1
|
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.
Collapse
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
| |
Collapse
|
2
|
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.
Collapse
|
3
|
Merino-Merino A, Saez-Maleta R, Salgado-Aranda R, AlKassam-Martinez D, Pascual-Tejerina V, Martin-Gonzalez J, Garcia-Fernandez J, Perez-Rivera JA. A Differential Profile of Biomarkers between Patients with Atrial Fibrillation and Healthy Controls. J Pers Med 2022; 12:jpm12091406. [PMID: 36143191 PMCID: PMC9503201 DOI: 10.3390/jpm12091406] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 08/23/2022] [Accepted: 08/26/2022] [Indexed: 11/16/2022] Open
Abstract
Atrial fibrillation (AF) is explained by anatomical and electrophysiological changes in the atria determined by high pressure, dilatation, infiltration and inflammation in the myocardium. There are some biomarkers implicated in these processes, namely, NT-proBNP, high sensitivity troponin (Hs-Tn), urate, galectin-3, ST2, C reactive protein and fibrinogen. The aim of this study was to assess differences in these biomarkers between patients with AF and healthy controls. We designed a cross-sectional study consecutively including all patients undergoing electrical cardioversion in our hospital for persistent AF and matched healthy controls. We included 115 patients with persistent non-valvular AF and 33 healthy subjects. The biomarkers NT-proBNP, ST2 and Hs-Tn T were significantly related to the presence of AF (1054 ± 833.30 vs. 58.31 ± 59.40, p < 0.001; 35.43 ± 15.89 vs. 27.43 ± 10.95, p < 0.001 and 10.25 ± 6.11 vs. 8.42 ± 6.85, p < 0.001, respectively). NT-proBNP was the best biomarker differentiating AF patients (area under the curve 0.995). The best NT-proBNP cut-off point to differentiate AF was 102 pg/mL; for Hs-Tn T it was 11.5 ng/L and for ST2 it was 37.7 ng/mL. It is possible that these biomarkers intervene at the onset of AF and have no role in AF maintenance.
Collapse
Affiliation(s)
- Ana Merino-Merino
- Cardiology Department, Hospital Universitario de Burgos, 09006 Burgos, Spain
| | - Ruth Saez-Maleta
- Clinical Analyses Department, Hospital Universitario de Burgos, 09006 Burgos, Spain
| | - Ricardo Salgado-Aranda
- Cardiology Department, Hospital Universitario de Burgos, 09006 Burgos, Spain
- Cardiology Department, Hospital Clínico San Carlos, 28040 Madrid, Spain
| | - Daniel AlKassam-Martinez
- Clinical Analyses Department, Hospital Universitario de Burgos, 09006 Burgos, Spain
- Clinical Analyses Department, Hospital Central de Asturias, 33011 Oviedo, Asturias, Spain
| | - Virginia Pascual-Tejerina
- Cardiology Department, Hospital Universitario de Burgos, 09006 Burgos, Spain
- Cardiology Department, Hospital Virgen de la Salud, 45004 Toledo, Spain
| | | | | | - Jose-Angel Perez-Rivera
- Cardiology Department, Hospital Universitario de Burgos, 09006 Burgos, Spain
- Universidad Isabel I, 09003 Burgos, Spain
- Correspondence: ; Tel.: +34-947281800 (ext. 35756)
| |
Collapse
|
4
|
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.
Collapse
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:
| |
Collapse
|
5
|
Perez Rivera JA, Merino-Merino A, Saez-Maleta R, Gundin-Menendez S. Recurrences of atrial fibrillation in patients with heart failure without reduced ejection fraction: a role for CA125. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Atrial fibrillation (AF) and heart failure (HF) without reduced ejection fraction often occur together, and their combination is associated with increased morbidity and mortality compared with each disorder alone. Sinus rhythm maintenance seems to be beneficial but challenging in these patients.
Purpose
We studied the possible value of CA125 to predict recurrences in patients with persistent AF and HF without reduced ejection fraction who underwent electrical cardioversion (ECV).
