Age-Related Frailty: A Clinical Model for Geroscience?

AbstractIn their everyday practice, geriatricians are confronted with the fact that older age and multimorbidity are associated to frailty. Indeed, if we take the example of a very old person with no diseases that progressively becomes frail with no other explanation, there is a natural temptation to link frailty to aging. On the other hand, when an old person with a medical history of diabetes, arthritis and congestive heart failure becomes frail there appears an obvious relationship between frailty and comorbidity. The unsolved question is: Considering that frailty is multifactorial and in the majority of cases comorbidity and aging are acting synergistically, can we disentangle the main contributor to the origin of frailty: disease or aging? We believe that it is important to be able to differentiate age-related frailty from frailty related to comorbidity. In fact, with the emergence of geroscience, the physiopathology, diagnosis, prognosis and treatment will probably have to be different in the future.

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Abstract 16010: Congestive Heart Failure and Coronavirus Disease 2019 Illness Severity

Circulation ◽

10.1161/circ.142.suppl_3.16010 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Max Ruge ◽

Joanne Michelle D Gomez ◽

Gatha G Nair ◽

Setri Fugar ◽

Jeanne du Fay de Lavallaz ◽

...

Keyword(s):

Heart Failure ◽

At Risk ◽

Congestive Heart Failure ◽

Case Fatality ◽

Severity Of Illness ◽

Severe Infection ◽

Severe Illness ◽

Increased Risk ◽

History Of ◽

Male Sex

Introduction: The coronavirus disease 2019 (COVID-19) pandemic has killed hundreds of thousands worldwide. Those with cardiovascular disease represent a vulnerable population with higher risk for contracting COVID-19 and worse prognosis with higher case fatality rates. Congestive heart failure (CHF) may lead to worsening COVID-19 symptoms. However, it is unclear if CHF is an independent risk factor for severe COVID-19 infection or if other accompanying comorbidities are responsible for the increased risk. Methods: From March to June 2020, data was obtained from adult patients diagnosed with COVID-19 infection who were admitted in the Rush University System for Health (RUSH) in Illinois. Heart failure patients, determined by ICD code assignments extracted from the electronic medical records, were identified. Multivariable logistic regression was performed between predictor variables and a composite outcome of severe infection consisting of Intensive Care Unit (ICU) admission, intubation, or in-hospital mortality. Results: In this cohort (n=1136), CHF [odds ratio (OR) 1.02] alone did not predict a more severe illness. Prior myocardial infarction [(MI), OR 3.55], history of atrial fibrillation [(AF), OR 2.14], and male sex (OR 1.55) were all significantly (p<0.001) associated with more severe COVID-19 illness course when controlling for CHF (Figure 1). In the 178 CHF patients, more advanced age (68.8 years vs. 63.8 years; p<0.05) and female sex (54.5% vs. 39.1%; p<0.05) were associated with increased severity of illness. Conclusions: Prior MI, history of AF, and male sex predicted more severe COVID-19 illness course in our cohort, but pre-existing heart failure alone did not. However, CHF patients who are females and older in age are at risk for severe infection. These findings help clinicians identify patients with comorbidities early at risk for severe COVID-19 illness.

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Derivation of a clinical decision rule for chest radiography in emergency department patients with chest pain and possible acute coronary syndrome

CJEM ◽

10.1017/s148180350001215x ◽

2010 ◽

Vol 12 (02) ◽

pp. 128-134 ◽

Cited By ~ 7

Author(s):

Erik P. Hess ◽

Jeffrey J. Perry ◽

Pam Ladouceur ◽

George A. Wells ◽

Ian G. Stiell

Keyword(s):

