Polymorbidity and its association with the unfavorable course of chronic heart failure in outpatients aged 60 years and older

Aim. This study was carried out to evaluate polymorbidity taking into account geriatric syndromes and their relationship with the course of chronic heart failure (CHF) in outpatients aged 60 years and older. Methods. We conducted an open, prospective, non-randomized study. The main group included 80 patients with CHF, the comparison group – 40 patients without CHF. Conducted clinical examination, ECG, echocardiography, two-photon X-ray absorptiometry. The scale of assessment of clinical status in CHF,Charlson comorbidity index were used. The criteria for frailty were the presence of at least 3 signs due FRAIL scale. Mean follow-up was 24.1±13.0 months. Results. All patients with CHF (100%) and 92.5% of the comparison group had a concomitant pathology. A combination of 3 or more of any diseases was more common in CHF compared to control group (p=0.008), CKD (66%) and obesity (35%) were the most common pathology. Combinations of osteoporosis and CKD (28%), obesity and CKD (23%) were the most frequent in the CHF patients, a combination of obesity and CKD (28%), obesity and diabetes (18%) – without CHF patients. The same incidence of osteoporosis (p=0.768), falls (p=0.980), fractures (p=0.549) and frailty (p=0.828) was observed in CHF patients and different EFLV, but prevalence of frailty was observed at the age of 75 years and older. During the observation period, 24% CHF patients and 5% patients without CHF (p=0.022) died. The worst survival of patients with ischemic genesis of CHF and osteoporosis was noted. The factors associated with an increased risk of death in CHF patients were the ischemic etiology of CHF (OR 8.33; 95% CI 1.11–62.4; p=0.039), male gender (OR 7.91; 95% CI 2.3–27.2; p=0.001), LV EF <45% (OR 2.52; 95% CI 1.01–6,27; p=0.047), low bone mineral density in femoral neck region (р=0.016, ОR 4.3, 95% CI 1.3–17.2), comorbidity score (OR 1.19; 95% CI 1.04–1.37; p=0.012), a total score on the scale of assessment of clinical status in CHF (OR 1.13; 95% CI 1.03–1.24; p=0.008). Conclusion. All СHF patients had concomitant diseases, CKD and obesity were the most common pathologies. The ischemic etiology of CHF, along with the male gender, LV EF less than 45%, severe clinical statusand high score on the Charlson comorbidity index turned out to be risk factors for death in outpatients aged 60 years and older with CHF.

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Bendopnea: Association With Echocardiographic Features and Clinical Outcomes in Elderly Patients With Chronic Heart Failure

Kardiologiia ◽

10.18087/cardio.2018.12.10190 ◽

2018 ◽

Vol 58 (12) ◽

pp. 36-44 ◽

Cited By ~ 2

Author(s):

V. N. Larina ◽

B. Y. Bart ◽

I. I. Chukaeva ◽

D. G. Karpenko ◽

M. I. Zacharova ◽

...

Keyword(s):

