF across the lifespan. Frailty in patients with HF has a significant impact on clinical features, diagnosis, management, adverse medical outcomes and costs. In everyday clinical practice, frail patients with HF require an individualized approach, often imposing the need to modify therapeutic decisions. The aim of this review is to illustrate how frailty and multimorbidity in HF can affect therapeutic decisions. The scientific evidence underlying this publication was obtained from an analysis of papers indexed in the PubMed database. The search was limited to articles published between 1990 and July 2022. The search was limited to full-text papers published in English. The database was searched for relevant MeSH phrases and their combinations and keywords including: "elderly, frail"; "frailty, elderly"; "frail older adults"; "frailty, older adults"; "adult, frail older"; "frailty, heart failure"; "frailty, multimorbidity"; "multimorbidity, heart failure"; "multimorbidity, elderly"; "older adults, cardiovascular diseases". In therapeutic decisions regarding patients with HF, additionally burdened with multimorbidity and frailty, it becomes necessary to individualize the approach in relation to optimization and treatment of coexisting diseases, frailty assessment, pharmacological and non-pharmacological treatment and in the implementation of invasive procedures in the form of implantable devices or cardiac surgery.

The concurrent impact of mild cognitive impairment and frailty syndrome in heart failure

Pathological processes associated with ageing increase the risk of cognitive deficits and dementia. Frailty syndrome, also known as weakness or reserve depletion syndrome, may significantly accelerate these pathological processes in the elderly population. Frailty syndrome is characterized by decreased physiological function and neuropsychiatric symptoms, including cognitive decline and depressive states. In people with cardiovascular disease, the risk of frailty is 3 times higher. Frailty syndrome is particularly prevalent in severe heart failure, which increases the risk of mortality, increases hospital readmission, and reduces patients' quality of life. In addition, co-occurrence of cognitive impairment and frailty syndrome significantly increases the risk of dementia and other adverse outcomes, including mortality, in the heart failure population.

Digital health and modern technologies applied in patients with heart failure: Can we support patients’ psychosocial well-being?

Despite advances in the treatment of heart failure (HF), the physical symptoms and stress of the disease continue to negatively impact patients’ health outcomes. Technology now offers promising ways to integrate personalized support from health care professionals via a variety of platforms. Digital health technology solutions using mobile devices or those that allow remote patient monitoring are potentially more cost effective and may replace in-person interaction. Notably, digital health methods may not only improve clinical outcomes but may also improve the psycho-social status of HF patients. Using digital health to address biopsychosocial variables, including elements of the person and their context is valuable when considering chronic illness and HF in particular, given the multiple, cross-level factors affecting chronic illness clinical management needed for HF self-care.

Nutritional Status among patients with Heart Failure and Thyroid Diseases - Result of Nutritional Status Heart Study (NSHS)

Funding Acknowledgements

Type of funding sources: Other. Main funding source(s): Wroclaw Medical University

Background

Nutritional status is related to the prognosis and the length of hospitalization of individuals with heart failure. The effects of thyroid dysfunction in patients with pre-existing heart failure and nutritional status have not been adequately studied.

Purpose

This study aims to assess how nutritional status affects thyroid disease in patients with heart failure.

Methods

We performed a retrospective study and analysis of medical records of 1056 patients admitted to the cardiology department of our University Clinical Hospital between September 2017 and September 2020 due to acute heart failure (HF) (ICD10: I50). We analyzed all the patients who met the inclusion criteria (diagnosis of HF, age ≥18 years old). A final group of 1056 patients’ medical records was analyzed. The analysis included data such as age, gender, patients’ body mass index (BMI), and laboratory results such as total data on past and comorbid disease units and assessment of the nutritional status of the patient via the NRS-2002. Our study was approved by the independent Bioethics Committee of the Wroclaw Medical University (decision no. KB–590/2020). Statistical analysis was performed using Statistica 13.1 (StatSoft, Inc., Tulsa, OK, USA). The results were considered statistically significant at p<0.05