Heart Failure ◽

Emergency Department ◽

Congestive Heart Failure ◽

Chest Pain ◽

Chest Radiography ◽

Clinical Decision ◽

Chest Radiographs ◽

Clinical Decision Rule ◽

Coronary Syndrome ◽

History Of

ABSTRACTObjective:We derived a clinical decision rule to determine which emergency department (ED) patients with chest pain and possible acute coronary syndrome (ACS) require chest radiography.Methods:We prospectively enrolled patients over 24 years of age with a primary complaint of chest pain and possible ACS over a 6-month period. Emergency physicians completed standardized clinical assessments and ordered chest radiographs as appropriate. Two blinded investigators independently classified chest radiographs as “normal,” “abnormal not requiring intervention” and “abnormal requiring intervention,” based on review of the radiology report and the medical record. The primary outcome was abnormality of chest radiographs requiring acute intervention. Analyses included interrater reliability assessment (with κ statistics), univariate analyses and recursive partitioning.Results:We enrolled 529 patients during the study period between Jul. 1, 2007, and Dec. 31, 2007. Patients had a mean age of 59.9 years, 60.3% were male, 4.0% had a history of congestive heart failure and 21.9% had a history of acute myocardial infarction. Only 2.1% (95% confidence interval [CI] 1.1%–3.8%) of patients had radiographic abnormality of the chest requiring acute intervention. The κ statistic for chest radiograph classification was 0.81 (95% CI 0.66–0.95). We derived the following rule: patients can forgo chest radiography if they have no history of congestive heart failure, no history of smoking and no abnormalities on lung auscultation. The rule was 100% sensitive (95% CI 32.0%–10.4%) and 36.1% specific (95% CI 32.0%–40.4%).Conclusion:This rule has potential to reduce health care costs and enhance ED patient flow. It requires validation in an independent patient population before introduction into clinical practice.

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Prognostic factors in patients admitted to an urban teaching hospital with COVID-19 infection

10.21203/rs.3.rs-38340/v1 ◽

2020 ◽

Author(s):

Donogh Maguire ◽

Marylynne Woods ◽

Conor Richards ◽

Ross Dolan ◽

Jesse Wilson Veitch ◽

...

Keyword(s):

Heart Failure ◽

Medical History ◽

Teaching Hospital ◽

Prognostic Score ◽

Glasgow Prognostic Score ◽

Early Warning Score ◽

Past Medical History ◽

Urban Teaching ◽

Neutrophil Lymphocyte Ratio ◽

History Of

Abstract BackgroundSevere COVID-19 infection results in a systemic inflammatory response (SIRS). This SIRS response shares similarities to the changes observed during the peri-operative period that are recognised to be associated with the development of multiple organ failure. MethodsElectronic patient records for patients who were admitted to an urban teaching hospital during the initial 7-week period of the COVID-19 pandemic in Glasgow, U.K. (17th March 2020 - 1st May 2020) were examined for routine clinical, laboratory and clinical outcome data. Age, sex, BMI and documented evidence of COVID-19 infection at time of discharge or death certification were considered minimal criteria for inclusion.ResultsOf the 224 patients who fulfilled the criteria for inclusion, 52 (23%) had died at 30-days following admission. COVID-19 related respiratory failure (75%) and multiorgan failure (12%) were the commonest causes of death recorded. Age>70 years (p<0.001), past medical history of cognitive impairment (p<0.001), previous delirium (p<0.001), clinical frailty score>3 (p<0.001), hypertension (p<0.05), heart failure (p<0.01), national early warning score (NEWS) >4 (p<0.01), positive CXR (p<0.01), and subsequent positive COVID-19 swab (p<0.001) were associated with 30-day mortality. CRP>80 mg/L (p<0.05), albumin <35g/L (p<0.05), peri-operative Glasgow Prognostic Score (poGPS) (p<0.05), lymphocytes <1.5 109/l (p<0.05), neutrophil lymphocyte ratio (p<0.001), haematocrit (<0.40 L/L (male) / <0.37 L/L (female)) (p<0.01), urea>7.5 mmol/L (p<0.001), creatinine >130 mmol/L (p<0.05) and elevated urea: albumin ratio (<0.001) were also associated with 30-day mortality.On analysis, age >70 years (O.R. 3.9, 95% C.I. 1.4 – 8.2, p<0.001), past medical history of heart failure (O.R. 3.3, 95% C.I. 1.2 – 19.3, p<0.05), NEWS >4 (O.R. 2.4, 95% C.I. 1.1 – 4.4, p<0.05), positive initial CXR (O.R. 0.4, 95% C.I. 0.2-0.9, p<0.05) and poGPS (O.R. 2.3, 95% C.I. 1.1 – 4.4, p<0.05) remained independently associated with 30-day mortality. Among those patients who tested PCR COVID-19 positive (n=122), age >70 years (O.R. 4.7, 95% C.I. 2.0 - 11.3, p<0.001), past medical history of heart failure (O.R. 4.4, 95% C.I. 1.2 – 20.5, p<0.05) and poGPS (O.R. 2.4, 95% C.I. 1.1- 5.1, p<0.05) remained independently associated with 30-days mortality.ConclusionAge > 70 years and severe systemic inflammation as measured by the peri-operative Glasgow Prognostic Score are independently associated with 30-day mortality among patients admitted to hospital with COVID-19 infection.

