High Prevalence of Respiratory Muscle Weakness in Hospitalized Acute Heart Failure Elderly Patients

Abstract

IntroductionRespiratory Muscle Weakness (RMW) has been defined when the maximum inspiratory pressure (MIP) is lower than 70% of the predictive value. The prevalence of RMW in chronic heart failure patients is 30 to 50%. So far there are no studies on the prevalence of RMW in acute heart failure (AHF) patients.ObjectivesEvaluate the prevalence of RMW in patients admitted because of AHF and the condition of respiratory muscle strength on discharge from the hospital.MethodsSixty-three patients had their MIP measured on two occasions: at the beginning of the hospital stay, after they had reached respiratory, hemodynamic and clinical stability and before discharge from the hospital. The apparatus and technique to measure MIP were adapted because of age-related limitations of the patients. Data on cardiac ejection fraction, ECG, brain natriuretic peptide (BNP) levels and on the use of noninvasive ventilation (NIV) were collected.ResultsThe mean age of the 63 patients under study was 75 years. On admission the mean ejection fraction was 33% (95% CI: 31–35) and the BNP hormone median value was 726.5 pg/ml (range: 217 to 2283 pg/ml); 65% of the patients used NIV. The median value of MIP measured after clinical stabilization was -52.7 cmH2O (range: -20 to -120 cmH2O); 76% of the patients had MIP values below 70% of the predictive value. On discharge, after a median hospital stay of 11 days, the median MIP was -53.5 cmH2O (range:-20 to -150 cmH2O); 71% of the patients maintained their MIP values below 70% of the predictive value. The differences found were not statistically significant.ConclusionElderly patients admitted with AHF may present a high prevalence of RMW on admission; this condition may be maintained at similar levels on discharge in a large percentage of these patients, even after clinical stabilization of the heart condition.

Diaphragm abnormalities in heart failure and aging: mechanisms and integration of cardiovascular and respiratory pathophysiology

“…In a general outpatient population of CHF patients (age 50–60 yrs and NYHA classes I to III), the prevalence of inspiratory dysfunction is 30–50% [36,35,37]. However, conservative estimates suggest that approximately 60% of CHF patients (Class II and III) with 67 ± 9 years of age have inspiratory dysfunction [38], whereas the prevalence was 70–75% for a group of older patients (75 ± 11 years of age) with acute exacerbation of heart failure [39]. …”

“…Altogether, the aspects discussed above emphasize the importance of understanding the pathophysiological processes and the need for the development of new therapeutic strategies for inspiratory dysfunction. Inspiratory dysfunction in CHF does not correlate with markers of left ventricular function [65,39], is unaffected by acute decompensation of heart failure [39], and is not reversed by heart transplant [42]. These observations indicate that mechanisms beyond cardiac abnormalities per se are responsible for inspiratory dysfunction in CHF [12].…”

Efficacy of Inspiratory Training on Blood Gases and Brain Naturitic Peptide Among Patients With Heart Failure

“…Respiratory exercises will consist of traditional breathing exercises. 12 Inspiratory muscle training by IMT as follows:…”

Non‐invasive mechanical ventilation in elderly patients: A narrative review

“…The measurement of maximum inspiratory pressure objectively evaluates respiratory muscle strength and has important clinical significance, as maximum inspiratory pressure has a direct prognostic correlation with mortality in HF . Inspiratory muscle weakness has a prevalence of 30–50% in outpatients with chronic HF . In older people, HF can be precipitated by several factors: severe mitral regurgitation, systemic hypertension and myocardial ischemia .…”

“…43 Inspiratory muscle weakness has a prevalence of 30-50% in outpatients with chronic HF. 44 In older people, HF can be precipitated by several factors: severe mitral regurgitation, systemic hypertension and myocardial ischemia. 39 The application of a ventilatory support (continuous positive airway pressure [CPAP] or bilevel positive airway pressure) improves lung compliance, recruits previously collapsed alveoli, reduces preload and afterload, leading to an improvement oxygenation and reduction of respiratory muscles' workload.…”