Predicting non-elective hospital readmission or death using a composite assessment of cognitive and physical frailty in elderly inpatients with cardiovascular disease

Yao, Simin; Zheng, Pan; Liang, Yutong; Wan, Yanan; Sun, Ning; Luo, Yong; Yang, Jiefu; Wang, Hua

doi:10.1186/s12877-020-01606-8

Cited by 17 publications

(13 citation statements)

References 42 publications

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“…Frailty is of particularly concern for patients with HF. HF put the repeatedly exposes geriatric patients to stress and vulnerability, and the prevalence of frailty is higher in these patients than in the general older adults, which may be associated with depression, disability, and cognitive impairment [ 6 – 8 ]. According to the process of HF development [ 9 ], HF is divided into four stages of A (preHF), B (preclinical HF), C (clinical HF), and D (refractory HF).…”

Section: Introductionmentioning

confidence: 99%

Frailty related all-cause mortality or hospital readmission among adults aged 65 and older with stage-B heart failure inpatients

Zheng

Yao

et al. 2021

BMC Geriatr

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Background Frailty increases the adverse outcomes of clinical heart failure; however, the relationship between frailty and stage-B heart failure (SBHF) remains unknown. We aimed to explore the epidemiology and predictive value of frailty in older adults with SBHF. Methods A prospective cohort of SBHF inpatients aged 65 years or older who were hospitalized between September 2018 and February 2019 and were followed up for 6 months were included. SBHF was defined as systolic abnormality, structural abnormality (left ventricular enlargement, left ventricular hypertrophy, wall motion abnormalities, valvular heart disease), or prior myocardial infarction. Frailty was assessed by the Fried frailty phenotype. Multivariable Cox proportional hazards regression was used to explore the independent risk and prognostic factors. Results Data of 443 participants (age: 76.1 ± 6.79 years, LVEF: 62.8 ± 4.92%, men: 225 [50.8%], frailty: 109 [24.6%]) were analyzed. During the 6-month follow-up, 83 (18.7%) older SBHF inpatients experienced all-cause mortality or readmission, and 29 (6.5%) of them developed clinical HF. Frail individuals had a 1.78–fold (95%CI: 1.02–3.10, P = 0.041) higher risk of 6-month mortality or readmission and a 2.83–fold (95%CI 1.24–6.47, P = 0.014) higher risk of developing clinical HF, independent of age, sex, left ventricular ejection fraction, and N-terminal pro-B-type natriuretic peptide level. Conclusions Frailty is common in older SBHF inpatients and should be considered to help identify individuals with an increased risk of mortality or readmission, and developing clinical HF. Trial registration ChiCTR1800017204.

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Section: Introductionmentioning

confidence: 99%

Frailty related all-cause mortality or hospital readmission among adults aged 65 and older with stage-B heart failure inpatients

Zheng

Yao

et al. 2021

BMC Geriatr

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“…Cognitive impairment exerts a detrimental effect on prognosis among older communitydwelling adults [31]. This same effect was observed in patients hospitalized in the cardiology department for acute heart failure or any cardiac cause at 6 months and 1-year follow-up [32][33][34]. Likewise, cognitive impairment diagnosed during hospitalization influenced in-hospital and 1-year mortality in acute myocardial infarction patients [4][5][6][7].…”

Section: Prognosis Impactmentioning

confidence: 74%

Long-Term Prognostic Value of Cognitive Impairment on Top of Frailty in Older Adults after Acute Coronary Syndrome

Forés

Bonanad

García‐Blas

et al. 2021

JCM

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Frailty is a marker of poor prognosis in older adults after acute coronary syndrome. We investigated whether cognitive impairment provides additional prognostic information. The study population consisted of a prospective cohort of 342 older (>65 years) adult survivors after acute coronary syndrome. Frailty (Fried score) and cognitive function (Pfeiffer’s Short Portable Mental Status Questionnaire—SPMSQ) were assessed at discharge. The endpoints were mortality or acute myocardial infarction at 8.7-year median follow-up. Patient distribution according to SPMSQ results was: no cognitive impairment (SPMSQ = 0 errors; n = 248, 73%), mild impairment (SPMSQ = 1–2 errors; n = 52, 15%), and moderate to severe impairment (SPMSQ ≥3 errors; n = 42, 12%). A total of 245 (72%) patients died or had an acute myocardial infarction, and 216 (63%) patients died. After adjustment for clinical data, comorbidities, and Fried score, the SPMSQ added prognostic value for death or myocardial infarction (per number of errors; HR = 1.11, 95%, CI 1.04–1.19, p = 0.002) and death (HR = 1.11, 95% 1.03–1.20, p = 0.007). An SPMSQ with ≥3 errors identified the highest risk subgroup. Geriatric conditions (SPSMQ and Fried score) explained 19% and 43% of the overall chi-square of the models for predicting death or myocardial infarction and death, respectively. Geriatric assessment after acute coronary syndrome should include both frailty and cognitive function. This is particularly important given that cognitive impairment without dementia can be subclinical and thus remain undetected.