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CASE REPORT: UNCONTROLLED HYPERTENSION CONTRIBUTES TO WORSENING OF PRESBYCUS SYMPTOMS IN THE ELDERLY

Journal of Community Medicine and Public Health Research ◽

10.20473/jcmphr.v1i1.20298 ◽

2020 ◽

Vol 1 (1) ◽

pp. 33

Author(s):

Faradila Budi Saputri ◽

Azizah Amimathul Firdha ◽

Safira Rahma ◽

Rieza Rizqy Alda ◽

Syahwina Inayasari ◽

...

Keyword(s):

Heart Failure ◽

Congestive Heart Failure ◽

Hearing Loss ◽

Case Report ◽

Hearing Aids ◽

Social Life ◽

Elderly Population ◽

The Elderly ◽

Uncontrolled Hypertension ◽

Age Related

Presbycusis is a disease that can befall the elderly, caused by a multifactorial process that should be allowed to disrupt communication and social life and cause mental disorders. According to WHO the proportion of the elderly population rises rapidly which is estimated in 2025, there are about 1,2 billion elderly people with a risk of presbycusis. Mr.S was 84 years old, married and had 2 children, complained of hearing loss since 10 years ago on the patient's left ear. The decline in hearing occurred gradually, giving the last 4 years after his wife's death. Patients was taken to Otorhinolaryngologist and expressed age-related hearing impairment and was advised to use hearing aids. Patients are not routinely using hearing aids. In addition, patients have hypertension and heart disease. Patients consumed Captopril 2x1 tablets, Fundifar 2x1, Furosemide 1x40 mg and Fargoxin 1x0.25 mg. Patients do not routinely consumed cardiac medicine and used hearing aids. From the results of heteroanamnesis, physical examination, and audiogram examination conducted in Mr.S patients, it can be concluded that Mr.S suffers from presbycusis with hypertensive and congestive heart failure. Mr.S was advised to routinely have their hearing check to Otorhinolaryngologist the as an evaluation and routine control to Cardiologist.

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SWEATING IN CONGENITAL HEART DISEASE

PEDIATRICS ◽

10.1542/peds.41.1.123 ◽

1968 ◽

Vol 41 (1) ◽

pp. 123-129

Author(s):

Blanche P. Alter ◽

Emily E. Czapek ◽

Richard D. Rowe

Keyword(s):

Heart Failure ◽

Congestive Heart Failure ◽

Congenital Heart Disease ◽

Heart Disease ◽

Congenital Heart ◽

Sweat Test ◽

Endocardial Fibroelastosis ◽

History Of Or ◽

History Of ◽

Sweat Tests

Sweating was found to be increased in children with congenital heart disease who had a propensity to congestive heart failure, e.g., children with endocardial fibroelastosis or large or moderate sized left-to-right shunts. This was suggested in a review of cardiac clinic records of 220 patients and was supported by the results of pilocarpine sweat tests which were performed on 34 cardiac patients. By history and by measurement of the amount of sweat produced, children with a history of or tendency toward heart failure could be predicted though patients did not need to be in failure when tested. Contrary to previous opinion, the left-to-right shunt was not in itself sufficient to cause the child to sweat. The shunt had to be large enough to be associated with failure at some time. It is suggested that the pilocarpine sweat test might actually be useful as an aid in predicting a child's potential for heart failure. Several theories regarding the mechanism of sweating in these situations are discussed.

