Cardiac Rehabilitation for Very Elderly Patients With Heart Failure: What Do We Know and Where Do We Need to Go?

2017 ◽  
Vol 23 (10) ◽  
pp. S10
Author(s):  
Kentaro Kamiya
Keyword(s):  
Heart Failure ◽  
Elderly Patients ◽  
Cardiac Rehabilitation ◽  
Very Elderly ◽  
Patients With Heart Failure

P6257Low systolic blood pressure on admission as a predictor of outcome in octogenarian patients with heart failure and preserved ejection fraction

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
K Tsuda ◽  
Y Kanzaki ◽  
D Maeda ◽  
K Akamatsu ◽  
S Nakayama ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Blood Pressure ◽  
Ejection Fraction ◽  
Elderly Patients ◽  
Cardiac Death ◽  
Preserved Ejection Fraction ◽  
Very Elderly ◽  
Patients With Heart Failure ◽  
Poor Outcomes

Abstract Background Heart failure (HF) is an epidemic in healthcare worldwide including Asia. It appears that HF will become more serious with aging of the population. The patients with heart failure and preserved ejection fraction (HFpEF) were older, more often female, and frequently have comorbidities including hypertension. However, lower systolic blood pressure (SBP) on admission is associated with poor outcomes in patients with HF. It remains unclear whether this association is similar in very elderly patients with HFpEF. Purpose To investigate clinical features and prognosis in octogenarian HFpEF subjects. Methods We analyzed 87 consecutive subjects aged 80 years or older who were hospitalized for acute decompensated HF with left ventricular ejection fraction (LVEF) ≥50% between 2015 and 2017. Clinical characteristics and a composite event of cardiac death and HF hospitalization were compared in two groups according to SBP cut-off of 140 mmHg on admission. Results The prevalence of lower SBP subjects (mean BP = 118 mmHg) and higher SBP (mean BP = 166 mmHg) subjects were 41.4% and 58.6%, respectively. Lower SBP subjects were more comorbid with atrial fibrillation (72.2 vs. 45.1%, p=0.01). In the lower SBP group, diuretics, mineralocorticoid receptor antagonists (MRA), beta-blockers and ACE inhibitors/ARBs were more commonly used than higher SBP group (Table). During the observational period (median = 1.0 year), lower SBP on admission was associated with a 2.65-fold [95% confidence interval (CI): 1.29–5.55, p=0.009] greater likelihood of experiencing the composite events of cardiac death and rehospitalization for HF (Figure). This observation was still consistent even after adjusting clinical demographics and comorbidity [hazard ratio = 2.95, 95% CI: 1.30–6.87, p=0.01]. Table 1 Lower SBP group (n=36) Higher SBP group (n=51) P-value Atrial fibrillation (%) 72.2 0.01 0.01 Loop diuretic (%) 97.1 83.7 0.08 MRA (%) 47.1 24.5 0.04 Beta-blocker (%) 52.9 44.9 0.51 ACE inhibitor/ARB (%) 59.2 29.4 0.01 Figure 1 Conclusions In octogenarian patients with acute decompensated HF and preserved LVEF, SBP on admission less than 140 mmHg is significantly associated with poor outcomes. Future studies need to prospectively evaluate optimal SBP treatment goals in very elderly patients with HFpEF.

scholarly journals Selection of Comprehensive Assessment Categories Based on the International Classification of Functioning, Disability, and Health for Elderly Patients with Heart Failure: A Delphi Survey among Registered Instructors of Cardiac Rehabilitation

2021 ◽  
Vol 2021 ◽  
pp. 1-9
Author(s):  
Shigehito Shiota ◽  
Makiko Naka ◽  
Toshiro Kitagawa ◽  
Takayuki Hidaka ◽  
Naoki Mio ◽  
...  
Keyword(s):  
Heart Failure ◽  
Occupational Therapy ◽  
Elderly Patients ◽  
Cardiac Rehabilitation ◽  
Comprehensive Assessment ◽  
Delphi Survey ◽  
International Classification Of Functioning ◽  
Disability And Health ◽  
Patients With Heart Failure