Heart Failure ◽

Chronic Heart Failure ◽

Elderly Patients ◽

Charlson Comorbidity Index ◽

Left Atrial ◽

Clinical Status ◽

Shortness Of Breath ◽

Left Atrial Size ◽

Atrial Size ◽

Comorbidity Index

Aim:to assess the prevalence of bendopnea and association of this symptom with clinical, laboratory and echocardiographic features, clinical outcomes during 2 years of followup in ambulatory elderly patients with chronic heart failure (CHF).Materials and methods.We conducted an open, prospective, nonrandomized study of 80 ambulatory patients aged ≥60 years admitted with heart failure II–IV NYHA class CHF. Baseline survey included physical examination, estimation of Charlson comorbidity index, echocardiography and laboratory tests. Bendopnea was considered when shortness of breath occurred within 30 sec of sitting on a chair and bending forward. Mean followup was 26.6±11.0 months.Results.Bendopnea was present in 38.8 % patients. All these patients complained of shortness of breath during physical exertion and 45.2 % of them had orthopnea. Bendopnea was associated with the male gender (odds ratio [OR] 11.8, 95 % confidence interval [CI] 4.04–34.8, p<0.001), severity of the clinical status (ШОКС [shocks] scale score) (OR 1.78, 95 % CI 1.29–2.38, p<0.001), Charlson comorbidity index (OR 1.29, 95 % CI 1.07–1.52, p=0.007), coronary heart disease (OR 26.6, 95 % CI 3.34–21.3, p=0.002), history of myocardial infarction (OR 13.9, 95 % CI 4.2–46.6, p<0.001), left ventricular (LV) aneurysm (OR 13.3, 95 % CI 2.69–65.9, p=0.002), increased indexed LV endsystolic diameter (OR 8.2, 95 % CI 1.9–34.1, p=0.004), left atrial size (OR 4.3, 95 % CI 1,4–12.5, p=0.008), indexed LV endsystolic volume (OR 1.32, 95 % CI 1.07–1.64, p=0.010), pulmonary artery systolic pressure (OR 1.26, 95 % 1.03–1.45, p=0.002), high levels of NTproBNP (OR 1.0, 95 % CI 1.0–1.002, p=0.055), creatinine (OR 1.04, 95 % CI 1.02–1.07, p=0.001), uric acid (OR 1.006, 95 % CI 1.002–1.011, p=0.004); hospitalizations (OR 7.61, 95 % 2.04–28.4, p=0.003), and patient’s mortality (OR 5.63, 95 % CI 1.94–16.4, p=0.001). Multifactorial analysis confirmed association of bendopnea with severity of clinical status (OR 1.70, 95 % CI 1.04–2.8, p=0.033), increased left atrial size (OR 5.67, 95 % CI 2.75–21.32, p=0.029) and Charlson comorbidity index (OR 1.17, 95 % CI 1.04–2.80, p=0.050). During followup 51.6 and 12.2 % of patients died among those with and without bendopnea, respectively (OR 4.22, 95 % CI 1.85–9.9, p<0.001).Conclusion. Bendopnea is associated with an adverse hemodynamic profile and prognosis, what allows to consider this symptom as a reliable marker of CHF severity.

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Charlson Comorbidity Index does not predict long-term mortality in elderly subjects with chronic heart failure

Age and Ageing ◽

10.1093/ageing/afp165 ◽

2009 ◽

Vol 38 (6) ◽

pp. 734-740 ◽

Cited By ~ 39

Author(s):

G. Testa ◽

F. Cacciatore ◽

G. Galizia ◽

D. Della-Morte ◽

F. Mazzella ◽

...

Keyword(s):

Heart Failure ◽

Chronic Heart Failure ◽

Charlson Comorbidity Index ◽

Elderly Subjects ◽

Comorbidity Index ◽

Long Term Mortality

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Adherence to Lifestyle Therapy in Patients with Chronic Heart Failure and Comorbidity

International Cardiovascular Forum Journal ◽

10.17987/icfj.v16i0.574 ◽

2019 ◽

Vol 16 ◽

Author(s):

Elena Efremova ◽

Alexander Shutov

Keyword(s):