Results

A total of 1056 individuals were included in the analysis. It included more men than women (66,7%) Due to a lack of data for some parameters, those numbers are smaller and are provided for each variable. More than 76% of participants were overweight or obese. 4.3% of patients were in risk of malnutrition. Thyroid disease registered in 15.1% of patients (Hyperthyroidism – 5.3% and Hypothyroidism 9.8%)

Based on BMI, four groups were distinguished: <18.5, 18.5–24.9, 25.0–29.9, and ≥30 The occurrence of Hyperthyroidism was more frequently observed in the group of overweight patients (p=0,02) (table 1).

Based on NRS2002, two groups were distinguished: <3 and ≥3. In the group with risk of malnutrition (NRS ≥3) patients had a mean statistically significant higher FT4 (<0.001) than the group with no risk of malnutrition (NRS <3) ( x̅ : 2,02 ng/dl vs x̅ : 1.35 ng/dl, p<0.001). Additionally, lower scores of FT3 were observed in the group NRS ≥3 (x̅ : 1.91 ng/dl, p<0.001) (table2).

Conclusion

This study shows that patients with thyroid disease and heart failure were often overweight and obese. The risk of malnutrition status correlates with a lower result of FT3 and the highest FT4. Undoubtedly, those phenomena require further research.

Relationship between multimorbidity and prevalence of frailty syndrome in patients qualified for elective cardiac surgery

Funding Acknowledgements

Type of funding sources: None.

Intorduction

Frailty syndrome (FS) and multimorbidity are closely related but separate constructs that are associated with higher risk of death, higher rehospitalization rates, disability, and reduced quality of life. Identification of multimorbidity and FS in the cardiac surgery patient population appears to be important in terms of the qualification process, incidence of perioperative risk, and optimization of patient status before the cardiac surgery procedure.

Purpose

Analysis of the relationship between multimorbidity and FS in patients qualified for elective cardiac surgery.

Methods

The study included 100 patients ≥ 65 years of age (40 women and 60 men, mean age M±SD =71.69±4). The study included elderly patients qualified for elective cardiac surgery (coronary artery bypass grafting, valvular surgery or combined surgery). In the study group frailty was identified with the use of standardized research tools including those for one-dimensional and multidimensional assessment (FRAIL scale, Frailty Phenotype, 5-meter gaid speed, Tilburg Frailty Indicator, Tilburg Frailty Indicator - TFI). The presence of more than 3 chronic diseases was considered as multimorbidity. A significance level of 0.05 was assumed in the analysis, so all p<0.05 values were interpreted as indicating significant relationships.

Results

Multimorbidity was reported in 88% of patients qualified for cardiac surgery. The prevalence of FS varied according to the screening tool used.Based on FRAIL was reported in 27% of patients, based on Frailty Phenotype in 17% of patients, based on 5-meter gaid speed in 43% of patients, and based on TFI in 63% of patients. In patients with multimorbidity FS was significantly more frequent than in patients without frailty syndrome, which was confirmed by FRAIL (96.3% vs. 60.0%; p-=0.003) and TFI questionnaire (95.2% vs. 75.7%; p=0.008) scores.

Conclusions

1. Most elderly patients qualified for elective cardiac surgery procedures are characterized by multimorbidity. 2 Multimorbidity is associated with a higher prevalence of FS in both unidimensional and multidimensional assessment. 3 This phenomenon requires further study, especially with regard to the occurrence of outcomes in this patient population.

