Multimorbidity, physical frailty, and self-rated health in older patients with atrial fibrillation

Abstract Background Holistic care models emphasize management of comorbid conditions to improve patient-reported outcomes in treatment of atrial fibrillation (AF). We investigated relations between multimorbidity, physical frailty, and self-rated health (SRH) among older adults with AF. Methods Patients (n = 1235) with AF aged 65 years and older were recruited from five medical centers in Massachusetts and Georgia between 2015 and 2018. Ten previously diagnosed cardiometabolic and 8 non-cardiometabolic conditions were assessed from medical records. Physical Frailty was assessed with the Cardiovascular Health Study frailty scale. SRH was categorized as either “excellent/very good”, “good”, and “fair/poor”. Separate multivariable ordinal logistic models were used to examine the associations between multimorbidity and SRH, physical frailty and SRH, and multimorbidity and physical frailty. Results Overall, 16% of participants rated their health as fair/poor and 14% were frail. Hypertension (90%), dyslipidemia (80%), and heart failure (37%) were the most prevalent cardiometabolic conditions. Arthritis (51%), anemia (31%), and cancer (30%), the most common non-cardiometabolic diseases. After multivariable adjustment, patients with higher multimorbidity were more likely to report poorer health status (Odds Ratio (OR): 2.15 [95% CI: 1.53–3.03], ≥ 8 vs 1–4; OR: 1.37 [95% CI: 1.02–1.83], 5–7 vs 1–4), as did those with more prevalent cardiometabolic and non-cardiometabolic conditions. Patients who were pre-frail (OR: 1.73 [95% CI: 1.30–2.30]) or frail (OR: 6.81 [95% CI: 4.34–10.68]) reported poorer health status. Higher multimorbidity was associated with worse frailty status. Conclusions Multimorbidity and physical frailty were common and related to SRH. Our findings suggest that holistic management approaches may influence SRH among older patients with AF.

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Clinically Meaningful Change in Quality of Life and Associated Factors Among Older Patients With Atrial Fibrillation

Journal of the American Heart Association ◽

10.1161/jaha.120.016651 ◽

2020 ◽

Vol 9 (18) ◽

Author(s):

Hawa O. Abu ◽

Jane S. Saczynski ◽

Jordy Mehawej ◽

Mayra Tisminetzky ◽

Catarina I. Kiefe ◽

...

Keyword(s):

Quality Of Life ◽

Atrial Fibrillation ◽

Older Patients ◽

Logistic Models ◽

Life Questionnaire ◽

Meaningful Change ◽

Patient Centered ◽

Factors Associated ◽

Fair Poor

Background Among older patients with atrial fibrillation, there are limited data examining clinically meaningful changes in quality of life (QoL). We examined the extent of, and factors associated with, clinically meaningful change in QoL over 1‐year among older adults with atrial fibrillation. Methods and Results Patients from cardiology, electrophysiology, and primary care clinics in Massachusetts and Georgia were enrolled in a cohort study (2015–2018). The Atrial Fibrillation Effect on Quality‐of‐Life questionnaire was used to assess overall QoL and across 3 subscales: symptoms, daily activities, and treatment concern. Clinically meaningful change in QoL (ie, difference between 1‐year and baseline QoL score) was categorized as either a decline (≤−5.0 points), no clinically meaningful change (−5.0 to +5.0 points), or an increase (≥+5.0 points). Ordinal logistic models were used to examine factors associated with QoL changes. Participants (n=1097) were on average 75 years old, 48% were women, and 87% White. Approximately 40% experienced a clinically meaningful increase in QoL and 1 in every 5 patients experienced a decline in QoL. After multivariable adjustment, women, non‐Whites, those who reported depressive and anxiety symptoms, fair/poor self‐rated health, low social support, heart failure, or diabetes mellitus experienced clinically meaningful declines in QoL. Conclusions These findings provide insights to the magnitude of, and factors associated with, clinically meaningful change in QoL among older patients with atrial fibrillation. Assessment of comorbidities and psychosocial factors may help identify patients at high risk for declining QoL and those who require additional surveillance to maximize important clinical and patient‐centered outcomes.

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Association between Physical Frailty Subdomains and Oral Frailty in Community-Dwelling Older Adults

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18062931 ◽

2021 ◽

Vol 18 (6) ◽

pp. 2931

Author(s):

Ryo Komatsu ◽

Koutatsu Nagai ◽

Yoko Hasegawa ◽

Kazuki Okuda ◽

Yuto Okinaka ◽

...

