Inaccurate recognition of own comorbidities is associated with poor prognosis in elderly patients with heart failure

Abstract

Aims A patient's understanding of his or her own comorbidities is part of the recommended patient education for those with heart failure. The accuracy of patients' understanding of their comorbidities and its prognostic impact have not been reported. Methods and resultsPatients hospitalized for heart failure (n = 1234) aged ≥65 years (mean age: 80.1 ± 7.7 years; 531 females) completed a questionnaire regarding their diagnoses of diabetes, malignancy, stroke, hypertension, chronic obstructive pulmonary disease (COPD), and coronary artery disease (CAD). The patients were categorized into three groups based on the number of agreements between self-reported comorbidities and provider-reported comorbidities: low (1-2, n = 19); fair (3-4, n = 376); and high (5-6, n = 839) agreement groups. The primary outcome was a composite of all-cause mortality or heart failure rehospitalization at 1 year. The low agreement group had more comorbidities and a higher prevalence of a history of heart failure. The agreement was good for diabetes (κ = 0.73), moderate for malignancy (κ = 0.56) and stroke (κ = 0.50), and poor-to-fair for hypertension (κ = 0.33), COPD (κ = 0.25), and CAD (κ = 0.30). The fair and low agreement groups had poorer outcomes than the good agreement group [fair agreement group: hazard ratio (HR): 1.25; 95% confidence interval (CI): 1.01-1.56; P = 0.041; low agreement group: HR: 2.74: 95% CI: 1.40-5.35; P = 0.003]. Conclusions The ability to recognize their own comorbidities among older patients with heart failure was low. Patients with less accurate recognition of their comorbidities may be at higher risk for a composite of all-cause mortality or heart failure rehospitalization.

Prognostic Value of Objective Social Isolation and Loneliness in Older Patients With Heart Failure: Subanalysis of FRAGILE‐HF and Kitasato Cohort

“…The FRAGILE‐HF study is a multicenter prospective observational study conducted in Japan to investigate the association between multidomain frailty and prognosis in older patients with HF. 12 , 31 , 32 , 33 A total of 1332 patients admitted to 15 hospitals in Japan were enrolled between September 2016 and March 2018. The study inclusion criteria were as follows: patients aged ≥65 years, diagnosed with HF, and capable of walking at the time of discharge.…”

Predictive value of the Ishii score for sarcopenia and the prognosis of older patients hospitalized with heart failure

“…This was a post hoc analysis of the FRAGILE‐HF study, a prospective multicenter registry aimed at evaluating the prevalence, overlap, and prognostic value of physical frailty, social frailty, and cognitive dysfunction in older patients with heart failure. The detailed protocol of the FRAGILE‐HF study has been previously reported 15–17 . In total, 1332 patients hospitalized for heart failure, aged ≥65 years, and able to ambulate at discharge were registered between September 2016 and March 2018.…”

“…The detailed protocol of the FRAGILE-HF study has been previously reported. [15][16][17] In total, 1332 patients hospitalized for heart failure, aged ≥65 years, and able to ambulate at discharge were registered between September 2016 and March 2018. Heart failure was defined on the basis of the Framingham criteria.…”

Frailty, Sarcopenia, Cachexia, and Malnutrition in Heart Failure

“…In total, the study enrolled 1,332 hospitalized patients with HF aged 65 years or older, who were capable of ambulation upon discharge, from 15 hospitals across Japan. 49) 50) 51) Using the data, we created an overlap diagram, as shown in Figure 1 . Our group previously highlighted the significance of multidomain frailty (i.e., physical, cognitive, and social domains) assessed by both the cumulative deficit and phenotypic models 49) 52) ; however, physical frailty defined by the Fried phenotype model is regarded as frailty in this analysis to enable the easy understanding of the interaction of these four entities.…”