Coexisting Frailty With Heart Failure

Uchmanowicz, Izabella; Nessler, Jadwiga; Gobbens, Robbert; Gackowski, Andrzej; Kurpas, Donata; Straburzyńska‐Migaj, Ewa; Kałużna‐Oleksy, Marta; Jankowska, Ewa A.

doi:10.3389/fphys.2019.00791

Cited by 38 publications

(39 citation statements)

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“…The pathobiologies of frailty and HF share several common pathways, particularly a consistent correlation with inflammatory biomarkers as well as impaired mitophagy and mitochondrial dysfunction within cardiomyocytes and skeletal muscle, causing cell death and activation of innate immunity to induce chronic, low-grade systemic inflammation [ 42 ]. Our study findings indicated unmeasured heterogeneity of functional frailty in older HF population.…”

Section: Discussionmentioning

confidence: 99%

Physical frailty and long-term mortality in older people with chronic heart failure with preserved and reduced ejection fraction: a retrospective longitudinal study

et al. 2021

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Background Frailty, a syndrome characterized by a decline in function reserve, is common in older patients with heart failure (HF) and is associated with prognosis. This study aimed to evaluate the impact of frailty on outcomes in older patients with preserved and reduced cardiac function. Methods In total, 811 adults aged ≥65 years were consecutively enrolled from 2009 to 2018. HF was diagnosed according to the ICD9 code and a 2D echocardiogram was categorized by reduced ejection fraction (HFrEF) and preserved ejection fraction (HFpEF). The index date was registered at the time of HF. All patients received a comprehensive geriatric assessment, and clinical outcomes were examined with adjustment of the other prognostic variables. Results Mean age was 80.5 ± 7.1 years. The prevalence of HF, HFpEF, HFrEF, Fried, and Rockwood frailty indicators was 28.5, 10.4, 9.7, 52.5, and 74.9%, respectively. At baseline, scores in the Timed Up and Go test was closely associated with the severity of HF, either with HFpEF or HFrEF. After a mean follow-up of 3.2 ± 2.0 years, we found that HF patients with low handgrip strength (HGS) had the poorest survival, followed by non-HF patients with decreased HGS, and HF with fair HGS in comparison with non-HF with fair HGS (p = 0.008) if participants were arbitrarily divided into two HGS groups. In all patients, a high Rockwood frailty index was independently associated with increased mortality (adjusted hazard ratio [aHR] = 1.05; 95% confidence interval [CI]: 1.0004 to 1.10). In addition, the adjusted mortality HR was 3.42 with decreased HGS (95% CI: 1.03 to 11.40), 7.65 with use of mineralocorticoid receptor antagonist (95% CI: 2.22 to 26.32), and 1.26 with associated multi-comorbidities assessed by Charlson comorbidity index (95% CI: 1.05 to 1.51). Conclusions Our study results indicate that frailty and decreased physical functions were associated with HF. Besides, frailty and HGS predicted prognosis in the patients, and there was a combined effect of HF and low HGS on survival.

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Section: Discussionmentioning

confidence: 99%

Physical frailty and long-term mortality in older people with chronic heart failure with preserved and reduced ejection fraction: a retrospective longitudinal study

et al. 2021

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“…5 Part A of TFI investigated frailty risk factors including age, gender, education level, economic status, lifestyle, marital status, experiences with different unfavorable events in the recent time, and satisfaction with living conditions. 5 The TFI was adapted and validated for the Polish population by Uchmanowicz et al 11,12…”

Section: Study Population and Methodsmentioning

confidence: 99%

<p>Simultaneous Employment of the FRAIL Scale and the Tilburg Frailty Indicator May Identify Elderly People Who Require Different Interventional Strategies</p>