The Association between Nutritional Status and Length of Hospital Stay among Patients with Hypertension

Background: Nutritional status is related to the prognosis and length of hospital stay (LOS) of patients with hypertension (HT). This study aimed to assess how nutritional status and body mass index (BMI) affect LOS for patients with hypertension. Method: We performed a retrospective analysis of 586 medical records of patients who had been admitted to the Institute of Heart Diseases of the University Clinical Hospital in Wroclaw, Poland. Results: A total of 586 individuals were included in the analysis. Individuals who were at a nutritional risk represented less than 2% of the study population, but more than 60% were overweight or obese. The mean BMI was 28.4 kg/m² (SD: 5.16). LOS averaged 3.53 days (SD = 2.78). In the case of obese individuals, hospitalisation lasted for 3.4 ± 2.43 days, which was significantly longer than for patients of normal weight. For underweight patients, hospitalisation lasted for 5.14 ± 2.27 days, which was also significantly longer than for those in other BMI categories (p = 0.017). The independent predictors of shorter hospitalisations involved higher LDL concentration (parameter of regression: −0.015) and HDL concentration (parameter of regression: −0.04). Conclusions: The study revealed that with regard to the nutritional status of hypertensive patients, being either underweight or obese was associated with longer LOS. Additional factors that related to prolonged LOS were lower LDL and HDL levels and higher CRP concentrations.

Frailty Syndrome in Older Adults with Cardiovascular Diseases-What Do We Know and What Requires Further Research?

Cardiovascular diseases (CVD) affect 60% of people over 60 years of age and are one of the main causes of death in the world. Diagnosed cardiovascular disease also triples the likelihood of Frailty syndrome (FS). FS has become increasingly relevant in cardiology and cardiac surgery and occurs in a significant number of patients with CVD, with prevalence ranging from 25% to 62%. Viewed in a multidimensional, biopsychosocial perspective, FS increases a patient's vulnerability, making them susceptible to several adverse clinical outcomes. Frailty syndrome also is a predictor of mortality in patients with CVD regardless of age, severity of disease, multi-morbidity, and disability. Frailty syndrome potentially can be prevented in patients with CVD and its early identification is important to avoid the development of disability, dependence on others and reduced quality of life. The aim of this paper is to show the relationship between FS and specific CVDs (coronary artery disease, hypertension, atrial fibrillation, heart failure) and cardiac procedures (device implantation, cardiac surgery, and transcatheter aortic valve implantation). Furthermore, we highlight those areas that require further research to fully understand the relationship between FS and CVD and to be able to minimize or prevent its adverse effects.

A Simple Risk Score Based on Routine Clinical Parameters Can Predict Frailty in Hospitalized Heart Failure Patients

Frailty syndrome (FS) has recently attracted attention as one of the major predictors of heart failure (HF) course severity. We aimed to develop a simple tool for predicting frailty in hospitalized HF patients using routine clinical parameters. A total of 153 hospitalized patients diagnosed with heart failure with reduced ejection fraction (HFrEF) were included in the study. Presence of FS was assessed with the SHARE-FI questionnaire. Clinical and biochemical parameters were collected. Using ROC curves and logistic regression analysis, a model predicting FS presence was developed and tested. Proposed model includes five variables with following cut-off values (1 point for each variable): age > 50 years, systolic pressure on admission < 110 mmHg, total cholesterol < 4.85 mmol/L, bilirubin ≥ 15.5 mmol/L, and alanine aminotransferase ≤ 34 U/L. Receiving 5 points was considered a high risk of FS with positive and negative predictive values (NPV), 83% and 72%, respectively, and specificity of 97%. Awarding 2 points or less ruled out FS in the studied group with negative predictive value 94%. The presented novel, simple score predicts FS in HFrEF patients with routine clinical parameters and has good positive and negative predictive values.

Is the disability of elderly patients related to increased blood transfusions after cardiac surgery?

Funding Acknowledgements

Type of funding sources: None.

Intorduction. Perioperative bleeding occurs in 2 to 15% of patients. Cardiac surgeries are associated with perioperative blood loss due to the invasive nature of the procedures, the need for high doses of anticoagulation and the need for extracorporeal circulation. Both transfusions and reoperations due to excessive postoperative bleeding are associated with adverse clinical outcomes and increased costs of care. In 2017, the common position of the European Association of Cardiac Cancer Surgeons (EACTS) and the European Association of Cardiac Cancer Surgical Anesthesiologists (EACTA) regarding the management of patient blood in order to maintain adequate perioperative homeostasis and minimizing bleeding, and thus reducing the amount of blood transfusions. Advanced age is one of the factors associated with an increased risk of perioperative bleeding, including the need for transfusion and reoperation.

