BACKGROUND With the intensification of social aging,the susceptibility of the elderly population to diseases has attracted increasing attention,especially chronic heart failure(CHF)that accounts for a large proportion...BACKGROUND With the intensification of social aging,the susceptibility of the elderly population to diseases has attracted increasing attention,especially chronic heart failure(CHF)that accounts for a large proportion of the elderly.AIM To evaluate the application value of health concept model-based detailed behavioral care in elderly patients with CHF.METHODS This study recruited 116 elderly CHF patients admitted from October 2018 to October 2020 and grouped them according to the nursing care that they received.The elderly patients who underwent health concept model-based detailed behavioral care were included in a study group(SG;n=62),and those who underwent routine detailed behavioral nursing intervention were included as a control group(CG;n=54).Patients’negative emotions(NEs),quality of life(QoL),and nutritional status were assessed using the self-rating anxiety/depression scale(SAS/SDS),the Minnesota Living with Heart Failure Questionnaire(MLHFQ),and the Modified Quantitative Subjective Global Assessment(MQSGA)of nutrition,respectively.Differences in rehabilitation efficiency,NEs,cardiac function(CF)indexes,nutritional status,QoL,and nursing satisfaction were comparatively analyzed.RESULTS A higher response rate was recorded in the SG vs the CG after intervention(P<0.05).After care,the left ventricular ejection fraction was higher while the left ventricular end-diastolic dimension and left ventricular end systolic diameter were lower in the SG compared with the CG(P<0.05).The post-intervention SAS and SDS scores,as well as MQSGA and MLHFQ scores,were also lower in the SG(P<0.05).The SG was also superior to the CG in the overall nursing satisfaction rate(P<0.05).CONCLUSION Health concept model-based detailed behavioral care has high application value in the nursing care of elderly CHF patients,and it can not only effectively enhance rehabilitation efficiency,but also mitigate patients’NEs and improve their CF and QoL.展开更多
OBJECTIVE To assess the role of beta-blockers(BB)in patients with chronic kidney disease(CKD)aged≥75 years.METHODS AND RESULTS From January 2008 to July 2014,we included 390 consecutive patients≥75 years of age with...OBJECTIVE To assess the role of beta-blockers(BB)in patients with chronic kidney disease(CKD)aged≥75 years.METHODS AND RESULTS From January 2008 to July 2014,we included 390 consecutive patients≥75 years of age with ejection fraction≤35%and glomerular filtration rate(GFR)≤60 m L/min per 1.73 m^2.We analyzed the relationship between treatment with BB and mortality or cardiovascular events.The mean age of our population was 82.6±4.1 years.Mean ejection fraction was 27.9%±6.5%.GFR was 60-45 m L/min per 1.73 m^2 in 50.3%of patients,45-30 m L/min per 1.73 m^2 in 37.4%,and<30 m L/min per 1.73 m^2 in 12.3%.At the conclusion of follow-up,67.4%of patients were receiving BB.The median follow-up was28.04(IR:19.41-36.67)months.During the study period,211 patients(54.1%)died and 257(65.9%)had a major cardiovascular event(death or hospitalization for heart failure).BB use was significantly associated with a reduced risk of death(HR=0.51,95%CI:0.35-0.74;P<0.001).Patients receiving BB consistently showed a reduced risk of death across the different stages of CKD:stage IIIa(GFR=30-45 m L/min per 1.73 m^2;HR=0.47,95%CI:0.26-0.86,P<0.0001),stage IIIb(GFR 30-45 m L/min per 1.73 m^2;HR=0.55,95%CI:0.26-1.06,P=0.007),and stages IV and V(GFR<30 m L/min per 1.73 m~2;HR=0.29,95%CI:0.11-0.76;P=0.047).CONCLUSIONS The use of BB in elderly patients with HFr EF and renal impairment was associated with a better prognosis.Use of BB should be encouraged when possible.展开更多
Heart failure (HF) is a major health problem for the geriatric population. In the United States, most of the 5 millions patients with HF are elderly.1 Seventy-five percent of HF hospitalizations occurred in patients o...Heart failure (HF) is a major health problem for the geriatric population. In the United States, most of the 5 millions patients with HF are elderly.1 Seventy-five percent of HF hospitalizations occurred in patients older than 65 years and 50% in patients 75 years and older.1 In the Framingham population, the prevalence of HF increased eightfold among men from the fifth decade of life to the seventh decade.2 However, despite of considerable improvement in the treatment, the mortality of HF patients remained relatively constant between 1948 and 1997.展开更多
