Patterns of Comorbidity in Older Adults with Heart Failure: The Cardiovascular Research Network PRESERVE Study

Abstract Aims Limited data exist on the epidemiology, evaluation, and prognosis of otherwise unexplained anaemia of the elderly in heart failure (HF). Thus, we aimed to determine the incidence of anaemia, to characterize diagnostic testing patterns for potentially reversible causes of anaemia, and to evaluate the independent association between incident anaemia and long-term morbidity and mortality. Methods and results Within the Cardiovascular Research Network (CVRN), we identified adults age ≥65 years with diagnosed HF between 2005 and 2012 and no anaemia at entry. Incident anaemia was defined using World Health Organization (WHO) haemoglobin thresholds (<13.0 g/dL in men; <12.0 g/dL in women). All-cause death and hospitalizations for HF and any cause were identified from electronic health records. Among 38 826 older HF patients, 22 163 (57.1%) developed incident anaemia over a median (interquartile range) follow-up of 2.9 (1.2–5.6) years. The crude rate [95% confidence interval (CI)] per 100 person-years of incident anaemia was 26.4 (95% CI 26.0–26.7) and was higher for preserved ejection fraction (EF) [29.2 (95% CI 28.6–29.8)] compared with borderline EF [26.5 (95% CI 25.4–27.7)] or reduced EF [26.6 (95% CI 25.8–27.4)]. Iron indices, vitamin B12 level, and thyroid testing were performed in 20.9%, 14.9%, and 40.2% of patients, respectively. Reduced iron stores, vitamin B12 deficiency, and/or hypothyroidism were present in 29.7%, 3.2%, and 18.6% of tested patients, respectively. In multivariable analyses, incident anaemia was associated with excess mortality [hazard ratio (HR) 2.14, 95% CI 2.07–2.22] as well as hospitalization for HF (HR 1.80, 95% CI 1.72–1.88) and any cause (HR 1.77, 95% CI 1.72–1.83). Conclusion Among older adults with HF, incident anaemia is common and independently associated with substantially increased risks of morbidity and mortality. Additional research is necessary to clarify the value of routine evaluation and treatment of potentially reversible causes of anaemia.

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Comparison of Medication Practices in Patients With Heart Failure and Preserved Versus Those With Reduced Ejection Fraction (from the Cardiovascular Research Network [CVRN])

The American Journal of Cardiology ◽

10.1016/j.amjcard.2013.01.276 ◽

2013 ◽

Vol 111 (9) ◽

pp. 1324-1329 ◽

Cited By ~ 9

Author(s):

Robert J. Goldberg ◽

Jerry H. Gurwitz ◽

Jane S. Saczynski ◽

Grace Hsu ◽

David D. McManus ◽

...

Keyword(s):

Heart Failure ◽

Ejection Fraction ◽

Research Network ◽

Cardiovascular Research ◽

Reduced Ejection Fraction ◽

Patients With Heart Failure

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Abstract 317: Outcomes after Primary Prevention Implantable Cardioverter Defibrillator Placement: Results of the Cardiovascular Research Network Longitudinal Study of Implantable Cardioverter Defibrillators

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.7.suppl_1.317 ◽

2014 ◽

Vol 7 (suppl_1) ◽

Author(s):

Frederick A Masoudi ◽

Alan S Go ◽

David J Magid ◽

Liza M Reifler ◽

Karen A Glenn ◽

...

Keyword(s):

Heart Failure ◽

Primary Prevention ◽

Left Ventricular ◽

Research Network ◽

Implantable Cardioverter Defibrillators ◽

Heart Failure Hospitalization ◽

Icd Implantation ◽

Cardiovascular Research ◽

Clinical Variables ◽

Cardioverter Defibrillators

Background: Implantable cardioverter defibrillators (ICDs) are commonly used for the primary prevention of sudden cardiac death. Controversies persist, however, about outcomes in representative cohorts and in clinically important patient subgroups. Observational studies of outcomes following primary prevention ICD implantation are typically limited to relatively restricted cohorts (e.g. Medicare) or with short follow up. Methods: In the Cardiovascular Research Network (CVRN), we conducted a study in 7 integrated health care delivery systems to identify patients undergoing primary prevention ICD implantation for left ventricular systolic dysfunction between 2006-2010. Baseline procedural and clinical data were obtained from the NCDR ICD Registry; longitudinal data to ascertain outcomes after implantation were obtained through clinical health system data from the CVRN Virtual Data Warehouse. We assessed the occurrence of complications at 90 days and mortality, all-cause hospitalization, and heart failure hospitalization up to 5 years after implantation in clinical strata designated a priori. Multivariable models accounting for clustering of patients within site were used to assess the relationship between clinical variables and each outcome. Clinical variables of interest (Table) were included in all models; additional variables were assessed with forward selection to account for possible confounders. Results: Among 2953 eligible patients, median age was 69 years and 26% were women Coexisting conditions, including hypertension (74%), atrial fibrillation (32%), COPD (20%), and diabetes (42%), were common. Overall event rates (per 1000 patient years) were 110 for death, 438 for any hospitalization, and 58 for heart failure hospitalization. The association between clinically important variables and outcomes are shown in the Table. Conclusions: In a diverse population of patients undergoing ICD implantation in contemporary practice we identified specific clinical variables associated with adverse outcomes. These data can inform prognosis in clinical care and guide the design of future trials of this therapy.