Purpose. Assessment of the relationship between preoperative disability and the amount of blood transfused in elderly patients after cardiac surgeries.

Methods. The study included 100 patients ≥ 65 years of age (40 women and 60 men, mean age M ± SD =71.69 ± 4). A sociodemographic questionnaire and the Nagi scale for disability assessment were used to collect the research material. The Nagi scale assesses the limitations of the patient in seven activities. A significant disability is considered to be ≥ 3 points. The number of blood transfusions was assessed based on the analysis of medical records. The number of blood units transfused during hospitalization was taken into account. Statistically significant was assumed to be p &lt; 0.05.

Results. In the study group the mean score on the Nagi scale was M ± SD = 3.41 ± 1.83 points. Blood transfusions were required by 66% of the study participants. The number of transfused blood units ranged from 1 to 11. The mean number of transfused blood units was 1.41 ± 1.83 points: M ± SD = 1.56 ± 1.93. 28 patients required 1 blood unit, 11 blood units required 1 patient. There was a significant positive correlation between the values of the Nagi scale and the number of blood units transfused (r = 0.233, p = 0.019) . Moreover, the number of blood units transfused to patients with values of the Nagi scale ≥3 points turned out to be significantly higher than in patients with values of this scale &lt;3 points (p = 0.015).

Conclusions. 1) Patients with disability are qualified for cardiac surgeries. 2) Patients with disabilities require more blood units to be transfused.

Cardiac Cachexia: A Well-Known but Challenging Complication of Heart Failure

Heart failure (HF) is a common complication of various cardiac diseases, and its incidence constantly increases. This is caused mainly by aging of populations and improvement in the treatment of coronary artery disease. As HF patients age, they tend to develop comorbidities, creating new problems for health-care professionals. Sarcopenia, defined as the loss of muscle mass and function, and cachexia, defined as weight loss due to an underlying illness, are muscle wasting disorders of particular relevance in the heart failure population, but they go mostly unrecognized. The coexistence of chronic HF and metabolic disorders facilitates the development of cachexia. Cachexia, in turn, significantly worsens a patient’s prognosis and quality of life. The mechanisms underlying cachexia have not been explained yet and require further research. Understanding its background is crucial in the development of treatment strategies to prevent and treat tissue wasting. There are currently no specific European guidelines or recommended therapy for cachexia treatment in HF (“cardiac cachexia”).

Relationship between Nutritional Status and Clinical and Biochemical Parameters in Hospitalized Patients with Heart Failure with Reduced Ejection Fraction, with 1-year Follow-Up

Heart Failure (HF) is a cardiovascular disease with continually increasing morbidity and high mortality. The purpose of this study was to analyze nutritional status in patients diagnosed with HF with reduced ejection fraction (HFrEF) and evaluate the impact of malnutrition on their prognosis. The Polish version of MNA form (Mini Nutritional Assessment) was used to assess the patients’ nutritional status. The New York Heart Association (NYHA) class, exacerbation of HF, chosen echocardiographic and biochemical parameters, e.g., natriuretic peptides or serum albumin, were also analyzed. Among the 120 consecutive patients, 47 (39%) had a normal nutritional status, 62 (52%) were at risk of malnutrition and 11 (9%) were malnourished. The patients with malnutrition more frequently presented with HF exacerbation in comparison to those with normal nutritional status (82% vs. 30% respectively, p = 0.004). There were no significant differences between the investigated groups as to natriuretic peptides; however, both the malnourished patients and those at risk of malnutrition tend to show higher B-type natriuretic peptide (BNP) and NT-proBNP concentrations. During the average 344 days of follow-up 19 patients died and 25 were hospitalized due to decompensated HF. Malnutrition or being at risk of malnutrition seems to be associated with both worse outcomes and clinical status in HFrEF patients.