BACKGROUND Frailty is prevalent in elderly patients with cardiovascular diseases.However,the association between frailty and in-hospital outcomes for elderly patients with heart failure and reduced ejection(HFrEF)rema...BACKGROUND Frailty is prevalent in elderly patients with cardiovascular diseases.However,the association between frailty and in-hospital outcomes for elderly patients with heart failure and reduced ejection(HFrEF)remains unknown.AIM To evaluate the predictive efficacy of frailty,compared with pre-frailty,for adverse events in these patients.METHODS Elderly patients(≥60 years)with HFrEF were assessed.Frailty was evaluated with the Fried phenotype criteria,and physical performance was evaluated based on handgrip strength and the short physical performance battery(SPPB).The composite incidence of adverse events,including all-cause death,multiple organ failure,cardiac shock,and malignant arrhythmia,during hospitalization was recorded.RESULTS Overall,252 elderly individuals with HFrEF[mean age:69.4±6.7 years,male:169(67.0%)]were included.One hundred and thirty-five(53.6%)patients were frail and 93(36.9%)were pre-frail.Frail patients were older,more likely to be female,to have a lower blood pressure,and to present with left ventricular thrombosis(P all<0.05).Frail patients with HFrEF had a higher incidence of in-hospital mortality(11.9%vs 4.3%,P=0.048).Multivariate analyses showed that female gender(OR=0.422),aging(OR=1.090),poor cardiac functional class(OR=2.167),frailty(OR=2.379),and lower handgrip strength(OR=1.106)were independent predictors of in-hospital adverse events(P all<0.05).CONCLUSION Frailty may be associated with poor in-hospital outcomes for elderly patients with HFrEF.The influence of frailty on long-term prognosis in these patients deserves further investigation.展开更多
Ms. BP is an 83 year old white female with a long history of congestive heart failure (HF). She is now symptomatic with minimal exertion, has a left ventricular ejection fraction (LVEF) of 20%. Her CHF is due to hyper...Ms. BP is an 83 year old white female with a long history of congestive heart failure (HF). She is now symptomatic with minimal exertion, has a left ventricular ejection fraction (LVEF) of 20%. Her CHF is due to hypertension (HTN) plus coronary artery disease (CAD) and she is on angiotensin converting enzyme inhibitor (ACEI), furosemide, digoxin,spironolactone, low dose beta blocker and nitrates. Her beta-natriuretic peptide (BNP) in clinic is 3030 pg/ml, heart rate (HR) 100, blood pressure (BP) 89/43.展开更多
Heart failure (HF) affects 5 million Americans, of whom three-fourths are over age 65 and half are over age 75.1 HF is currently the leading cause of hospitalization among older adults in the U.S., and it is the m... Heart failure (HF) affects 5 million Americans, of whom three-fourths are over age 65 and half are over age 75.1 HF is currently the leading cause of hospitalization among older adults in the U.S., and it is the most costly medical illness by a factor of almost two.……展开更多
Chronic heart failure (CHF) is a clinical syndrome as a common pathway at the end stage of cardiac diseases of different etiologies, and it is currently the only cardiovascular disease with an increasing prevalenc... Chronic heart failure (CHF) is a clinical syndrome as a common pathway at the end stage of cardiac diseases of different etiologies, and it is currently the only cardiovascular disease with an increasing prevalence in the developed countries. In the United States, the prevalence of CHF at age 50 years is 1.0%, whereas it reaches 7.5% at age 80years. In the United Kingdom, the prevalence of CHF is5.0% at age 60-70 years, and 10-20% at age 80 years. The situation is similar in Italy and Portugal. Despite being a developing country in Asia, China has experienced rapid progress in acquiring medical knowledge and advancing techniques in recent years. Due to the markedly declined mortality of acute myocardial infarction (AMI) as well as the aging of Chinese population, about four million Chinese have CHF with a prevalence of 0.9%, most of whom are 60 years of age and older.……展开更多
The current issue of the Journal of Geriatric Cardiology contains an interesting paper by Dr. Yixin Song and colleagues raising important issues in the diagnosis and management of heart failure in elderly patients. Re...The current issue of the Journal of Geriatric Cardiology contains an interesting paper by Dr. Yixin Song and colleagues raising important issues in the diagnosis and management of heart failure in elderly patients. Readers of this journal are in all likelihood aware that the epidemic of heart failure is of great impact medically and economically worldwide.展开更多