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Developing and validating models to predict sudden death and pump failure death in patients with heart failure and preserved ejection fraction

Clinical Research in Cardiology ◽

10.1007/s00392-020-01786-8 ◽

2020 ◽

Author(s):

Li Shen ◽

Pardeep S. Jhund ◽

Inder S. Anand ◽

Peter E. Carson ◽

Akshay S. Desai ◽

...

Keyword(s):

Heart Failure ◽

Heart Rate ◽

Sudden Death ◽

Ejection Fraction ◽

External Validation ◽

Model Performance ◽

Preserved Ejection Fraction ◽

Clinical Model ◽

Pump Failure ◽

History Of

Abstract Background Sudden death (SD) and pump failure death (PFD) are leading modes of death in heart failure and preserved ejection fraction (HFpEF). Risk stratification for mode-specific death may aid in patient enrichment for new device trials in HFpEF. Methods Models were derived in 4116 patients in the Irbesartan in Heart Failure with Preserved Ejection Fraction trial (I-Preserve), using competing risks regression analysis. A series of models were built in a stepwise manner, and were validated in the Candesartan in Heart failure: Assessment of Reduction in Mortality and morbidity (CHARM)-Preserved and Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist (TOPCAT) trials. Results The clinical model for SD included older age, men, lower LVEF, higher heart rate, history of diabetes or myocardial infarction, and HF hospitalization within previous 6 months, all of which were associated with a higher SD risk. The clinical model predicting PFD included older age, men, lower LVEF or diastolic blood pressure, higher heart rate, and history of diabetes or atrial fibrillation, all for a higher PFD risk, and dyslipidaemia for a lower risk of PFD. In each model, the observed and predicted incidences were similar in each risk subgroup, suggesting good calibration. Model discrimination was good for SD and excellent for PFD with Harrell’s C of 0.71 (95% CI 0.68–0.75) and 0.78 (95% CI 0.75–0.82), respectively. Both models were robust in external validation. Adding ECG and biochemical parameters, model performance improved little in the derivation cohort but decreased in validation. Including NT-proBNP substantially increased discrimination of the SD model, and simplified the PFD model with marginal increase in discrimination. Conclusions The clinical models can predict risks for SD and PFD separately with good discrimination and calibration in HFpEF and are robust in external validation. Adding NT-proBNP further improved model performance. These models may help to identify high-risk individuals for device intervention in future trials. Clinical trial registration I-Preserve: ClinicalTrials.gov NCT00095238; TOPCAT: ClinicalTrials.gov NCT00094302; CHARM-Preserved: ClinicalTrials.gov NCT00634712. Graphic abstract

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Cor triatriatum sinistrum diagnosed in the adulthood: a systematic review

Heart ◽

10.1136/heartjnl-2019-314714 ◽

2019 ◽

pp. heartjnl-2019-314714 ◽

Cited By ~ 1

Author(s):

Virginija Rudienė ◽

Cristel M S Hjortshøj ◽

Sigita Glaveckaitė ◽

Diana Zakarkaitė ◽

Žaneta Petrulionienė ◽

...

Keyword(s):

