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Aguilar-Iglesias L, Merino-Merino A, Sanchez-Corral E, Garcia-Sanchez MJ, Santos-Sanchez I, Dominguez-Calvo J, Saez-Maleta R, Perez-Rivera JA. Prognostic effect of systematic geriatric assessment on patients with acute heart failure. ESC Heart Fail 2024; 11:1194-1204. [PMID: 38287508 DOI: 10.1002/ehf2.14692] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 12/28/2023] [Accepted: 01/09/2024] [Indexed: 01/31/2024] Open
Abstract
AIMS Frailty and dependence are frequent in patients admitted for acute heart failure (AHF), but their prognostic significance is unknown, especially in young adults. We aimed to study in adults admitted for AHF, regardless of age, the effect of frailty and dependence on the incidence of mortality and a combined event of mortality, readmissions for AHF, and visits to the emergency room (ER) for AHF at 1 and 6 months. METHODS AND RESULTS We designed a prospective cohort study by including all the patients with AHF admitted in our Cardiology Department from July 2020 through May 2021. A multidimensional geriatric assessment was performed during the admission. We clinically followed up the patients 6 months after discharge. We enrolled 202 patients. The mean age was 73 ± 12.32 years, and 100 (49.5%) of the patients were elderly (>75 years). Just 78 patients (38.6%) were women, and 100 (49.5%) had previous HF. Frailty (FRAIL ≥ 3) was observed in 68 (33.7%) patients (mean FRAIL score: 1.88 ± 1.48). Dependence (Barthel < 100) was observed in 65 (32.2%) patients (mean Barthel index: 94.38 ± 11.21). Frailty and dependence showed a significant association with both prognostic events at 1 and 6 months. In the multivariable analysis, frailty was associated with higher mortality at 1 month [hazard ratio (HR) 12.61, 95% confidence interval (CI) 1.57-101.47, P = 0.017] but not at 6 months (HR 2.25, 95% CI 0.61-8.26, P = 0.224) or with the combined endpoint at neither 1 month (HR 1.64, 95% CI 0.54-5.03, P = 0.384) nor 6 months (HR 1.35, 95% CI 0.75-2.46, P = 0.320). Dependence was related to higher mortality at 1 month (HR 13.04, 95% CI 1.62-104.75, P = 0.016) and 6 months (HR 7.18, 95% CI 1.99-25.86, P = 0.003) and to higher incidence of the combined event at 1 month (HR 5.93, 95% CI 1.63-21.50, P = 0.007) and 6 months (HR 2.62, 95% CI 1.49-4.61, P = 0.001). CONCLUSIONS In AHF patients, frailty and dependence implied a worse prognosis, rising mortality, readmissions, and ER visits for AHF.
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Affiliation(s)
- Lara Aguilar-Iglesias
- Department of Cardiology, University Hospital of Burgos, Avda. Islas Baleares, 3, 09005, Burgos, Spain
| | - Ana Merino-Merino
- Department of Cardiology, University Hospital of Burgos, Avda. Islas Baleares, 3, 09005, Burgos, Spain
| | - Ester Sanchez-Corral
- Department of Cardiology, University Hospital of Burgos, Avda. Islas Baleares, 3, 09005, Burgos, Spain
| | | | - Isabel Santos-Sanchez
- Department of Cardiology, University Hospital of Burgos, Avda. Islas Baleares, 3, 09005, Burgos, Spain
| | - Jesus Dominguez-Calvo
- Department of Cardiology, University Hospital of Burgos, Avda. Islas Baleares, 3, 09005, Burgos, Spain
| | - Ruth Saez-Maleta
- Department Clinical Analysis, University Hospital of Burgos, Burgos, Spain
| | - Jose-Angel Perez-Rivera
- Department of Cardiology, University Hospital of Burgos, Avda. Islas Baleares, 3, 09005, Burgos, Spain
- Universidad Isabel I, Burgos, Spain
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Aguilar-Iglesias L, Merino-Merino A, Sanchez-Corral E, Garcia-Sanchez MJ, Santos-Sanchez I, Dominguez-Calvo J, Saez-Maleta R, Perez-Rivera JA. Fast systematic geriatric assessment in acute heart failure patients admitted in Cardiology. Heart Lung 2023; 60:133-138. [PMID: 36996756 DOI: 10.1016/j.hrtlng.2023.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 03/13/2023] [Accepted: 03/17/2023] [Indexed: 03/30/2023]
Abstract
BACKGROUND Heart failure prevalence is increasing in elder adults. These patients usually present geriatric syndromes, especially frailty. The effect of frailty on heart failure is under discussion but there are few data about the clinical characterization of frail patients who are admitted for acute heart failure decompensation. OBJECTIVE The purpose of this study was to study the differences in clinical baseline variables and geriatric scales between frail and non-frail patients admitted to the Cardiology unit via the Emergency Department for acute heart failure. METHODS We enrolled all patients with acute heart failure who were admitted to the Cardiology unit from the Emergency Department of our hospital from July 2020 through May 2021. A multidimensional and comprehensive geriatric assessment was performed at the moment of admission. We studied differences in baseline variables and geriatric scales according to the frailty status determined by the FRAIL scale. RESULTS A total of 202 patients were included. In the whole population, 68 (33.7%) patients presented frailty defined by a FRAIL score ≥ 3. The frail patients were older (80±9 vs. 69±12 years; p<0.001), and had a worse quality of life (58.31±12.18 vs.39.26±13.71 points; p<0.001) according to the Minnesota scale, presented high comorbidity (47 (69.1%) vs. 67 (50.4%) patients; p = 0.011) defined as ≥3 points according to the Charlson scale and were more dependent (40 (58.8%) vs. 25 (18.8%) patients; p<0.001) according to the Barthel scale. The frail patients presented higher MAGGIC risk scores (24.09±4.99 vs. 18.89±6.26; p<0.001). Despite this adverse profile, the treatments prescribed during the admission and at the hospital discharge were similar. CONCLUSIONS The prevalence of geriatric syndromes, especially frailty, is very high in patients admitted for acute heart failure. Frail patients with acute heart failure had an adverse clinical profile with more prevalence of concomitant geriatric syndromes. Therefore, we consider that a geriatric assessment should be performed during the admission of acute heart failure patients to improve care and attention.
