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. 2024 May 14;11(5):150.
doi: 10.3390/jcdd11050150.

The Impact of Acute Heart Failure on Frailty Degree and Outcomes in Elderly Patients with Severe Aortic Stenosis and Chronic Heart Failure with Preserved Ejection Fraction

Augusto Esposito  1 , Ilenia Foffa  1   2 , Cecilia Vecoli  1   2 , Luca Bastiani  1   2 , Sergio Berti  1   2 , Annamaria Mazzone  1
Affiliations

The Impact of Acute Heart Failure on Frailty Degree and Outcomes in Elderly Patients with Severe Aortic Stenosis and Chronic Heart Failure with Preserved Ejection Fraction

Augusto Esposito et al. J Cardiovasc Dev Dis. .

Abstract

Frailty degree plays a critical role in the decision-making and outcomes of elderly patients with severe aortic stenosis (AS). Acute heart failure (AHF) results in a severely worse clinical hemodynamic status in this population. This study aimed to evaluate the impact of AHF on frailty degree and outcomes in older patients referred for tailored interventional treatment due to AS. A total of 109 patients (68% female; mean age 83.3 ± 5.4), evaluated by a multidisciplinary path for "frailty-based management" of valve disease, were divided into two groups, one with (AHF+) and one without AHF (AHF-) and preserved ejection fraction (mean value EF: 57.4 ± 8.6). AHF occurred a mean value of 55 days before geriatric, clinical, and surgical assessment. A follow-up for all-cause mortality and readmission was conducted at 20 months. AHF+ patients showed a higher frequency of advanced frailty (53.3% vs. 46.7%, respectively), rehospitalization (35.5% vs. 12.8; p = 0.007), and death (41.9% vs. 12.8%; p < 0.001). In stepwise logistic regression analysis, AHF emerged as an independent risk factor for advanced frailty (OR: 3.8 CI 1.3-10.7; p = 0.01) and hospital readmission (OR: 3.6 CI 1.1-11.6; p = 0.03). In addition, preceding AHF was an independent determinant associated with a higher risk of mortality (HR 2.65; CI 95% 1.04-6.74; p-value 0.04). AHF is independently associated with advanced frailty and poor outcomes in elderly patients with severe AS. So, this population needs careful clinical and geriatric monitoring and the implementation of interventional therapy for AS in the early stages of frailty to avoid the occurrence of AHF and poor outcomes.

Keywords: acute heart failure; elderly patients; frailty; hospitalization; mortality; multidisciplinary approach; severe aortic stenosis.

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Conflict of interest statement

The authors declare that they have no conflicts of interest.

Figures

Figure 1
Figure 1
Frequency of physical frailty degree in patients with (AHF+) or without (AHF-) acute heart failure.
Figure 2
Figure 2
Cox proportional hazard regression analysis of risk of all-cause mortality in elderly AHF+ patients.
Figure 3
Figure 3
Schematic representation of study protocol and the major results.
See this image and copyright information in PMC

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References

    1. Lindman B.R., Clavel M.A., Mathieu P., Iung B., Lancellotti P., Otto C.M., Pibarot P. Calcific aortic stenosis. Nat. Rev. Dis. Primers. 2016;2:16006. doi: 10.1038/nrdp.2016.6. - DOI - PMC - PubMed
    1. van Gils L., Clavel M.A., Vollema E.M., Hahn R.T., Spitzer E., Delgado V., Nazif T., De Jaegere P.P., Geleijnse M.L., Ben-Yehuda O., et al. Prognostic Implications of Moderate Aortic Stenosis in Patients with Left Ventricular Systolic Dysfunction. J. Am. Coll. Cardiol. 2017;69:2383–2392. doi: 10.1016/j.jacc.2017.03.023. - DOI - PubMed
    1. Fischer-Rasokat U., Renker M., Liebetrau C., Weferling M., Rolf A., Doss M., Möllmann H., Walther T., Hamm C.W., Kim W.K. Outcome of patients with heart failure after transcatheter aortic valve implantation. PLoS ONE. 2019;14:e0225473. doi: 10.1371/journal.pone.0225473. - DOI - PMC - PubMed
    1. Green P., Woglom A.E., Genereux P., Daneault B., Paradis J.M., Schnell S., Hawkey M., Maurer M.S., Kirtane A.J., Kodali S., et al. The impact of frailty status on survival after transcatheter aortic valve replacement in older adults with severe aortic stenosis: A single-center experience. JACC Cardiovasc. Interv. 2012;5:974–981. doi: 10.1016/j.jcin.2012.06.011. - DOI - PMC - PubMed
    1. Mazzone A., Del Turco S., Trianni G., Quadrelli P., Marotta M., Bastiani L., Gasbarri T., D’Agostino A., Mariani M., Basta G., et al. The Positive Impact of Early Frailty Levels on Mortality in Elderly Patients with Severe Aortic Stenosis Undergoing Transcatheter/Surgical Aortic Valve Replacement. J. Cardiovasc. Dev. Dis. 2023;10:212. doi: 10.3390/jcdd10050212. - DOI - PMC - PubMed