Sacha

Wieczorowska‐Tobis

2020

CIA

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Purpose: Frailty is a geriatric syndrome that is usually considered as a set of physical deficits (unidimensional concept); however, it can also concern the psychological and social domains of human functioning (multidimensional concept). The FRAIL scale is a diagnostic tool which ascertains only physical frailty, whereas the Tilburg Frailty Indicator (TFI) is a diagnostic instrument for multidimensional frailty. The study investigates if non-robust physical status and multidimensional frailty affect the same individuals and whether simultaneous employment of the FRAIL scale and TFI identifies specific subgroups of elderly people which require different interventions. Patients and Methods: In this cross-sectional study, 1024 community dwelling elderly individuals at the age of 65 years or older (mean age 72.6 ± 6.3 years; range 65-93 years) were evaluated with the FRAIL scale and TFI. Results: According to the FRAIL scale, 52.9% of the subjects were physically non-robust, but according to TFI, 54.6% presented multidimensional frailty. These two diagnostic tools were concordant in their outcomes in 77.1% (ie, 42.3% of individuals were physically and multidimensionally frail but 34.8% were robust according to both two instruments); however, in 22.9% the outcomes were discordant. Consequently, by simultaneous employment of the FRAIL scale and TFI, four distinct functional categories have been distinguished: (i) nonrobust physical status with multidimensional frailty, (ii) exclusive non-robust physical status, (iii) exclusive multidimensional frailty, and (iv) full robust status. Conclusion: By applying simple physical and multidimensional frailty diagnostic tools, subgroups of elderly people may be identified that require specific management strategies to improve their functional status.

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“…The appearance of "vitamins" being prescribed in the medications table may be related to age or nutrition as malnutrition is associated with increased frailty [30], and that nutritional supplementation (including the prescribing of vitamins) has been shown to be a potential therapy for frailty [31][32][33][34]. The prescription of furosemide, a common drug prescribed for heart failure was also recorded, and there is evidence to suggest that concurrent heart failure and frailty has been observed in patients and that these patients require targeted interventions [35][36][37]. Constipation is a prevalent disorder affecting 15% of seniors [38], a risk factor for frailty [39], and is listed as a deficit in the Frailty Index [14].…”

Section: Number Of Features Examplementioning

confidence: 99%

Developing and validating a primary care EMR-based frailty definition using machine learning

Williamson

Aponte-Hao

Mele

et al. 2020

IJPDS

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Introduction. Individuals who have been identified as frail have an increased state of vulnerability, often leading to adverse health events, increased health spending, and potentially detrimental outcomes. Objective. The objective of this work is to develop and validate a case definition for frailty that can be used in a primary care electronic medical record database. Methods. This is a cross-sectional validation study using data from the Canadian Primary Care Sentinel Surveillance Network (CPCSSN) in Southern Alberta. 52 CPCSSN sentinels assessed a random sample of their own patients using the Rockwood Clinical Frailty scale, resulting in a total of 875 patients to be used as reference standard. Patients must be over the age of 65 and have had a clinic visit within the last 24 months. The case definition for frailty was developed using machine learning methods using CPCSSN records for the 875 patients. Results. Of the 875 patients, 155 (17.7%) were frail and 720 (84.2%) were not frail. Validation metrics of the case definition were: sensitivity and specificity of 0.28, 95% CI (0.21 to 0.36) and 0.94, 95% CI (0.93 to 0.96), respectively; PPV and NPV of 0.53, 95% CI (0.42 to 0.64) and 0.86, 95% CI (0.83 to 0.88), respectively. Conclusion. The low sensitivity and specificity results could be because frailty as a construct remains under-developed and relatively poorly understood due to its complex nature. These results contribute to the literature by demonstrating that case definitions for frailty require expert consensus and potentially more sophisticated algorithms to be successful

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Coexisting Frailty With Heart Failure

Cited by 38 publications

References 103 publications

Physical frailty and long-term mortality in older people with chronic heart failure with preserved and reduced ejection fraction: a retrospective longitudinal study

Physical frailty and long-term mortality in older people with chronic heart failure with preserved and reduced ejection fraction: a retrospective longitudinal study

<p>Simultaneous Employment of the FRAIL Scale and the Tilburg Frailty Indicator May Identify Elderly People Who Require Different Interventional Strategies</p>

Developing and validating a primary care EMR-based frailty definition using machine learning

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