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Aguilar-Iglesias L, Merino-Merino A, Sanchez-Corral E, Garcia-Sanchez MJ, Santos-Sanchez I, Saez-Maleta R, Perez-Rivera JA. Differences According to Age in the Diagnostic Performance of Cardiac Biomarkers to Predict Frailty in Patients with Acute Heart Failure. Biomolecules 2022; 12:biom12020245. [PMID: 35204746 PMCID: PMC8961634 DOI: 10.3390/biom12020245] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 01/25/2022] [Accepted: 01/27/2022] [Indexed: 02/06/2023] Open
Abstract
Frailty has traditionally been studied in the elderly population but scarcely in younger individuals. The objective of the present study is to analyze differences according to age in the diagnostic performance of cardiac biomarkers to predict frailty in patients admitted to the hospital for acute heart failure (AHF). A frailty assessment was performed with the SPPB and FRAIL scales (score > 3). We included 201 patients who were divided according to age: those older and younger than 75 years. In the younger group, no biomarker was related to the presence of frailty. This was mainly determined by age and comorbidities. In the elderly group, NT-proBNP was significantly related to the presence of frailty, but none of the baseline characteristics were. The best cut-off point in the elderly group for NT-proBNP was 4000 pg/mL. The area under the curve (AUC) for proBNP for frailty detection was 0.62 in the elderly. Another similar frailty scale, the SPPB, also showed a similar AUC in this group; however, adding the NT-proBNP (one point if NT-proBNP < 4000 pg/mL), it showed a slightly higher yield (AUC 0.65). The addition of biomarkers could improve frailty detection in members of the elderly population who are admitted to the hospital for AHF.
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Affiliation(s)
- Lara Aguilar-Iglesias
- Department of Cardiology, University Hospital of Burgos, 09006 Burgos, Spain; (L.A.-I.); (A.M.-M.); (E.S.-C.); (M.-J.G.-S.); (I.S.-S.)
| | - Ana Merino-Merino
- Department of Cardiology, University Hospital of Burgos, 09006 Burgos, Spain; (L.A.-I.); (A.M.-M.); (E.S.-C.); (M.-J.G.-S.); (I.S.-S.)
| | - Ester Sanchez-Corral
- Department of Cardiology, University Hospital of Burgos, 09006 Burgos, Spain; (L.A.-I.); (A.M.-M.); (E.S.-C.); (M.-J.G.-S.); (I.S.-S.)
| | - Maria-Jesus Garcia-Sanchez
- Department of Cardiology, University Hospital of Burgos, 09006 Burgos, Spain; (L.A.-I.); (A.M.-M.); (E.S.-C.); (M.-J.G.-S.); (I.S.-S.)
| | - Isabel Santos-Sanchez
- Department of Cardiology, University Hospital of Burgos, 09006 Burgos, Spain; (L.A.-I.); (A.M.-M.); (E.S.-C.); (M.-J.G.-S.); (I.S.-S.)
| | - Ruth Saez-Maleta
- Department Clinical Analysis, University Hospital of Burgos, 09006 Burgos, Spain;
| | - Jose-Angel Perez-Rivera
- Department of Cardiology, University Hospital of Burgos, 09006 Burgos, Spain; (L.A.-I.); (A.M.-M.); (E.S.-C.); (M.-J.G.-S.); (I.S.-S.)
- Facultad de Ciencias de la Salud, Universidad Isabel I, 09003 Burgos, Spain
- Correspondence:
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