Quality Of Life ◽

Heart Failure ◽

Chronic Heart Failure ◽

Charlson Comorbidity Index ◽

Dietary Sodium ◽

Psychological State ◽

Lifestyle Modifications ◽

Comorbidity Index ◽

High Comorbidity

BackgroundInfluence of comorbidity on adherence to lifestyle therapy in patients with chronic heart failure (CHF) have not been studied yet.The aimThe aim of this study was to investigate awareness and adherence to lifestyle therapy in patient with CHF and comorbidity.Мethods203 patients with CHF (130 males and 73 females, mean age was 61,8±9,6 years) were studied. CHF was defined according to ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure, 2016. Charlson comorbidity index was calculated. Awareness of lifestyle modifications was determined using a questionnaire developed in our clinic and used in previous scientific studies. Quality of life, psychological state, relation to disease were estimated. Follow-Up period was 1 year.ResultsThe awareness about lifestyle modifications in patients with CHF ranged from 38.9% (daily control of body weight) to 87.2% (reduced intake of dietary sodium). Adherence to lifestyle therapy was from 7.9% (daily weight control) to 37.9% (reduced intake of dietary sodium). Charlson comorbidity index corrected by age was 5.0±2.1 scores. Patients with high comorbidity (Charlson comorbidity index > 6 scores) had decreased of quality of life. There were not differences in adherence to lifestyle therapy in patients with CHF, depending on the level of comorbidity. Nonadherence patients were characterized by sensitive type of relation to disease, emotional lability (p< 0,05).СonclusionNonadherence to lifestyle therapy in patients with CHF is associated with desadaptive type of relation to disease, which is more common in patients with high comorbidity.

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Portrait of the patient with intermediate ejection fraction of the left ventricle on the background of acute decompencation of heart failure

HERALD of North-Western State Medical University named after I I Mechnikov ◽

10.17816/mechnikov201810287-91 ◽

2018 ◽

Vol 10 (2) ◽

pp. 87-91

Author(s):

E G Skorodumova ◽

V A Kostenko ◽

E A Skorodumova ◽

A V Siverina ◽

A V Rysev ◽

...

Keyword(s):

Heart Failure ◽

Chronic Heart Failure ◽

Left Ventricle ◽

Ejection Fraction ◽

Statistical Processing ◽

Risk Of Death ◽

Acute Decompensation ◽

Hemodynamic Profile ◽

Comorbidity Index ◽

Microsoft Office

Background. Medico-statistical portrait of patient are a fairly new concept. Materials and methods. 71 patients with intermediate ejection fraction of left ventricle (ILVEF) under acute decompensation of chronic heart failure were examined, 51 of them were male (71.8%) and 20 female (28.2%). Main cause of cronic heart failure was ischemic heart disease and arterial hypertension. The Charlson comorbidity index and Stevenson’s hemodynamic profile of patients. The average age of the individuals is 65.6 ± 12.1 years. Statistical processing of the data was carried out using the method of multifactor analysis using SPSS 23 and the Microsoft Office Excel 10.0 package. Results. Main features of portrait of a patient with ILVEF with acute decompensation of heart failure, which has an high risk of death, is a male aged 64 to 71 years, with a Charlson’s comorbidity index equal to 5 points and higher, as well as a hemodynamic profile of B or C. Portrait of a patient with ILVEF who has a low risk of death - a male / female aged 55 to 64 with a Charlson’s index from 1 to 4 points, as well as hemodynamic profile A and L. The conclusion. This article describes a creation of mathematical model for patients with ILVEF and acute decompensation of chronic heart failure under background of comorbidity and hemodynamics with a check of the obtained models using ROC-analysis. (For citation: Skorodumova EG, Kostenko VA, Skorodumova EA, et al. Portrait of the patient with intermediate ejection fraction of the left ventricle on the background of acute decompencation of heart failure. Herald of North-Western State Medical University named after I.I. Mechnikov. 2018;10(2):87-91. doi: 10.17816/mechnikov201810287-91).

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Polymorphism of the ITGAM gene (rs7193943) and bioelectric impedance analysis as potential predictors of cachexia in chronic heart failure

Scientific Reports ◽

10.1038/s41598-021-99719-6 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Grzegorz Sobieszek ◽

Radosław Mlak ◽

Tomasz Powrózek ◽

Marcin Mazurek ◽

Aneta Skwarek-Dziekanowska ◽

...

