Ambarish Pandey1, Dalane Kitzman2, David J Whellan3, Pamela W Duncan4, Robert J Mentz5, Amy M Pastva6, M Benjamin Nelson2, Bharathi Upadhya2, Haiying Chen7, Gordon R Reeves8. 1. Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas. 2. Department of Internal Medicine, Section of Cardiovascular Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina. 3. Department of Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania. 4. Department of Neurology, Wake Forest School of Medicine, Winston-Salem, North Carolina. 5. Department of Medicine, Cardiology Division, Duke University School of Medicine, Durham, North Carolina. 6. Department of Medicine and Orthopedic Surgery, Duke University School of Medicine, Durham, North Carolina. 7. Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, North Carolina. 8. Heart and Vascular Institute, Novant Health, Charlotte, North Carolina. Electronic address: grreeves@novanthealth.org.
Abstract
OBJECTIVES: This study sought to assess the prevalence of frailty, its associations with physical function, quality of life (QoL), cognition, and depression and to investigate more efficient methods of detection in older patients hospitalized with acute decompensated heart failure (ADHF). BACKGROUND: In contrast to the outpatient population with chronic HF, much less is known regarding frailty in older, hospitalized patients with ADHF. METHODS: Older hospitalized patients (N = 202) with ADHF underwent assessment of frailty (using Fried criteria), short physical performance battery (SPPB), 6-min walk test (6-MWT) distance, quality of life (QoL using the Kansas City Cardiomyopathy Questionnaire), cognition (using the Montreal Cognition Assessment), and depression (using the Geriatric Depression Screen [GDS]). The associations of frailty with these patient-centered outcomes were assessed by using adjusted linear regression models. Novel strategies to identify frailty were examined. RESULTS: A total of 50% of older, hospitalized patients with ADHF were frail, 48% were pre-frail, and 2% were non-frail. Female sex, burden of comorbidity, and prior HF hospitalization were significantly associated with higher likelihood of frailty. Frailty (vs. pre-frail status) was associated with a significantly worse SPPB score (5 ± 2.2 vs. 7 ± 2.4, respectively), 6-MWT distance (143 ± 79 m vs. 221 ± 99 m, respectively), QoL (35 ± 19 vs. 46 ± 21, respectively), and more depression (GDS score: 5.5 ± 3.5 vs. 4.2 ± 3.3, respectively) but similar cognition. These associations were unchanged after adjustment for age, sex, race, total comorbidities, and body mass index. Slow gait speed plus low physical activity signaled frailty status as well (C-statistic = 0.85). CONCLUSIONS: Ninety-eight percent of older, hospitalized patients with ADHF are frail or pre-frail. Frailty (vs. pre-frail status) is associated with worse physical function, QoL, comorbidity, and depression. The simple 4-m walk test combined with self-reported physical activity may quickly and efficiently identify frailty in older patients with ADHF.
OBJECTIVES: This study sought to assess the prevalence of frailty, its associations with physical function, quality of life (QoL), cognition, and depression and to investigate more efficient methods of detection in older patients hospitalized with acute decompensated heart failure (ADHF). BACKGROUND: In contrast to the outpatient population with chronic HF, much less is known regarding frailty in older, hospitalized patients with ADHF. METHODS: Older hospitalized patients (N = 202) with ADHF underwent assessment of frailty (using Fried criteria), short physical performance battery (SPPB), 6-min walk test (6-MWT) distance, quality of life (QoL using the Kansas City Cardiomyopathy Questionnaire), cognition (using the Montreal Cognition Assessment), and depression (using the Geriatric Depression Screen [GDS]). The associations of frailty with these patient-centered outcomes were assessed by using adjusted linear regression models. Novel strategies to identify frailty were examined. RESULTS: A total of 50% of older, hospitalized patients with ADHF were frail, 48% were pre-frail, and 2% were non-frail. Female sex, burden of comorbidity, and prior HF hospitalization were significantly associated with higher likelihood of frailty. Frailty (vs. pre-frail status) was associated with a significantly worse SPPB score (5 ± 2.2 vs. 7 ± 2.4, respectively), 6-MWT distance (143 ± 79 m vs. 221 ± 99 m, respectively), QoL (35 ± 19 vs. 46 ± 21, respectively), and more depression (GDS score: 5.5 ± 3.5 vs. 4.2 ± 3.3, respectively) but similar cognition. These associations were unchanged after adjustment for age, sex, race, total comorbidities, and body mass index. Slow gait speed plus low physical activity signaled frailty status as well (C-statistic = 0.85). CONCLUSIONS: Ninety-eight percent of older, hospitalized patients with ADHF are frail or pre-frail. Frailty (vs. pre-frail status) is associated with worse physical function, QoL, comorbidity, and depression. The simple 4-m walk test combined with self-reported physical activity may quickly and efficiently identify frailty in older patients with ADHF.
