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. 2018 Nov;11(11):e005254.
doi: 10.1161/CIRCHEARTFAILURE.118.005254.

Physical Function, Frailty, Cognition, Depression, and Quality of Life in Hospitalized Adults ≥60 Years With Acute Decompensated Heart Failure With Preserved Versus Reduced Ejection Fraction

Haider J Warraich  1   2 , Dalane W Kitzman  3 , David J Whellan  4 , Pamela W Duncan  5 , Robert J Mentz  1   2 , Amy M Pastva  6 , M Benjamin Nelson  3 , Bharathi Upadhya  3 , Gordon R Reeves  4
Affiliations

Physical Function, Frailty, Cognition, Depression, and Quality of Life in Hospitalized Adults ≥60 Years With Acute Decompensated Heart Failure With Preserved Versus Reduced Ejection Fraction

Haider J Warraich et al. Circ Heart Fail. 2018 Nov.

Abstract

Background: Older hospitalized acute decompensated heart failure (HF) patients have persistently poor outcomes and delayed recovery regardless of ejection fraction (EF). We hypothesized that impairments in physical function, frailty, cognition, mood, and quality of life (QoL) potentially contributing to poor clinical outcomes would be similarly severe in acute decompensated HF patients ≥60 years of age with preserved versus reduced EF (HFpEF and HFrEF).

Methods and results: In 202 consecutive older (≥60 years) hospitalized acute decompensated HF patients in a multicenter trial, we prospectively performed at baseline: short physical performance battery, 6-minute walk distance, frailty assessment, Geriatric Depression Scale, Montreal Cognitive Assessment, and QoL assessments. Older acute decompensated HFpEF (EF ≥45%, n=96) and HFrEF (EF <45%, n=106) patients had similar impairments in all physical function measures (short physical performance battery [5.9±0.3 versus 6.2±0.2]; 6-minute walk distance [184±10 versus 186±9 m]; and gait speed [0.60±0.02 versus 0.61±0.02 m/s]) and rates of frailty (55% versus 52%; P=0.70) and cognitive impairment (77% versus 81%; P=0.56) when adjusted for differences in sex, body mass index, and comorbidities. However, depression and QoL were consistently worse in HFpEF versus HFrEF. Depression was usually unrecognized clinically with 38% having Geriatric Depression Scale ≥5 and no documented history of depression.

Conclusions: Patients ≥60 years hospitalized with acute decompensated HF patients have broad, marked impairments in physical function and high rates of frailty and impaired cognition: these impairments are similar in HFpEF versus HFrEF. Further, depression was common and QoL was reduced, and both were worse in HFpEF than HFrEF. Depression was usually unrecognized clinically. These findings suggest opportunities for novel interventions to improve these important patient-centered outcomes.

Clinical trial registration: URL: https://www.clinicaltrials.gov . Unique identifier: NCT02196038.

Keywords: aging; depression; frailty; heart failure; quality of life.

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Figures

Figure 1.
Figure 1.
Differences in physical function and quality of life between patients ≥60 years of age hospitalized with ADHF. Values adjusted for sex, race, BMI, and total comorbidities, except GDS, which was adjusted for sex, race, and BMI only. Abbreviations: 6MWD – six-minute walk distance, GDS – geriatric depression scale score, KCCQ – Kansas City cardiomyopathy questionnaire, SPPB – short physical performance battery.
Figure 2.
Figure 2.
EQ-5D-5L dimensions of self-reported mobility and self-care in older hospitalized patients with ADHF. P-value represents difference in frequency of problem of any severity.
Figure 3.
Figure 3.
Profile of patient-centered outcomes in acute decompensated HF with preserved and reduced ejection fraction.
See this image and copyright information in PMC

Comment in

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