Heart Failure ◽

Systematic Review ◽

Congestive Heart Failure ◽

Natural History ◽

Cor Triatriatum ◽

Interventional Treatment ◽

Cardiac Defects ◽

First Choice ◽

History Of ◽

Membrane Physiology

BackgroundWe performed a systematic review of cor triatriatum sinistrum (CTS) diagnosed in adults. The aim of this review was to describe the clinical presentation, natural history and management of this congenital heart disease.MethodsA PubMed literature search for ‘cor triatriatum sinistrum’ published since 2005 was performed. Included patients were divided into those with and without obstructive membrane physiology. The clinical course differences were compared.ResultsA total of 171 published cases were included. The median age at diagnosis was 43 years (IQR, 30–60). Obstructive membrane physiology was observed in 70 (41%), and this patient group was younger at presentation (median age 39 (IQR, 28–52) vs 50 years (IQR, 32–64), p=0.003).Patients with obstructive membrane more frequently had associated cardiac defects (58.6% vs 42.4%, p=0.039). Overall, the most frequent clinical symptom was atrial fibrillation, as this was present in 56 (32.8%) of all patients. CTS-related symptoms were more frequent in patients with obstructive membrane: congestive heart failure (44.3% vs 15.2%, p<0.001), pulmonary hypertension (27.1% vs 6.1%, p<0.001), haemorrhage (8.6% vs 0%, p=0.004) and infections manifestation (8.6% vs 0%, p=0.004).A total of 71 (41.5%) patients with CTS required interventional treatment, mainly within patients with the obstructive membrane (86.8% vs 12.6%, p<0.001).ConclusionThe natural history of CTS most often manifests with symptoms of congestive heart failure. Patients with obstructive membrane most often have associated cardiac defects and higher risk for infections and haemorrhage. The interventional treatment of CTS remains the first choice for obstructive membrane.

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Being a Palliative Nurse for Persons with Severe Congestive Heart Failure in Advanced Homecare

European Journal of Cardiovascular Nursing ◽

10.1016/j.ejcnurse.2005.04.007 ◽

2005 ◽

Vol 4 (4) ◽

pp. 314-323 ◽

Cited By ~ 24

Author(s):

Margareta Brännström ◽

Christine Brulin ◽

Astrid Norberg ◽

Kurt Boman ◽

Gunilla Strandberg

Keyword(s):

Heart Failure ◽

Congestive Heart Failure ◽

Severe Congestive Heart Failure ◽

The Other ◽

Culture Clash ◽

Great Weight ◽

Way Of Life ◽

Narrative Interviews ◽

Other Hand ◽

Good For

Advanced homecare for persons with congestive heart failure is a ‘new’ challenge for palliative nurses. The aim of this study is to illuminate the meaning of being a palliative nurse for persons with severe congestive heart failure in advanced homecare. Narrative interviews with 11 nurses were conducted, tape-recorded, and transcribed verbatim. A phenomenological-hermeneutic method was used to interpret the text. One meaning of being a palliative nurse is being firmly rooted and guided by the values of palliative culture. Being adaptable to the patient's way of life carries great weight. On one hand nurses live out this value, facilitating for the patients to live their everydaylife as good as possible. Being a facilitator is revealed as difficult, challenging, but overall positive. On the other hand nurses get into a tight corner when values of palliative culture clash and do not correspond with the nurses interpretation of what is good for the person with congestive heart failure. Being in such a tight corner is revealed as frustrating and giving rise to feelings of inadequacy. Thus, it seems important to reflect critical on the values of palliative culture.

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Computer Modeling of Fluid-Stress-Induced Blood Damage in a Mechanical Ventricular Assist Device

Volume 2: Biomedical and Biotechnology Engineering ◽

10.1115/imece2009-11605 ◽

2009 ◽

Author(s):

Alexandrina Untaroiu ◽

Houston G. Wood ◽

Paul E. Allaire

Keyword(s):