Keyword(s):

Older Adults ◽

Gait Speed ◽

Community Dwelling ◽

Health Study ◽

Cardiovascular Health Study ◽

Physical Frailty ◽

Cross Sectional ◽

Important Indicator ◽

Community Dwelling Older Adults ◽

Oral Frailty

This cross-sectional study aimed to demonstrate the association between physical frailty subdomains and oral frailty. This study involved community-dwelling older adults (aged ≥65 years). Physical frailty was assessed with the Japanese version of the Cardiovascular Health Study criteria. Oral frailty was defined as limitations in at least three of six domains. Logistic regression analysis was used to analyze the association between physical frailty risk and oral frailty. In addition, we examined the association between physical frailty subdomains (gait speed, grip strength, exhaustion, low physical activity, and weight loss) and oral frailty. A total of 380 participants were recruited for this study. Overall, 18% and 14% of the participants were at risk of physical frailty and had oral frailty, respectively. Physical frailty risk (odds ratio (OR) = 2.40, 95% confidence interval (CI): 1.22–4.75, p = 0.012) was associated with oral frailty in multivariate analysis. In secondary analysis, among physical frailty subdomains, gait speed (OR = 0.85, 95% CI: 0.73–0.97, p = 0.019) was associated with oral frailty. The present findings suggest that physical frailty is closely related to oral frailty. Among physical frailty subdomains, decreased gait speed in particular is an important indicator related to the development of oral frailty.

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Letter by Mont et al Regarding Article, “Physical Activity and Incidence of Atrial Fibrillation in Older Adults: The Cardiovascular Health Study”

Circulation ◽

10.1161/circulationaha.108.821926 ◽

2009 ◽

Vol 119 (5) ◽

Cited By ~ 2

Author(s):

Lluís Mont ◽

Josep Brugada ◽

Roberto Elosua

Keyword(s):

Physical Activity ◽

Atrial Fibrillation ◽

Older Adults ◽

Cardiovascular Health ◽

Health Study ◽

Cardiovascular Health Study

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CONCURRENCE OF FRAILTY AND PARKINSON’S DISEASE

Journal of Frailty & Aging ◽

10.14283/jfa.2012.20 ◽

2012 ◽

pp. 1-5

Author(s):

K.P. ROLAND ◽

K.M.D. CORNETT ◽

O. THEOU ◽

J.M. JAKOBI ◽

G.R. JONES

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Cardiovascular Health ◽

Community Dwelling ◽

Health Study ◽

Cardiovascular Health Study ◽

Physical Frailty ◽

Levodopa Dose ◽

Frailty Phenotype ◽

Age Related

Background: Females with Parkinson’s disease (PD) are at greater risk of frailty than males. Little is known about how age and disease-related characteristics influence frailty in females with PD because frailty studies often exclude persons with underlying neurological pathologies. Objective: To determine age and diseaserelated characteristics that best explain physical frailty in community-dwelling females with and without PD. Design & Measurement: Correlation coefficients described relationships between PD-related characteristics and physical frailty phenotype criteria (Cardiovascular Health Study). Regression analysis identified associations between disease-related characteristics and frailty in non-PD and PD females. Setting: Community-dwelling. Participants: Females with mild to moderate PD (n = 17, mean age = 66 ± 8.5 years) and non-PD (n = 18, mean age = 72 ± 13.2 years) participated. Results: Daily carbidopa-levodopa dose best explained frailty in PD females (β = 0.5), whereas in non-PD females, age (β = 0.7) and comorbidity (β = 0.5) were most associated with frailty. Conclusions: Dopaminergic medication explained frailty in PD and not measures of disease progression (i.e. severity, duration). In females without PD age-related accumulation of comorbidities resulted in greater risk of frailty. This indicates dopaminergic management of PD symptoms may better reflect frailty in females with PD than disease severity or duration. These data suggest the influence of underlying frailty should be considered when managing neurological conditions. Understanding how frailty concurrently exists with PD and how these conditions progress within the aging female will facilitate future care management.