Keyword(s):

Heart Failure ◽

Chronic Heart Failure ◽

Systolic Pressure ◽

Impedance Analysis ◽

Severe Malnutrition ◽

Pulmonary Artery Systolic Pressure ◽

Integrin Subunit ◽

Bioelectric Impedance Analysis ◽

Cardiac Cachexia ◽

Risk Of Death

AbstractCardiac cachexia (CC) is an unfavorable metabolic syndrome leading to exacerbation of chronic heart failure (CHF) and a higher risk of death. The main factor contributing to the development of cachexia is the ongoing inflammatory process mediated by genes (e.g. Integrin Subunit Alpha M—ITGAM). The study aimed to assess the relationship between a single nucleotide polymorphism (SNP) -323G > A of the ITGAM and the occurrence of nutritional disorders in patients with CHF. 157 CHF patients underwent clinical and nutritional screening. Body composition was evaluated by bioelectrical impedance analysis (BIA). Patients with cachexia were characterized by significantly lower weight, body mass index (BMI), lower fat mass (FM), albumin, and hemoglobin. Lower values of BIA parameters: capacitance of membrane (Cm), phase angle (PA), and impedance ratio (Z200/Z5) were noted in women. Those patients demonstrated significantly higher values of creatinine, c-reactive protein (CRP), N-terminal prohormone of brain natriuretic peptide (NT-proBNP), and pulmonary artery systolic pressure (PASP). A significantly higher risk of cachexia was reported in patients: aged ≥ 74 years (OR 3.55), with renal failure (OR 3.75), New York Heart Association classification (NYHA) III-IV (OR 2.83), with moderate or severe malnutrition according to the score of subjective global assessment (SGA) (OR 19.01) and AA genotype of ITGAM gene (OR 2.03). Determination of the -323G > A SNP in the ITGAM may prove to be a useful marker (after confirmation in further studies and appropriate validation) in the assessment of the risk of nutritional disorders in patients with CHF.

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Obesity Paradox" – another look at the problem of cardiovascular disease

Obesity and metabolism ◽

10.14341/omet201343-9 ◽

2013 ◽

Vol 10 (4) ◽

pp. 3-9

Author(s):

O V Shpagina ◽

I Z Bondarenko

Keyword(s):

Heart Failure ◽

Chronic Heart Failure ◽

Obesity Paradox ◽

Developed Countries ◽

Epidemiologic Studies ◽

Normal Weight ◽

Overweight And Obesity ◽

Published Data ◽

Risk Of Death ◽

Cardiovascular Prognosis

Major epidemiologic studies over the last century demonstrated that obesity leads to several severe diseases such as diabetes mellitus, hypertension, coronary heart disease, chronic heart failure, cerebrovascular accidents. In developed countries cardiovascular diseases became the main cause of death. In the last 5–6 years some studies showed that people with overweight and obesity of the first degree have a higher life expectancy than people with normal weight. In 2009, the published data showed that the presence of obesity in patients with chronic heart failure does not impair cardiovascular prognosis. Overweight correlates with a decrease in overall mortality by 25%. And in a first degree of obesity the risk of death is reduced by 12%. This phenomenon is called "obesity paradox" and the causes of which are discussed in this review.

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CHRONIC HEART FAILURE CAUSES OSTEOPATHY OR IS OSTEOPATHY A FACTOR IN DEVELOPMENT OF CHRONIC HEART FAILURE?

Asian Journal of Pharmaceutical and Clinical Research ◽

10.22159/ajpcr.2018.v11i1.17532 ◽

2018 ◽

Vol 11 (1) ◽

pp. 111

Author(s):

Mariya Marushchak ◽

Inna Krynytska ◽

Anna Mikolenko ◽

Yurii Andreychyn ◽

Yaroslav Bodnar

Keyword(s):