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Technology versus Touch: Targeting Heart Failure Self-Care in Older Adults

10.22371/07.2017.012 ◽

2017 ◽

Author(s):

Millicent De Jesus

Keyword(s):

Heart Failure ◽

Older Adults ◽

Self Care

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Telephone Calls To Reduce 30-Day Readmissions For Older Adults With Heart Failure

10.22371/07.2015.037 ◽

2015 ◽

Author(s):

Juanette Clark

Keyword(s):

Heart Failure ◽

Older Adults ◽

Telephone Calls

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A Qualitative Study toward Technologies for Active and Healthy Aging: A Thematic Analysis of Perspectives among Primary, Secondary, and Tertiary End Users

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18147489 ◽

2021 ◽

Vol 18 (14) ◽

pp. 7489

Author(s):

Margherita Rampioni ◽

Adrian Alexandru Moșoi ◽

Lorena Rossi ◽

Sorin-Aurel Moraru ◽

Dan Rosenberg ◽

...

Keyword(s):

Older Adults ◽

Qualitative Study ◽

Information And Communication Technologies ◽

Healthy Aging ◽

Perceived Usefulness ◽

Research Network ◽

Political Agenda ◽

User Centered Design ◽

Sensing Technology ◽

Care Systems

It is expected that, by 2050, people aged over 60 in 65 nations will constitute 30% of the total population. Healthy aging is at the top of the world political agenda as a possible means for hindering the collapse of care systems. How can ICT/sensing technology meet older people’s needs for active and healthy aging? This qualitative study carried out in Italy and Romania in 2020 involved 30 participants: older adults, caregivers, and stakeholders. Based on a user-centered design approach, this study aimed to understand which requirements of ICT/sensing technologies could match people’s needs of active and healthy aging. Findings highlighted that ICT/sensing technology needs to focus on six major themes: (1) learnability, (2) security, (3) independence, empowerment, and coaching values, (4) social isolation, (5) impact of habit, culture, and education variables, and (6) personalized solutions. These themes are consistent with the Active Aging framework and the factors that influence perceived usefulness and potential benefits among older adults. Consequently, this study shows how well-known, but still unresolved, issues affect the field of information and communication technologies (ICTs) to promote active and healthy aging. This suggests that the reinforcement of the public health system, especially considering the pandemic effect, requires a concrete and formidable effort from an interdisciplinary research network.

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Impact of cardiac rehabilitation on 3 year outcomes amongst patients after acute coronary syndrome: (ACS) SNAPSHOT ACS follow-up study

European Heart Journal ◽

10.1093/ehjci/ehaa946.3108 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

J Redfern ◽

K Hyun ◽

D Brieger ◽

D Chew ◽

J French ◽

...

Keyword(s):

Acute Coronary Syndrome ◽

Cardiac Rehabilitation ◽

Data Linkage ◽

Research Network ◽

Funding Source ◽

Cardiovascular Research ◽

Coronary Syndrome ◽

Follow Up Study ◽

Significant Difference

Abstract Background Cardiovascular disease is the leading cause of disease burden globally. With advancements in medical and surgical care more people are surviving initial acute coronary syndrome (ACS) and are in need of secondary prevention and cardiac rehabilitation (CR). Increasing availability of high quality individual-level data linkage provides robust estimates of outcomes long-term. Purpose To compare 3 year outcomes amongst ACS survivors who did and did not participate in Australian CR programs. Methods SNAPSHOT ACS follow-up study included 1806 patients admitted to 232 hospitals who were followed-up by data linkage (cross-jurisdictional morbidity, national death index, Pharmaceutical Benefit Schedule) at 6 and 36 months to compare those who did/not attend CR. Results In total, the cohort had a mean age of 65.8 (13.4) years, 60% were male, only 25% (461/1806) attended CR. During index admission, attendees were more likely to have had PCI (39% v 14%, p<0.001), CABG (11% v 2%, p<0.001) and a diagnosis of STEMI (21% v 5%, p<0.001) than those who did not attend. However, there was no significant difference between CR attendees/non-attendees for risk factors (LDL-cholesterol, smoking, obesity). Only 19% of eligible women attended CR compared to 30% of men (p<0.001). At 36 months, there were fewer deaths amongst CR attendees (19/461, 4.1%) than non-attendees (116/1345, 8.6%) (p=0.001). CR attendees were more likely to have repeat ACS, PCI, CABG at both 6 and 36 months (Table). At 36 months, CR attendees were more likely to have been prescribed antiplatelets (78% v 53%, p<0.001), statins (91% 73%, p<0.001), beta-blockers (11% v 13%, p=0.002) and ACEI/ARBs (72% v 61%, p<0.001) than non-attendees. Conclusions Amongst Australian ACS survivors, participation in CR was associated with less likelihood of death and increased prescription of pharmacotherapy. However, attendance at CR was associated with higher rates of repeat ACS and revascularisation. Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): New South Wales Cardiovascular Research Network, National Heart Foundation

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