Impact of Frailty and Disability on 30-Day Mortality in Older Patients With Acute Heart Failure
Section snippets
Methods
We performed a retrospective analysis of the Older Acute Heart Failure Key Data (OAK) Registry. This is a prospective observational multicenter cohort study,14 which was approved by the Clinical Ethical Committees of all the participating hospitals.
The OAK Registry prospectively included all patients ≥65 years old with ADHF attended in 3 Spanish EDs (Hospital Clínico San Carlos, Madrid; Hospital Reina Sofía, Murcia; and Hospital de la Santa Creu i Sant Pau, Barcelona) over a 4-month period, in
Results
We selected for the present study 596 of 952 (62.6%) patients consecutively included in the OAK Registry (Figure 1). Comparison between included and nonincluded patients showed significant differences in higher age and frequency of ischemic heart disease, dementia, cardiorespiratory and functional baseline dependence, and lower NT-proBNP levels in the included patients (Supplementary Table 1).
Table 1 shows the characteristics of the patients included in the study. Two hundred and eighty-one
Discussion
The present study shows that frailty and disability have an impact on 30-day mortality in older patients with ADHF attended in EDs. The presence of the frailty phenotype (≥3 Fried criteria) in patients with moderate baseline functional dependence (BI = 60 to 85 points) and the presence of severe disability (BI < 60 points) are factors independently associated with a poor short-term prognosis. These results suggest that the baseline functional status (basic activities of daily living and
List of Investigators of the OAK Registry
María José Pérez-Durá, Pablo Berrocal Gil (Hospital La Fe de Valencia). Óscar Miró, Víctor Gil Espinosa, Carolina Sánchez, Sira Aguiló (Hospital Clinic de Barcelona). Maria Àngels Pedragosa Vall, Alfons Aguirre (Hospital del Mar de Barcelona). Pascual Piñera, Paula Lázaro Aragues (Hospital Reina Sofia de Murcia). Miguel Alberto Rizzi Bordigoni, Aitor Alquezar (Hospital San Pau de Barcelona). Fernando Richard (Hospital de Burgos). Javier Jacob, Carles Ferrer, Ferrán Llopis (Hospital Universitari
Disclosures
FJM-S received advisory/consulting fees from, Novartis, MSD, Pfizer, The Medicine Company, Otsuka, and research grants from the Spanish Ministry of Health and FEDER, Novartis, Abbot, and Orion-Pharma. PLL received advisory/consulting fees from Novartis, MSD, Boehringer Ingelheim, Pfizer and Orion-Pharma and research grants: Abbot, Otsuka, Cardiorentis and Novartis. PH received advisory/consulting fees from Novartis and research grants: Abbot, Otsuka, and Novartis. JJ received
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Cited by (32)
A Systematic Review of Frailty Scores Used in Heart Failure Patients
2023, Heart Lung and CirculationThe utility of the Barthel index as an outcome predictor in older patients with acute infection attending the emergency department
2022, Australasian Emergency CareCitation Excerpt :For instance, in community-acquired pneumonia, several studies have reported that lower BI scores are associated with a higher need for hospitalization, increases in hospitalization costs and longer duration of hospital stay [18–21]. Nevertheless, as far as we know, most studies have focused on baseline functional status or even its decline as a short-term prognostic factor [6,7,17,19], but its assessment by the BI score during the ED visit has received much less attention. Although information about the baseline BI is lacking in our study, functional impairment, either pre-existing or arising from acute illness, seems to be an important prognostic predictor in the study population.
Current Emergency Department Disposition of Patients With Acute Heart Failure: An Opportunity for Improvement
2022, Journal of Cardiac FailureConsensus of experts from the French Society of Geriatrics and Gerontology on the management of heart failure in very old subjects
2021, Archives of Cardiovascular DiseasesCitation Excerpt :Thus, a person with HF is 4–6 times more likely to have frailty criteria than a person of the same age without HF [31,32]. Because these “physical” criteria may be altered by the presence of HF, it is proposed to use scales and questionnaires that cover areas of frailty other than physical performance alone, such as cognition, mood, social context, nutrition and disability [33–35]. Such an approach provides a better interpretation of the clinical manifestations of HF, and offers a holistic and personalized patient management strategy (prioritization of therapeutic strategies, and evaluation of the benefit/risk ratio) (Table 2).
Geriatric assessment for older adults admitted to the emergency department: A systematic review and meta-analysis
2021, Experimental GerontologyImpact of inpatient cardiac rehabilitation on Barthel Index score and prognosis in patients with acute decompensated heart failure
2019, International Journal of CardiologyCitation Excerpt :Frequently coexisting frailty and disability affect quality of life across the entire age spectrum of patients with HF [6]. A recent study described that frailty and disability impacted 30-day mortality in older patients with acute decompensated HF (ADHF) in emergency departments [7]. Thus, broader interventions beyond HF management are necessary for frail patients, including the treatment of concurrent decompensated chronic conditions, reduction of polypharmacy, monitoring of patient capacities during and after hospitalization to minimize disability, and prescription of physical exercise and nutritional supplementation [8,9].
Funding: This study was partially supported by grants from the Instituto de Salud Carlos III supported with funds from the Spanish Ministry of Health and FEDER (PI15/00773, PI15/01019, and PI11/01021) and Fundació la Marató de TV3 (2015).
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