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“…One possible reason for this inconsistency may be that we excluded patients with dementia from our study, and only patients with mild cognitive decline were enrolled, and thus there was an insufficient number of cases with CVD to detect early changes in cognitive function. Second, previous studies have found that some forms of CVD and risk factors, such as heart failure ( Yao et al, 2020 ), coronary artery disease ( Ma et al, 2020 ), stroke ( Chumha et al, 2020 ), atrial fibrillation ( Guo et al, 2020 ), and obesity ( Chan et al, 2020 ), are significantly associated with frailty, thus the relationship between CVDs or risk factors and MCI may be weakened in frail patients. Further research on CVDs and MCI in frail patients should be performed in the future.…”

Section: Discussionmentioning

confidence: 99%

Urinary 8-OxoGsn as a Potential Indicator of Mild Cognitive Impairment in Frail Patients With Cardiovascular Disease

Yao

Zheng

et al. 2021

Front. Aging Neurosci.

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Oxidative RNA damage has been found to be associated with age-related diseases and 8-oxo-7,8-dihydroguanosine (8-oxoGsn) is a typical marker of oxidative modification of RNA. Urine tests are a feasible non-invasive diagnostic modality. The present study aimed to assess whether the measurement of urinary 8-oxoGsn could represent a potential early maker in mild cognitive impairment (MCI) of frail patients with cardiovascular disease (CVD). In this cross-sectional study performed in China from September 2018 to February 2019. Urinary 8-oxoGsn was measured in frail (Fried phenotype: 3–5) in patients with CVD and was adjusted by urinary creatinine (Cre) levels. Cognitive function was assessed by the Chinese version of the Mini-Mental State Examination (MMSE) and participants were classified into non-MCI (≥24) and MCI (<24) groups. Univariate and multivariate logistic regression models were used to determine the relationship between 8-oxoGsn/Cre and MCI. Receiver operating characteristic (ROC) curve analysis was used to assess the 8-oxoGsn/Cre ratio in relation to MCI in frail patients with CVD. A total of 106 elderly patients were enrolled in this study. The mean age of participants was 77.9 ± 6.8 years, the overall prevalence of MCI was 22.6% (24/106), and 57.5% (61/106) of participants were women. In the multivariate logistic regression analysis, urinary 8-oxoGsn/Cre was independently associated with MCI (odds ratio [OR] = 1.769, 95% confidence interval [CI] = 1.234–2.536, P = 0.002), after adjusting for age, sex, education level, marital status, and serum prealbumin levels. The area under the ROC curve was 0.786 (0.679–0.893) (P < 0.001), and the optimal cut-off value was 4.22 μmol/mol. The urinary 8-oxoGsn/Cre ratio showed a sensitivity of 87.5% and a specificity of 69.5%. The present study suggests the urinary 8-oxoGsn/Cre ratio may be a useful indicator for the early screening of MCI in frail patients with CVD.Clinical Trial RegistrationChiCTR1800017204; date of registration: 07/18/2018. URL: http://www.chictr.org.cn/showproj.aspx?proj=28931.

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Predicting non-elective hospital readmission or death using a composite assessment of cognitive and physical frailty in elderly inpatients with cardiovascular disease

Cited by 17 publications

References 42 publications

Frailty related all-cause mortality or hospital readmission among adults aged 65 and older with stage-B heart failure inpatients

Frailty related all-cause mortality or hospital readmission among adults aged 65 and older with stage-B heart failure inpatients

Long-Term Prognostic Value of Cognitive Impairment on Top of Frailty in Older Adults after Acute Coronary Syndrome

Urinary 8-OxoGsn as a Potential Indicator of Mild Cognitive Impairment in Frail Patients With Cardiovascular Disease

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