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Abstract MP03: Plasma Sphingolipids and Risks of Heart Failure and Atrial Fibrillation in Older Adults: The Cardiovascular Health Study

Circulation ◽

10.1161/circ.137.suppl_1.mp03 ◽

2018 ◽

Vol 137 (suppl_1) ◽

Author(s):

Rozenn N Lemaitre ◽

Paul N Jensen ◽

Barbara McKnight ◽

Andrew Hoofnagle ◽

Irena B King ◽

...

Keyword(s):

Heart Failure ◽

Atrial Fibrillation ◽

Fatty Acid ◽

Lower Risk ◽

Cardiovascular Health ◽

Biological Activities ◽

Experimental Studies ◽

Health Study ◽

Cardiovascular Health Study

Introduction: Ceramides and sphingomyelins (sphingolipids) are circulating lipids involved in multiple physiological pathways relevant to heart failure (HF) and atrial fibrillation (AF), including apoptosis, oxidative stress, and inflammation. Experimental studies suggest that sphingolipids with different saturated fatty acids exhibit different biological activities, but their relationships with HF and AF are unknown. Hypothesis: Higher levels of plasma ceramide and sphingomyelin that contain the fatty acid 16:0 are associated with higher risks of HF and AF; and higher levels of ceramides and sphingomyelins that contain the fatty acid 20:0, 22:0 or 24:0 are associated with lower risks. Methods: We measured sphingolipids in the Cardiovascular Health Study (CHS) in plasma samples from 1994-95 (N=4026) or from 1992-93 (N=586). We assessed the separate associations of the levels of 8 sphingolipids with risks of incident HF and incident AF using Cox regression. A p-value threshold of 0.006 was used to account for multiple testing. Results: Among 4,612 participants, 1179 incident HF and 1198 incident AF occurred during >40,000 person-years of follow-up. In adjusted analyses, higher levels of Cer-16 (ceramide with 16:0) and SM-16 (sphingomyelin with 16:0) were associated with higher risk of incident HF, but not with risk of incident AF (Table). In contrast, higher levels of Cer-20, Cer-22 and Cer-24 were each associated with lower risk of AF, but not with risk of HF. Higher levels of SM-20, SM-22, and SM-24 tended to be associated with lower risks of AF and HF, with only the association of SM-20 with AF significant. Conclusions: Plasma levels of ceramide and sphingomyelin with 16:0 show different associations with HF and AF than species with 20:0, 22:0 or 24:0. Associations of Cer-16 and SM-16 specifically with higher risk of HF may be due to a role of apoptosis in HF. The novel findings that Cer-20, Cer-22, and Cer-24 are associated with lower risk of AF warrant further examination of the role of these sphingolipids in protecting from AF.

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Plasma Ceramides and Sphingomyelins in Relation to Atrial Fibrillation Risk: The Cardiovascular Health Study

Journal of the American Heart Association ◽

10.1161/jaha.119.012853 ◽

2020 ◽

Vol 9 (4) ◽

Author(s):

Paul N. Jensen ◽

Amanda M. Fretts ◽

Andrew N. Hoofnagle ◽

Colleen M. Sitlani ◽

Barbara McKnight ◽

...

Keyword(s):

Atrial Fibrillation ◽

Fatty Acids ◽

Palmitic Acid ◽

Cardiovascular Health ◽

Saturated Fatty Acids ◽

Behenic Acid ◽

Hazard Ratio ◽

Health Study ◽

Cardiovascular Health Study ◽

Long Chain

Background Ceramides exhibit multiple biological activities that may influence the pathophysiological characteristics of atrial fibrillation (AF). Whether the length of the saturated fatty acid carried by the ceramide or their sphingomyelin precursors are associated with AF risk is not known. Methods and Results Among 4206 CHS (Cardiovascular Health Study) participants (mean age, 76 years; 40% men) who were free of prevalent AF at baseline, we identified 1198 incident AF cases over a median 8.7 years of follow‐up. We examined 8 sphingolipid species: ceramide and sphingomyelin species with palmitic acid and species with very‐long‐chain saturated fatty acids: arachidic; behenic; and lignoceric. In adjusted Cox regression analyses, ceramides and sphingomyelins with very‐long‐chain saturated fatty acids were associated with reduced AF risk (ie, per 2‐fold higher ceramide with behenic acid hazard ratio, 0.71; 95% CI, 0.59–0.86; sphingomyelin with behenic acid hazard ratio, 0.60; 95% CI, 0.46–0.77). In contrast, ceramides and sphingomyelins with palmitic acid were associated with increased AF risk (ceramide with palmitic acid hazard ratio, 1.31; 95% CI, 1.03–1.66; sphingomyelin with palmitic acid hazard ratio, 1.73; 95% CI, 1.18–2.55). Associations were attenuated with adjustment for NT‐proBNP (N‐terminal pro‐B‐type natriuretic peptide), but did not differ significantly by age, sex, race, body mass index, or history of coronary heart disease. Conclusions Our findings suggest that several ceramide and sphingomyelin species are associated with incident AF, and that these associations differ on the basis of the fatty acid. Ceramides and sphingomyelins with palmitic acid were associated with increased AF risk, whereas ceramides and sphingomyelins with very‐long‐chain saturated fatty acids were associated with reduced AF risk.