Heart Failure ◽

Chronic Heart Failure ◽

Bone Mineralization ◽

Stage I ◽

Proximal Segment ◽

Equal Proportion ◽

Lumbar Region ◽

Mineral Density ◽

Functional Changes ◽

The Right

Objective: As their proportion rises in the aging population, cardiovascular disease and osteoporosis increasingly become significant health problems of the developed world, leading to reduced lifespan and substantial financial burdens, not the least because of complications and comorbidities associated with each disorder. This study investigates bone mineralization in patients with coronary heart disease (CHD) complicated by Stage I chronic heart failure (CHF).Methods: The study group consisted of 41 patients of both sexes with CHF Stage I against the background of CHD that with no severe comorbidities that could have potentially caused changes in bone tissue. Bone mineral density was measured using dual-energy X-ray densitometry of lumbar region of spine and proximal right femur.Results: Structural and functional changes in the bone of the lumbar spine were found in 75.9% of the patients with Stage I CHF caused by CHD. Osteopenia was diagnosed in 64.4% of the patients, while osteosclerotic bone changes were less frequent and found in 11.5% of the patients. 75.8% of the patients had structural and functional changes in the proximal segment of the right femur bone. In men with Stage I CHF against the background of CHD osteopenia was more often diagnosed in the proximal segment of the right femur, while in women it was found in almost equal proportion in the spine and hip.Conclusions: In both sexes with I Stage CHF against the background of CHD were diagnosed changes in bone mineralization, with osteopenia being the prevailing diagnosis.

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Calf muscle pump function as a predictor of all-cause mortality

Vascular Medicine ◽

10.1177/1358863x20953212 ◽

2020 ◽

Vol 25 (6) ◽

pp. 519-526

Author(s):

Meghana Halkar ◽

Jose Medina Inojosa ◽

David Liedl ◽

Waldemar Wysokinski ◽

Damon E Houghton ◽

...

Keyword(s):

Heart Failure ◽

Charlson Comorbidity Index ◽

Negative Impact ◽

Calf Muscle ◽

Study Objective ◽

Muscle Pump ◽

Calf Muscle Pump ◽

Comorbidity Index ◽

Predominantly Female ◽

Poor Outcomes

Calf muscle pump (CMP) promotes venous return from the lower extremity and contributes to preload and cardiac output. Impaired CMP function may reflect a measure of frailty or cumulative disease burden or may impede cardiac function. The study objective was to test the hypothesis that impaired CMP negatively impacts survival. Consecutive adult patients who underwent venous strain gauge plethysmography at the Mayo Clinic Gonda Vascular Laboratory (January 1, 1998 – December 31, 2011) were assessed for overall survival. Patients with venous incompetence, venous obstruction or unilateral calf pump dysfunction were excluded. Risk of mortality was assessed with Cox proportional hazard ratios and after adjusting for Charlson Comorbidity Index variables. Over the study period, 2728 patients were included in the analysis. Compared to patients with normal CMP, those with impaired CMP were older ( p < 0.001), predominantly female ( p = 0.01) and had higher mean Charlson scores ( p < 0.001). Patients with impaired CMP had a higher mortality rate at 5 (8.9% vs 2.4%), 10 (17.5% vs 5.9%), and 15 years (22.8% vs 8.3%) compared to those with normal CMP ( p < 0.001 for each comparison). Of patients with heart failure, those with impaired CMP had worse survival at each 5-year increment compared to those with normal CMP ( p < 0.05 at each increment). In conclusion, impaired CMP appears to be an independent predictor of poor outcomes after adjusting for variables within the Charlson Comorbidity Index. The association between impaired CMP, heart failure, and mortality may represent a negative impact on circulatory function or a surrogate measure of frailty.

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Malondialdehyde and Uric Acid as Predictors of Adverse Outcome in Patients with Chronic Heart Failure

Oxidative Medicine and Cellular Longevity ◽

10.1155/2019/9246138 ◽

2019 ◽

Vol 2019 ◽

pp. 1-15 ◽

Cited By ~ 1

Author(s):

Ewa Romuk ◽

Celina Wojciechowska ◽

Wojciech Jacheć ◽

Aleksandra Zemła-Woszek ◽

Alina Momot ◽

...