Methods
We designed a prospective cohort study by consecutively including all the patients who underwent ECV in our hospital with symptomatic persistent non-valvular AF and a concomitant diagnosis of HF without reduced ejection fraction. We excluded patients with clinical instability or ejection fraction <40%. We defined HF as the presence of diastolic dysfunction in echo (left atrium indexed volume >34 ml/m2 or e/e' >8) or ejection fraction between 40 and 50%. We followed-up them during 6 months for detecting AF recurrences with an ECG-Holter 3 months after ECV and an ECG at 6th month. We considered a recurrence as any AF documentation in ECG or ECG-Holter after the ECV. A peripheral blood sample was extracted just before ECV and CA125 was determined. Kaplan-Meyer analysis was used to study the possible relationship between CA125 plasmatic levels, dichotomized according to the median value, and AF recurrence.
Results
We included 95 patients with a medium age of 64±9 years old. Of them, 31 (32.6%) were women, 14 (14.7%) had diabetes and 56 (58.9%) hypertension. The medium ejection fraction was 58.14±10.27% and the median CA125 was 10.98±8.97 U/ml. We detected 54 (57.4%) recurrences in 6 months. In patients with AF recurrences, CA125 values were higher than in patients who maintained sinus rhythm (19.28±29.11 U/ml vs. 14.98±17.02 U/ml). CA125 was significantly related with AF recurrences (log-rank 5.37; p=0.021).
Conclusions
In our sample of patients with persistent AF and HF without reduced ejection fraction, CA125 plasmatic levels are related with AF recurrences after ECV. CA125 has been associated with the clinical severity of HF and the symptoms and signs of fluid congestion. This probably means more ventricular and atrial myocardial damage that might predispose to AF. Sinus rhythm maintenance is specially challenging in patients with HF so those with higher levels of CA125 probably need a closer surveillance and a more aggressive rhythm control.
Funding Acknowledgement
Type of funding sources: None.
Collapse
|
6
|
Saez-Maleta R, Merino-Merino A, Gundin-Menendez S, Salgado-Aranda R, AlKassam-Martinez D, Pascual-Tejerina V, Martin-Gonzalez J, Garcia-Fernandez J, Perez-Rivera JA. sST2 and Galectin-3 genotyping in patients with persistent atrial fibrillation. Mol Biol Rep 2021; 48:1601-1606. [PMID: 33486675 DOI: 10.1007/s11033-021-06150-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 01/11/2021] [Indexed: 11/30/2022]
Abstract
Genotyping of ST2 and galectin-3 in atrial fibrillation (AF) is not well analyzed. The aim of our study was to analyze the possible relationship between levels of sST2 and galectin-3 and three polymorphisms in patients with AF. We included 125 patients with persistent AF undergoing electric cardioversion. We analyzed sST2 and galectin-3 levels and three polymorphisms in peripheral blood samples. Rs2274273 was significantly related with levels of galectin-3. Rs1558648 was associated with levels of sST2 but rs13019803 were not. None of the polymorphisms were connected to the variation of biomarkers levels during the follow up. We found a relationship between rs2274273 and galectin-3 levels and rs1558648 and sST2 levels in patients with AF.
Collapse
Affiliation(s)
- Ruth Saez-Maleta
- Clinical Analyses Department, Universitary Hospital of Burgos, Burgos, Spain
| | - Ana Merino-Merino
- Cardiology Department, Universitary Hospital of Burgos, Avda. Islas Baleares, 3. 09006, Burgos, Spain
| | | | - Ricardo Salgado-Aranda
- Cardiology Department, Universitary Hospital of Burgos, Avda. Islas Baleares, 3. 09006, Burgos, Spain
| | - Daniel AlKassam-Martinez
- Clinical Analyses Department, Universitary Hospital of Burgos, Burgos, Spain
- Laboratory of Medicine, Central Hospital of Asturias, Oviedo, Spain
| | - Virginia Pascual-Tejerina
- Cardiology Department, Universitary Hospital of Burgos, Avda. Islas Baleares, 3. 09006, Burgos, Spain
| | - Javier Martin-Gonzalez
- Cardiology Department, Universitary Hospital of Burgos, Avda. Islas Baleares, 3. 09006, Burgos, Spain
| | - Javier Garcia-Fernandez
- Cardiology Department, Universitary Hospital of Burgos, Avda. Islas Baleares, 3. 09006, Burgos, Spain
| | - Jose-Angel Perez-Rivera
- Cardiology Department, Universitary Hospital of Burgos, Avda. Islas Baleares, 3. 09006, Burgos, Spain.
