title: Comparison of Frequency of Frailty and Severely Impaired Physical Function in Patients ≥60 Years Hospitalized With Acute Decompensated Heart Failure Versus Chronic Stable Heart Failure With Reduced and Preserved Left Ventricular Ejection Fraction.
abstract: Older patients with acute decompensated heart failure (ADHF) have persistently poor outcomes including frequent rehospitalization despite guidelines-based therapy. We hypothesized that such patients have multiple, severe impairments in physical function, cognition, and mood that are not addressed by current care pathways. We prospectively examined frailty, physical function, cognition, mood, and quality of life in 27 consecutive older patients with ADHF at 3 medical centers and compared these with 197 participants in 3 age-matched cohorts: stable heart failure (HF) with preserved ejection fraction (n = 80), stable HF with reduced ejection fraction (n = 56), and healthy older adults (n = 61). Based on Fried criteria, frailty was present in 56% of patients with ADHF versus 0 for the age-matched chronic HF and health cohorts. Patients with ADHF had markedly reduced Short Physical Performance Battery score (5.3 ± 2.8) and 6-minute walk distance (178 ± 102 m) (p <0.001 vs other cohorts), with severe deficits in all domains of physical function: balance, mobility, strength, and endurance. In the patients with ADHF, cognitive impairment (78%) and depression (30%) were common, and quality of life was poor. In conclusion, older patients with ADHF are frequently frail with severe and widespread impairments in physical function, cognition, mood, and quality of life that may contribute to their persistently poor outcomes, are frequently unrecognized, are not addressed in current ADHF care paradigms, and are potentially modifiable with targeted interventions.
authors.affiliation: Department of Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania.
authors.forename: Gordon R
authors.initials: GR
authors.lastname: Reeves
authors.affiliation: Department of Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania.
authors.forename: David J
authors.initials: DJ
authors.lastname: Whellan
authors.affiliation: Department of Medicine, Duke University School of Medicine, Durham, North Carolina; Merck Research Laboratories, Rahway, New Jersey.
authors.forename: Mahesh J
authors.initials: MJ
authors.lastname: Patel
authors.affiliation: Department of Medicine, Duke University School of Medicine, Durham, North Carolina; Inova Heart and Vascular Institute, Falls Church, Virginia.
authors.forename: Christopher M
authors.initials: CM
authors.lastname: O'Connor
authors.affiliation: Department of Medicine, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, North Carolina.
authors.forename: Pamela
authors.initials: P
authors.lastname: Duncan
authors.affiliation: Department of Medicine, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, North Carolina.
authors.forename: Joel D
authors.initials: JD
authors.lastname: Eggebeen
authors.affiliation: Department of Medicine, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, North Carolina.
authors.forename: Timothy M
authors.initials: TM
authors.lastname: Morgan
authors.affiliation: Department of Physical Therapy, Jefferson College of Health Professions, Philadelphia, Pennsylvania.
authors.forename: Leigh A
authors.initials: LA
authors.lastname: Hewston
authors.affiliation: Division of Physical Therapy, Duke University School of Medicine, Durham, North Carolina.
authors.forename: Amy M
authors.initials: AM
authors.lastname: Pastva
authors.affiliation: Department of Medicine, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, North Carolina. Electronic address: dkitzman@wfubmc.edu.
authors.forename: Dalane W
authors.initials: DW
authors.lastname: Kitzman
mesh_terms: D000208:Acute Disease; D017677:Age Distribution; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D003071:Cognition / Q000502:physiology; D005080:Exercise Test; D005260:Female; D005500:Follow-Up Studies; D016330:Frail Elderly / Q000706:statistics & numerical data*; D006333:Heart Failure / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology*; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D009017:Morbidity / Q000639:trends; D009043:Motor Activity; D010045:Outpatients; D011446:Prospective Studies; D011788:Quality of Life; D012720:Severity of Illness Index; D013318:Stroke Volume / Q000502:physiology*; D013997:Time Factors; D014481:United States / Q000453:epidemiology; D016277:Ventricular Function, Left / Q000502:physiology*