Keyword(s):

Oxidative Stress ◽

Heart Failure ◽

Uric Acid ◽

Chronic Heart Failure ◽

Predictive Biomarkers ◽

Cox Regression Analysis ◽

Risk Of Death ◽

Increased Risk ◽

Baseline Levels

In chronic heart failure (HF), some parameters of oxidative stress are correlated with disease severity. The aim of this study was to evaluate the importance of oxidative stress biomarkers in prognostic risk stratification (death and combined endpoint: heart transplantation or death). In 774 patients, aged 48-59 years, with chronic HF with reduced ejection fraction (median: 24.0 (20-29)%), parameters such as total antioxidant capacity, total oxidant status, oxidative stress index, and concentration of uric acid (UA), bilirubin, protein sulfhydryl groups (PSH), and malondialdehyde (MDA) were measured. The parameters were assessed as predictive biomarkers of mortality and combined endpoint in a 1-year follow-up. The multivariate Cox regression analysis was adjusted for other important clinical and laboratory prognostic markers. Among all the oxidative stress markers examined in multivariate analysis, only MDA and UA were found to be independent predictors of death and combined endpoint. Higher serum MDA concentration increased the risk of death by 103.0% (HR=2.103; 95% CI (1.330-3.325)) and of combined endpoint occurrence by 100% (HR=2.000; 95% CI (1.366-2.928)) per μmol/L. Baseline levels of MDA in the 4th quartile were associated with an increased risk of death with a relative risk (RR) of 3.64 (95% CI (1.917 to 6.926), p<0.001) and RR of 2.71 (95% CI (1.551 to 4.739), p<0.001) for the occurrence of combined endpoint as compared to levels of MDA in the 1st quartile. Higher serum UA concentration increased the risk of death by 2.1% (HR=1.021; 95% CI (1.005-1.038), p<0.001) and increased combined endpoint occurrence by 1.4% (HR=1.014; 95% CI (1.005-1.028), p<0.001), for every 10 μmol/L. Baseline levels of UA in the 4th quartile were associated with an increased risk for death with a RR of 3.21 (95% CI (1.734 to 5.931)) and RR of 2.73 (95% CI (1.560 to 4.766)) for the occurrence of combined endpoint as compared to the levels of UA in the 1st quartile. In patients with chronic HF, increased MDA and UA concentrations were independently related to poor prognosis in a 1-year follow-up.

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PHARMACOLOGICAL TREATMENT OF OSTEOPOROSIS IN PATIENTS WITH CORONARY HEART DISEASE COMPLICATED BY CHRONIC HEART FAILURE

Asian Journal of Pharmaceutical and Clinical Research ◽

10.22159/ajpcr.2019.v12i1.29293 ◽

2019 ◽

Vol 12 (1) ◽

pp. 443

Author(s):

Mariya Marushchak ◽

Inna Krynytska

Keyword(s):

Heart Failure ◽

Coronary Heart Disease ◽

Heart Disease ◽

Lumbar Spine ◽

Chronic Heart Failure ◽

Vitamin D3 ◽

Femoral Bone ◽

Metabolic Disturbances ◽

Mineral Density ◽

Multisystem Disorder

Objective: Chronic heart failure (CHF) is a chronic multisystem disorder associated with a myriad of metabolic disturbances. Moreover, CHF may adversely affect bone metabolism and induce a severe bone loss, increasing susceptibility to fractures and osteoporosis. This study investigates the effect of combined calcium with Vitamin D3 supplement called “calcemin advance” and calcitonin in the prophylaxis and treatment of osteopenia and osteoporosis in patients with coronary heart disease (CHD) complicated by CHF with the establishment of their influence on the bone mineral density (BMD).Methods: A total of 59 patients with CHD complicated by CHF. Interventions: The physical examination findings, dual-energy X-ray absorptiometry findings, and treatment results were assessed.Results: The results of the calcemin advance usage in patients with osteopenic changes showed a positive dynamics of the studied parameters, both in the lumbar spine and in the femoral bone. In patients with osteoporosis, the usage of osteoprotective therapy (calcemin advance+miacalcic) contributed to the increasing of BMD in the lumbar spine and in the femoral bone versus patients who received only combined calcium with Vitamin D3 supplement.Conclusions: Our results suggest that bone density screening could be recommended in patients with prevalent CHF. Moreover, the results of our investigation substantiate the necessity and effectiveness of osteoprotective therapy in patients with CHF with osteoporosis by calcitonin (Miacalcic), in combination with combined calcium and Vitamin D3 supplement (calcemin advance), and by only calcemin advance - in patients with CHF and osteopenia.

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