Multidimensional Approach to Frailty

The concept of frailty syndrome (FS) was first described in the scientific literature three decades ago. For a very long time, we understood it as a geriatric problem, recently becoming one of the dominant concepts in cardiology. It identifies symptoms of FS in one in 10 elderly people. It is estimated that in Europe, 17% of elderly people have FS. The changes in FS resemble and often overlap with changes associated with the physiological aging process of the body. Although there are numerous scientific reports confirming that FS is age correlated, it is not an unavoidable part of the aging process and does not apply only to the elderly. FS is a reversible clinical condition. To maximize benefits of frailty-reversing activities for patient with frailty, identification of its determinants appears to be fundamental. Many of the determinants of the FS have already been known: reduction in physical activity, malnutrition, sarcopenia, polypharmacy, depressive symptom, cognitive disorders, and lack of social support. This review shows that insight into FS determinants is the starting point for building both the comprehensive definition of FS and the adoption of the assessment method of FS, and then successful clinical management.

BeGuideWell: A prospective cross-sectional study analysing the awareness and opinions of nursing students in Poland on the usefulness of European Society of Cardiology guidelines in post-graduate education programme

BACKGROUND

The role of clinical guidelines is to provide patients with the best quality, evidence-based care. Nurses are actively involved in the development of the European Society of Cardiology guidelines. A number of the guidelines include specific recommendations relating to nursing duties and, hence, nurses require necessary knowledge and skills for their implementation. Inclusion of the guidelines in the curricula for university nursing programmes could facilitate their implementation to everyday practice.

AIM

The purpose of this study was to determine the awareness and opinions of Polish nursing students who participated in a guideline-based Master of Science education programme about the usefulness of the European Society of Cardiology guidelines.

METHODS

A prospective and cross-sectional research design was used and Strengthening the Reporting of Observational studies in Epidemiology guidelines were followed. A total of 188 nursing students (mean age 31.18±10.41 years) who met the inclusion criteria were invited to complete the BeGuideWell survey. This instrument included 16 questions: five on participants' demographics and 11 addressing the issues associated with the European Society of Cardiology guidelines. The Yates chi-squared test or Fisher exact test were used for statistical analysis.

RESULTS

The majority of students had become familiar with the diagnostics and treatment of acute and chronic heart failure. Nearly half of the students documented that they had never heard of the European Society of Cardiology guidelines before starting the Master of Science programme. Most students found the European Society of Cardiology guidelines helpful for their university education. Most respondents stated that the guidelines were useful in their everyday practice and believed that they contributed to better quality of patient care.

CONCLUSIONS

Students can become more familiar with the European Society of Cardiology guidelines during the course of their post-graduate education, preparing them to implement the European Society of Cardiology guidelines in their everyday practice.

The relationship between frailty syndrome and quality of life in older patients following acute coronary syndrome

Purpose: Elderly patients with ST-segment-elevation myocardial infarction (STEMI) have a high risk of mortality, which is particularly high in the first 30 days. Quality of life (QoL) and risk-benefit assessments are of pivotal importance in the elderly. The objective of this study is to assess the relationship between frailty syndrome (FS) and QoL in patients following acute coronary syndrome (ACS) non-ST elevation myocardial infarction (NSTEMI).

Patients and Methods: The study involved 100 patients (61 men, 39 women, the average age: M ± SD =66.12±10.92 years). The study used standardized research tools: a questionnaire to assess QoL (World Health Organization Quality of Life Scale Brief version), and a questionnaire to assess FS (Tilburg Frailty Indicator).

Results: FS occurred in 80% of patients after ACS. FS has a negative impact on the QoL of patients with ACS. The most important domain of FS in the studied group was the psychological: M ± SD=2.2±0.75 points. The greater FS in the physical domain, the lower the QoL in all areas. The greater FS in the social domain, the lower the QoL in psychological and social fields. Self-evaluation of patient QoL was M ± SD=3.68±0.71 points. Self-assessment of health was M ± SD=2.59±0.98 points.