- Universidad Isabel I, Burgos, Spain.
| |
Collapse
|
7
|
Merino-Merino A, Saez-Maleta R, Salgado-Aranda R, AlKassam-Martinez D, Pascual-Tejerina V, Martin-González J, Garcia-Fernandez J, Perez-Rivera JA. When should we measure biomarkers in patients with atrial fibrillation to predict recurrences? Am J Emerg Med 2020; 39:248-249. [PMID: 32487461 DOI: 10.1016/j.ajem.2020.05.051] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 04/30/2020] [Accepted: 05/13/2020] [Indexed: 11/30/2022] Open
Affiliation(s)
- Ana Merino-Merino
- Cardiology Department, Universitary Hospital of Burgos, Burgos, Spain
| | - Ruth Saez-Maleta
- Clinical Analyses Department, Universitary Hospital of Burgos, Burgos, Spain
| | | | - Daniel AlKassam-Martinez
- Laboratory of Medicine, Central Hospital of Asturias, Oviedo, Spain; Clinical Analyses Department, Universitary Hospital of Burgos, Burgos, Spain
| | | | | | | | - Jose-Angel Perez-Rivera
- Cardiology Department, Universitary Hospital of Burgos, Burgos, Spain; Universidad Isabel I, Burgos, Spain.
| |
Collapse
|
8
|
Merino-Merino A, Saez-Maleta R, Salgado-Aranda R, AlKassam-Martinez D, Pascual-Tejerina V, Martin-Gonzalez J, Garcia-Fernandez J, Perez-Rivera JA. Biomarkers in atrial fibrillation and heart failure with non-reduced ejection fraction: Diagnostic application and new cut-off points. Heart Lung 2020; 49:388-392. [PMID: 32145960 DOI: 10.1016/j.hrtlng.2020.02.043] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 09/10/2019] [Revised: 02/17/2020] [Accepted: 02/21/2020] [Indexed: 01/26/2023]
Abstract
BACKGROUND Atrial fibrillation (AF) and heart failure (HF) with non-reduced left ventricle ejection fraction (LVEF) present a diagnostic overlap. In this paper, we analyze differences in biomarkers between patients with and without HF, in a cohort of patients presenting with symptomatic AF. Differences in biomarkers between patients with medium range ejection fraction HF (HFmrEF) and those with preserved ejection fraction HF (HFpEF) are also analyzed. METHODS A total of 115 patients with symptomatic persistent AF were included. Seven biomarkers were measured: NT-proBNP, high sensitivity T troponin (hsTNT), galectin-3, ST2, fibrinogen, urate and C-reactive protein. RESULTS Patients with non-reduced LVEF HF had significantly higher NT-proBNP levels than those without HF. This biomarker was the only variable independently related with the presence of non-reduced LVEF HF. Troponin was the only factor independently related with the presence of HFmrEF. CONCLUSIONS NT-proBNP showed the best diagnostic accuracy for detecting the presence of non-reduced LVEF HF. We found higher diagnostic NT-proBNP cut-off values than those previously reported. Troponin was the most accurate biomarker differentiating HFmrEF from HFpEF.
Collapse
Affiliation(s)
- Ana Merino-Merino
- Cardiology Department, Universitary Hospital of Burgos, Burgos, Spain
| | - Ruth Saez-Maleta
- Clinical Analyses Department, Universitary Hospital of Burgos, Burgos, Spain
| | | | - Daniel AlKassam-Martinez
- Clinical Analyses Department, Universitary Hospital of Burgos, Burgos, Spain; Laboratory of Medicine, Central Hospital of Asturias, Oviedo, Spain
| | | | | | | | - Jose-Angel Perez-Rivera
- Cardiology Department, Universitary Hospital of Burgos, Burgos, Spain; Universidad Isabel I, Burgos, Spain.
| |
Collapse
|