Authors: J M Guralnik; L Ferrucci; C F Pieper; S G Leveille; K S Markides; G V Ostir; S Studenski; L F Berkman; R B Wallace Journal: J Gerontol A Biol Sci Med Sci Date: 2000-04 Impact factor: 6.053
Authors: Sameer Ather; Wenyaw Chan; Biykem Bozkurt; David Aguilar; Kumudha Ramasubbu; Amit A Zachariah; Xander H T Wehrens; Anita Deswal Journal: J Am Coll Cardiol Date: 2012-03-13 Impact factor: 24.094
Authors: Kevin S Shah; Haolin Xu; Roland A Matsouaka; Deepak L Bhatt; Paul A Heidenreich; Adrian F Hernandez; Adam D Devore; Clyde W Yancy; Gregg C Fonarow Journal: J Am Coll Cardiol Date: 2017-11-12 Impact factor: 24.094
Authors: María T Vidán; Vendula Blaya-Novakova; Elísabet Sánchez; Javier Ortiz; José A Serra-Rexach; Héctor Bueno Journal: Eur J Heart Fail Date: 2016-04-12 Impact factor: 15.534
Authors: Susan M Joseph; Joshua L Manghelli; Justin M Vader; Tamra Keeney; Eric L Novak; Joost Felius; Sara C Martinez; Michael E Nassif; Brian Lima; Scott C Silvestry; Michael W Rich Journal: Am J Cardiol Date: 2017-08-01 Impact factor: 2.778
Authors: Sheila M McNallan; Mandeep Singh; Alanna M Chamberlain; Robert L Kane; Shannon M Dunlay; Margaret M Redfield; Susan A Weston; Véronique L Roger Journal: JACC Heart Fail Date: 2013-04 Impact factor: 12.035
Authors: Shannon M Dunlay; Soon J Park; Lyle D Joyce; Richard C Daly; John M Stulak; Sheila M McNallan; Véronique L Roger; Sudhir S Kushwaha Journal: J Heart Lung Transplant Date: 2013-12-27 Impact factor: 10.247
Authors: Gordon R Reeves; David J Whellan; Christopher M O'Connor; Pamela Duncan; Joel D Eggebeen; Timothy M Morgan; Leigh Ann Hewston; Amy Pastva; Mahesh J Patel; Dalane W Kitzman Journal: JACC Heart Fail Date: 2017-03-08 Impact factor: 12.035
Authors: Eiran Z Gorodeski; Parag Goyal; Scott L Hummel; Ashok Krishnaswami; Sarah J Goodlin; Linda L Hart; Daniel E Forman; Nanette K Wenger; James N Kirkpatrick; Karen P Alexander Journal: J Am Coll Cardiol Date: 2018-05-01 Impact factor: 24.094
Authors: Evan M Murray; David J Whellan; Haiying Chen; Alain G Bertoni; Pamela Duncan; Amy M Pastva; Dalane W Kitzman; Robert J Mentz Journal: Am J Med Date: 2021-09-10 Impact factor: 4.965
Authors: M Benjamin Nelson; Olivia N Gilbert; Pamela W Duncan; Dalane W Kitzman; Gordon R Reeves; David J Whellan; Robert J Mentz; Haiying Chen; Leigh Ann Hewston; Karen M Taylor; Amy M Pastva Journal: J Am Heart Assoc Date: 2022-06-03 Impact factor: 6.106
Authors: Jamie N Justice; Nicholas M Pajewski; Mark A Espeland; Peter Brubaker; Denise K Houston; Santica Marcovina; Barbara J Nicklas; Stephen B Kritchevsky; Dalane W Kitzman Journal: Geroscience Date: 2022-01-10 Impact factor: 7.581
Authors: Ambarish Pandey; Sanjiv J Shah; Javed Butler; Dean L Kellogg; Gregory D Lewis; Daniel E Forman; Robert J Mentz; Barry A Borlaug; Marc A Simon; Julio A Chirinos; Roger A Fielding; Elena Volpi; Anthony J A Molina; Mark J Haykowsky; Flora Sam; Bret H Goodpaster; Alain G Bertoni; Jamie N Justice; James P White; Jingzhone Ding; Scott L Hummel; Nathan K LeBrasseur; George E Taffet; Iraklis I Pipinos; Dalane Kitzman Journal: J Am Coll Cardiol Date: 2021-09-14 Impact factor: 27.203
Authors: Dalane W Kitzman; David J Whellan; Pamela Duncan; Amy M Pastva; Robert J Mentz; Gordon R Reeves; M Benjamin Nelson; Haiying Chen; Bharathi Upadhya; Shelby D Reed; Mark A Espeland; LeighAnn Hewston; Christopher M O'Connor Journal: N Engl J Med Date: 2021-05-16 Impact factor: 176.079
Authors: Parag Goyal; Brian Yum; Pedram Navid; Ligong Chen; Dae H Kim; Jason Roh; Byron C Jaeger; Emily B Levitan Journal: Am J Cardiol Date: 2021-03-03 Impact factor: 3.133