Conclusion: Patients with a coexisting FS have a poorer QoL in the physical, psychological, social, and environmental fields. For a multidisciplinary team, these findings can help make the therapeutic decision for frail patients who have poor QoL. Frailty among elderly patients with ACS can be considered as a determinant of high risk of adverse outcomes.

Heart Failure and Problems with Frailty Syndrome: Why it is Time to Care About Frailty Syndrome in Heart Failure

Frailty syndrome (FS) is an independent predictor of mortality in cardiovascular disease and is found in 15–74% of patients with heart failure (HF). The syndrome has a complex, multidimensional aetiology and contributes to adverse outcomes. Proper FS diagnosis and treatment determine prognosis and support the evaluation of treatment outcomes. Routine FS assessment for HF patients should be included in daily clinical practice as an important prognostic factor within a holistic process of diagnosis and treatment. Multidisciplinary team members, particularly nurses, play an important role in FS assessment in hospital and primary care settings, and in the home care environment. Raising awareness of concurrent FS in patients with HF patients and promoting targeted interventions may contribute to a decreased risk of adverse events, and a better prognosis and quality of life.

Psychometric Evaluation Of Appetite Questionnaires In Elderly Polish Patients With Heart Failure

PURPOSE

Loss of appetite is caused by multifaceted disorders and affects an average of 40% of patients with heart failure (HF). The Council on Nutrition Appetite Questionnaire (CNAQ) and the Simplified Nutritional Appetite Questionnaire (SNAQ) are designed to assess appetite among older adults. We aimed to assess the psychometric properties of both CNAQ and SNAQ questionnaires in elderly Polish patients with HF.

METHODS

The study sample involved 103 patients aged ≥ 65 years with HF diagnosed according to the New York Heart Association (NYHA) functional classes II-IV. The study was conducted among hospitalized patients with HF. In the study, the Mini Nutritional Assessment (MNA) questionnaire was used to assess the validity of the questionnaire. The evaluation of the following psychometric values was taken into account: data quality and homogeneity, factor structure, construct validity and internal consistency.

RESULTS

Parallel analysis confirmed the unidimensional structure of both CNAQ and SNAQ. The adjusted eigenvalues for CNAQ were 3.50 for the first factor and 0.62 for the second factor, and for SNAQ they were 2.2 and 0.31, respectively. For CNAQ, the desired CFA values were obtained after modification (RMSEA <0.06, CFI, TLI> 0.95), for SNAQ without modification (RMSEA <0.06, CFI, TLI> 0.95). The correlation between CNAQ and SNAQ and MNA was strong (rs = 0.8 and rs = 0.81, p <0.001, respectively). The internal consistency of the CNAQ and SNAQ tools was 0.88 and 0.86, respectively.

CONCLUSION

The CNAQ and SNAQ questionnaires have positive psychometric properties and can be used to evaluate appetite among elderly Polish patients with HF.

Frailty Syndrome: Nursing Interventions

Background

Frailty syndrome is now becoming a challenge for multidisciplinary teams. Frailty assessment in elderly patients is recommended due to the associated cascade of irreversible alterations that ultimately result in disability.

Aims

The purpose of this article is to identify interventions, which can be implemented and performed by nurses as part of a multidisciplinary plan. Nursing strategies related to nutrition, polypharmacy, adherence to treatment, falls, exercise, and mood and cognitive intervention are described.

Design

Discussion paper.

Data sources

Relevant and up-to-date literature from PubMed, MEDLINE, and Scopus databases regarding the selected issues, such as nutritional status, polypharmacy, falls, physical activity, and cognitive functions.

Conclusion

Frailty is considered preventable or even reversible with the appropriate interventions, which can help maintain or even restore physical abilities, cognitive function, or nutritional status in frail elderly patients. Hence, the nursing interventions are significant in clinical practice and should be implemented for frail patients.