The development of a comprehensive assessment tool based on the International Classification of Functioning, Disability, and Health (ICF) for elderly patients with heart failure is urgently required. In this study, we classified the ICF categories relevant to heart failure in the elderly through a Delphi survey (3-step questionnaire survey) of 108 Registered Instructors of Cardiac Rehabilitation in the Hiroshima Prefecture. Questionnaires were conducted using postal mail or a web-based platform. The survey was conducted three times, and the survey results were provided as feedback to the participants in the second and third rounds. More than 80% of the respondents selected categories according to the ICF core set methodology. Data were collected from December 2018 to March 2019, with 67, 54, and 46 participants in the first, second, and third rounds, respectively. A total of 58 ICF items were adopted based on the results: 27 body function items, 4 body structure items, 20 activity and participation items, and 7 environmental factor items. This study is characterised by the inclusion of a large number of ICF items for mental function. This result seems to be influenced by the increasing interest in cognitive dysfunction in elderly patients with heart failure. The ICF categories selected for this study allow for a comprehensive assessment of clients for occupational therapy. The findings of this study are expected to provide a basis for an outcome measure to determine the effectiveness of occupational therapy for these patients.

scholarly journals Guideline-directed medical therapy in elderly patients with heart failure with reduced ejection fraction: a cohort study

BMJ Open ◽  
2020 ◽  
Vol 10 (2) ◽  
pp. e030514 ◽  
Author(s):  
Won-Woo Seo ◽  
Jin Joo Park ◽  
Hyun Ah Park ◽  
Hyun-Jai Cho ◽  
Hae-Young Lee ◽  
...  
Keyword(s):  
Heart Failure ◽  
Clinical Trials ◽  
Elderly Patients ◽  
Beta Blockers ◽  
Very Elderly ◽  
Reduced Ejection Fraction ◽  
Patients With Heart Failure ◽  
All Cause Mortality ◽  
Reduced Risk ◽  
Ras Inhibitors

Objectives and designGuideline-directed medical therapy (GDMT) with renin–angiotensin system (RAS) inhibitors and beta-blockers has improved survival in patients with heart failure with reduced ejection fraction (HFrEF). As clinical trials usually do not include very old patients, it is unknown whether the results from clinical trials are applicable to elderly patients with HF. This study was performed to investigate the clinical characteristics and treatment strategies for elderly patients with HFrEF in a large prospective cohort.SettingThe Korean Acute Heart Failure (KorAHF) registry consecutively enrolled 5625 patients hospitalised for acute HF from 10 tertiary university hospitals in Korea.ParticipantsIn this study, 2045 patients with HFrEF who were aged 65 years or older were included from the KorAHF registry.Primary outcome measurementAll-cause mortality data were obtained from medical records, national insurance data or national death records.ResultsBoth beta-blockers and RAS inhibitors were used in 892 (43.8%) patients (GDMT group), beta-blockers only in 228 (11.1%) patients, RAS inhibitors only in 642 (31.5%) patients and neither beta-blockers nor RAS inhibitors in 283 (13.6%) patients (no GDMT group). With increasing age, the GDMT rate decreased, which was mainly attributed to the decreased prescription of beta-blockers. In multivariate analysis, GDMT was associated with a 53% reduced risk of all-cause mortality (HR 0.47, 95% CI 0.39 to 0.57) compared with no GDMT. Use of beta-blockers only (HR 0.57, 95% CI 0.45 to 0.73) and RAS inhibitors only (HR 0.58, 95% CI 0.48 to 0.71) was also associated with reduced risk. In a subgroup of very elderly patients (aged ≥80 years), the GDMT group had the lowest mortality.ConclusionsGDMT was associated with reduced 3-year all-cause mortality in elderly and very elderly HFrEF patients.Trial registration numberNCT01389843.

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