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Incident Atrial Fibrillation and Disability-Free Survival in the Cardiovascular Health Study

Journal of the American Geriatrics Society ◽

10.1111/jgs.14037 ◽

2016 ◽

Vol 64 (4) ◽

pp. 838-843 ◽

Cited By ~ 12

Author(s):

Erin R. Wallace ◽

David S. Siscovick ◽

Colleen M. Sitlani ◽

Sascha Dublin ◽

Pamela H. Mitchell ◽

...

Keyword(s):

Atrial Fibrillation ◽

Cardiovascular Health ◽

Health Study ◽

Cardiovascular Health Study ◽

Free Survival

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Response to Letter Regarding Article, “Physical Activity and Incidence of Atrial Fibrillation in Older Adults: The Cardiovascular Health Study”

Circulation ◽

10.1161/circulationaha.108.830901 ◽

2009 ◽

Vol 119 (5) ◽

Author(s):

Dariush Mozaffarian ◽

Curt D. Furberg ◽

Bruce M. Psaty ◽

David Siscovick

Keyword(s):

Physical Activity ◽

Atrial Fibrillation ◽

Older Adults ◽

Cardiovascular Health ◽

Health Study ◽

Cardiovascular Health Study

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Profiles of patients’ self-reported health after acute stroke

Neurological Research and Practice ◽

10.1186/s42466-021-00146-9 ◽

2021 ◽

Vol 3 (1) ◽

Author(s):

D. Leander Rimmele ◽

Theresa Schrage ◽

Lisa Lebherz ◽

Levente Kriston ◽

Christian Gerloff ◽

...

Keyword(s):

Atrial Fibrillation ◽

Health Status ◽

Acute Stroke ◽

Stroke Severity ◽

Inpatient Stay ◽

Class Membership ◽

Link Type ◽

Patient Reported ◽

Reported Health ◽

Baseline Characteristics

Abstract Background We aimed to identify groups of patients with similar health status after stroke, assessed by patient reported outcome measures (PROMs), to improve initial risk stratification. Methods In a prospective study, inpatients were recruited during acute stroke treatment. Demographics, history, and cardio-vascular risk factors were assessed at baseline. Self-reported functional status, physical and mental health as well as anxiety and depressive symptoms were assessed 3 and 12 months after stroke and used to identify latent classes. The association of patient characteristics with latent class membership was investigated with multinomial logistic regression. Results Of the 650 patients included with a mean age of 75 years and 48% female, 70% had ischemic, 6% hemorrhagic strokes, and 24% transient ischemic attacks. Median NIHSS on admission was 2 (IQR:0,5). Values of PROMs remained comparable at 3 and 12 months. A three-class model was developed, differentiating between patients with mildly (75%), moderately (17%), and severely (8%) impaired self-reported health status. Adjusted for univariately significant baseline characteristics, initial NIHSS distinguished mild- from moderate-, and moderate- from severe-class-membership (p < 0.001). Length of inpatient stay (p < 0.001;OR = 1.1), diabetes (p = 0.021;OR = 1.91), and atrial fibrillation (p = 0.004;OR = 2.20) predicted allocation to the moderately vs. mildly affected class. Conclusions Grading stroke patients by a standard set of PROMs up to 1 year after stroke allows to distinguish the diverse impact of baseline characteristics on differently affected groups. In addition to initial stroke severity, longer inpatient stay, presence of diabetes and atrial fibrillation correlate with greater impairment of self-reported health in the less affected groups. Trial registration http://www.ClinicalTrials.gov; Unique identifier: NCT03795948.

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