Implications for nursing

Health-care providers, especially nurses, in their clinical practice should recognize not only elderly patients but also elderly patients with concurrent frailty, requiring intensified therapeutic interventions tailored to their individual needs. Frailty syndrome is undoubtedly a challenge for multidisciplinary teams providing health care for geriatric patients.

The Role of Nutritional Status in Elderly Patients with Heart Failure

Evidence indicates that malnutrition very frequently co-occurs with chronic heart failure (HF) and leads to a range of negative consequences. Studies show associations between malnutrition and wound healing disorders, an increased rate of postoperative complications, and mortality. In addition, considering the increasing age of patients with HF, a specific approach to their treatment is required. Guidelines proposed by the European Society of Cardiology (ESC) for treating acute and chronic HF refer to the need to monitor and prevent malnutrition in HF patients. However, the guidelines feature no strict nutritional recommendations for HF patients, who are at high nutritional risk as a group, nor do they offer any such recommendations for the poor nutritional status subgroup, for which high morbidity and mortality rates have been observed. In the context of multidisciplinary healthcare, recommended by the ESC and proven by research to offer multifaceted benefits, nutritional status should be systematically assessed in HF patients. Malnutrition has become a challenge within healthcare systems and day-to-day clinical practice, especially in developed countries, where it affects the course of disease and patients' prognosis.

Frailty syndrome and self-care ability in elderly patients with heart failure

Background

Chronic heart failure is a serious medical condition. Recently, there has been an increasing interest in frailty syndrome and self-care levels among patients with cardiovascular conditions. Demonstrating the influence of frailty syndrome on self-care could improve the quality of self-care and prevent the adverse effects of frailty syndrome. The purpose of this study was to assess the influence of frailty syndrome on the self-care capabilities of patients with chronic heart failure, and to identify factors associated with frailty.

Methods

The data were collected between January and July 2014. The study included 110 patients with chronic heart failure who were hospitalized in the cardiology clinic. Frailty syndrome was assessed using the Tilburg Frailty Indicator, a self-report questionnaire, and self-care behavior was assessed using the European Heart Failure Self-Care Behavior Scale.

Results

Fifty-four percent of the study patients were male and 46% were female. The mean age was 66±11 years, the mean Tilburg Frailty Indicator score was 7.45±3.02 points, and the mean self-care level was 27.6±7.13 points. Correlation analyses showed that patients with higher scores in the social components of the frailty scale had better self-care capabilities. Frailty was associated with age, education, duration of heart failure, number of hospitalizations, and New York Heart Association class. The effects of these patient characteristics differed across components of frailty (physical, psychological, social).

Conclusion

The social components of frailty syndrome adversely affect the ability to self-care in elderly patients with heart failure. It is relevant to use a multidimensional measurement of frailty.

Health-related quality of life of patients suffering from cystic fibrosis

BACKGROUND

Cystic fibrosis (CF) is a particular example of a chronic disease with progressive course. Current statistical data shows that the life span of patients with CF has extended. Therefore, it is necessary to undertake interdisciplinary actions aiming at improving the efficiency of medical activities as well as minimalizing the influence of those interventions on the patients' quality of prolonged life.

OBJECTIVES

The aim of the study was to depict the QoL of patients suffering from mucoviscidosis and show the differences in the assessment of patients' QoL depending on age and sex.

MATERIAL AND METHODS

The study covered 30 patients with CF. Mean age of the respondent group was 24.83 ± 6.98; mean age of females 25.8 ± 7.27, whereas of males - 23.5 ± 6.56. A specific questionnaire for testing cystic fibrosis quality of life (CFQoL) of patients was used in the study.