Heart Failure ◽

Congestive Heart Failure ◽

Red Blood Cells ◽

Blood Cells ◽

Damage Index ◽

Computational Domain ◽

Ventricular Assist ◽

Blood Damage ◽

History Of ◽

Number Of Particles

Congestive heart failure results the heart is unable to pump the required amount of blood to maintain the systemic circulation. World-wide, millions of patients are diagnosed with congestive heart failure every year, many of which ultimately become candidates for heart transplants. The limited number of available donor hearts, however, has resulted in a tremendous demand for alternative, supplemental circulatory support in the form of artificial heart pumps to serve as a “Bridge-to-Transplant”. The prospect of artificial heart pumps used for long-term support of congestive heart failure patients is directly dependent upon excellent blood compatibility. High fluid stress levels may arise due to high rotational speeds and narrow clearances between the stationary and rotating parts of the pump. Thus, fluid stress may result in damage to red blood cells and activation of platelets, contributing to thrombus formation. Therefore, it is essential to evaluate levels of blood trauma for successful design of a mechanical Ventricular Assist Device. Estimating the fluid stress levels that occur in a blood pump during the design phase also provides valuable information for optimization considerations. This study describes the CFD evaluation of blood damage in a magnetically suspended axial pump that occurs due to fluid stress. Using CFD, a blood damage index, reflecting the percentage of damaged red blood cells, was numerically estimated based on the scalar fluid stress values and exposure time to such stresses. A number of particles, with no mass and reactive properties, was injected at the inflow of the computational domain and traveled along their corresponding streamlines. A Lagrangian particle tracking technique was employed to obtain the stress history of each particle along its streamline, making it possible to consider the damage history of each particle. Maximum scalar stresses of approximately 430 Pa were estimated to occur along the tip surface of the impeller blades, more precisely at the leading edge of the impeller blades. The maximum time required for the vast majority of particles to pass through the pump was approximately 0.085sec. A small number of particles (approximately 5%), which traveled through the narrow gap between the stationary and rotating part of the pump, exited the computational domain in approximately 0.2 sec. The mean value of blood damage index was found to be 0.15% with a maximum value of approximately 0.47%. These values are one order of magnitude lower than the approximated damage indices published in the literature for other Ventricular Assist Devices. The low blood damage index indicates that red blood cells traveling along the streamlines considered are not likely to be ruptured, mainly due to the very small time of exposure to high stress.

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Evaluation of ACE Inhibitor Therapy for Congestive Heart Failure in an Outpatient Setting

Journal of Pharmacy Technology ◽

10.1177/875512259801400106 ◽

1998 ◽

Vol 14 (1) ◽

pp. 7-11 ◽

Cited By ~ 1

Author(s):

Barry E Bleske ◽

Laura A Cornish ◽

Steven R Erickson ◽

John M Nicklas

Keyword(s):

Heart Failure ◽

Congestive Heart Failure ◽

Ace Inhibitor ◽

Standard Of Care ◽

Outpatient Setting ◽

Inhibitor Therapy ◽

University Teaching ◽

Patient Specific ◽

Heart Failure Clinic ◽

History Of

Objective: Angiotensin-converting enzyme (ACE) inhibitor therapy is considered the standard of care for the treatment of congestive heart failure. Despite this, clinical experience suggests that not all patients may be receiving ACE inhibitor therapy or may be receiving low dosages. This study was performed to better understand the use of ACE inhibitor therapy in clinical practice. Design and Participants: We reviewed the medical therapy of 110 patients with a history of congestive heart failure referred to an outpatient heart failure clinic at a university teaching hospital. Outcome Measures: This observational study evaluated the use of ACE inhibitors, including dosage, as well as other drugs to treat congestive heart failure. Results: Approximately 85% (93/110) of patients were receiving an ACE inhibitor. Twenty percent (22/110) were receiving enalapril 20 mg/d or more, captopril 150 mg/d or more, lisinopril 20 mg/d or more, or quinapril 40 mg/d or more. The remaining patients (n = 71) were receiving these drugs at lower dosages. However, 21 of the remaining patients (19% of all patients) were receiving lower dosages based on patient-specific parameters; 47 of the remaining patients (43% of all patients) were eligible to have their dosage increased. Ten eligible patients were not receiving an ACE inhibitor. The majority of patients were also receiving digoxin (70%) and loop diuretic (80%) therapy. Conclusions: Approximately 85% of patients were receiving ACE inhibitor therapy, with 9% of eligible patients not receiving an ACE inhibitor. In the patients receiving ACE inhibitor therapy, approximately 50% (47/93) were receiving dosages below those suggested in the guidelines. Overall, the use of ACE inhibitor therapy is varied and intervention appears required to ensure that all patients receive appropriate therapy for the treatment of congestive heart failure.

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