RESULTS

Generally patients with CF evaluated their QoL as low. In the study with the use of a CFQoL questionnaire they evaluated their QoL as the lowest in a subscale: future concerns. In most domains women got lower mean values than men. A dependence between patients' QoL and their age was ascertained. The older the patient is, the lower QoL is in the case of subscales (CFQoL): physical, emotional and social functioning, chest symptoms, interpersonal relationships, body image, career concerns.

CONCLUSIONS

Patients with CF generally evaluate their QoL as low; there are differences in the evaluation of QoL between women and men. There is a relation between patients' QoL their age. The older the patient is, the worse his QoL in most subscales is.

Structural basis for antiviral activity of flavonoids-naturally occurring compounds

The effect of different substituents of quercetin and luteolin on the ability to inhibit the herpes simplex virus (HSV-1) replication in RK-13 cells was studied. It seems that parent compounds with free hydroxyl groups at C-5, C-7, C-3', C-4' and additionally at C-3 have the highest activity. Substitution of those groups caused decrease of or completely abolished the antiviral activity of the tested compounds.

Tuftsin a natural peptide with antiviral activity--structural basis of its action

The influence of tuftsin--the natural phagocytosis stimulating tetrapeptide and its elongated analogues--on the mortality of encephalomyocarditis virus-infected NMRI mice was investigated. It seems that amino acids elongation in the parent peptide chain does not result in significant increase of antiviral activity of the compounds tested.

Isolation and subunit composition of tuftsin receptor

Tuftsin (Thr-Lys-Pro-Arg) receptor was purified to apparent homogeneity by affinity chromatography, using a pentapeptide analog (Thr-Lys-Pro-Pro-Arg) that binds the receptor more than 4 times as avidly as tuftsin. The analog was covalently linked to a solid support (Affi-Gel 10). Rabbit peritoneal granulocyte membrane solubilized with 3-[(3-cholamidopropyl)dimethylammonio]-1-propanesulfonate was applied to the affinity column, the column was washed with 0.1 M ammonium carbonate (pH 7.9) and 0.1 M ammonium acetate (pH 5), and bound material was eluted with 20 nM tuftsin or pentapeptide. The eluate was concentrated and subjected to gel filtration; this yielded one major peak of [3H]tuftsin binding activity corresponding to approximately 500 kDa and a minor peak at approximately 250 kDa. Rechromatography of either peak resulted in the appearance of the same major and minor peaks. NaDodSO4/PAGE of the affinity-purified material under nonreducing conditions showed only two silver-staining bands. Electroblotting followed by [3H]tuftsin overlay and fluorography showed two adjacent radioactive bands corresponding in mobility to the silver-stained bands. Under reducing conditions, NaDodSO4/PAGE yielded molecular mass values 62 kDa and 52 kDa for the two tuftsin receptor subunits. Electron microscopy revealed a homogeneous population of spherical molecules with diameters of 104 A.

Suppression of Friend virus-induced leukaemia in mice by tuftsin

A significant decrease in mortality was observed when 25 micrograms of the tetrapeptide tuftsin was given to DBA/2J mice 5 days before infection with Friend leukaemia virus (FLV). The same effect was observed when tuftsin was given 5 days before and twice a week for 3 weeks after FLV infection. No effect was observed when the same amount of tuftsin was given 1 day before infection. A 5 micrograms dose of tuftsin given 5 days before and twice-weekly for 3 weeks had no effect on leukaemia induced by FLV infection. These findings showed that time and dosage were critical to the protective effect of tuftsin against virus-induced leukaemia.

Modification of morphine withdrawal: effect of tuftsin, [Lys4]-tuftsinyltuftsin, tetrapeptide fragment (1-4) of substance P and its amide

Withdrawal behavior in morphine-dependent rats precipitated by naloxone was attenuated after pretreatment with the tetrapeptide tuftsin and to some extent by its synthetic derivative [Lys4]-tuftsinyltuftsin. The tetrapeptide fragment (1-4) of Substance P was ineffective in suppressing morphine-withdrawal behavior, whereas its C-amide exerted only weak action. Possible involvement of an immunological mechanism is discussed.