Heart failure with preserved ejection fraction(HFpEF)is a clinical syndrome characterized by symptoms and sings of heart failure with elevated left ventricular filling pressures at rest or during exercise.It is the mo...Heart failure with preserved ejection fraction(HFpEF)is a clinical syndrome characterized by symptoms and sings of heart failure with elevated left ventricular filling pressures at rest or during exercise.It is the most common type of heart failure in the elderly and its prevalence increases with age and is higher in females at any given age.HFpEF is frequently accompanied of comorbid conditions such as diabetes mellitus,obesity,atrial fibrillation and renal dysfunction.The diagnosis relies in the integration of clinical information,laboratory data and interpretation of cardiac imaging and hemodynamic findings at rest and during exercise.Conditions that have a specific treatment such as coronary artery disease,valvular disease,cardiac amyloidosis and constrictive pericarditis should be considered and evaluated as appropriate.Aggressive management of comorbidities,optimization of blood pressure control and volume status using diuretics as needed are among the current treatment recommendations.There are no specific therapies that have shown to decrease mortality in HFpEF.In symptomatic patients with history of hospital admission for decompensated heart failure,the implantation of a wireless pulmonary artery pressure monitor should be considered.Finally,given the high mortality of this condition,goals of care discussion should be initiated early and involvement of palliative care medicine should be considered.展开更多
Objective To assess the prognostic utility of serum albumin among elderly patients admitted for acute decompensated heart failure(ADHF)in terms of all-cause mortality and also to identify the predictors of hypoalbumin...Objective To assess the prognostic utility of serum albumin among elderly patients admitted for acute decompensated heart failure(ADHF)in terms of all-cause mortality and also to identify the predictors of hypoalbuminemia.Methods Retrospective cohort study of 119 elderly patients admitted for ADHF.Elderly patients were defined as patients over the age of 65 years.The patients were followed up for approximately 11 years.Patients with advanced renal failure,liver disease not due to HF,cancer and other causes of low life expectancy were excluded.Hypoalbuminemia was defined as serum albumin≤2.9 g/dL.Results The study was made up of 65 females and 54 males with age ranging from 65 to 96 years.Of the 119 elderly patients with ADHF,there were 26 deaths.A significantly higher proportion of patients in the mortality group had an admission serum albumin level of≤2.9 g/dL than those surviving(P=0.011).After Cox’s logistic regression,low albumin(P=0.016),elevated direct bilirubin(P=0.03),age greater than 85(P=0.008),lack of use of beta blockers(P=0.0001)and left ventricular ejection fraction less than 35%(P=0.005)increased the risk of death.Elevated serum creatinine(P=0.0357)was the only predictor of hypoalbuminemia following multiple linear regression.Conclusions Hypoalbuminemia may be an unrecognized marker of death in elderly patients with ADHF.展开更多
Objectives To evaluate the effect of thyroid hormone therapy with low dose of thyroxin on cardiac function in elderly patients with heart failure and sick euthyroid syndrome. Methods Forty-seven patients (33 males and...Objectives To evaluate the effect of thyroid hormone therapy with low dose of thyroxin on cardiac function in elderly patients with heart failure and sick euthyroid syndrome. Methods Forty-seven patients (33 males and 14 females, mean age 85.9+4.6 years,ranging from 80 to 99 years) with chronic heart failure (NYHA Ⅱ-Ⅳ) and low triiodothyronine (T3) state were randomly allocated to the treatment group or control group. The treatment group patients received oral administration of levothyroxine sodium (Euthyrox) 25-50mg/d in addition to conventional therapy of heart failure, whereas patients in control group were given conventional therapy only. Serum level of total T3 (TT3), free T3 (FT3), total thyroxine (TT4), free thyroxine (FT4), and thyroid-stimulating hormone (TSH) were determined. For both groups, left ventricular ejection fraction (LVEF) and stroke volume (SV) were assessed by two-dimensional echocardiography before and at 8 weeks after treatment. The changes of these parameters after the treatment were evaluated by adjusting heart rate in the two groups. Results The reduced serum T3 level in the treatment group was corrected after thyroid hormone therapy,and these patients had a significant improvement in cardiac function after treatment. By contrast, in the control group only changes of serum TT3 and TT4 levels and SV and LVEF after treatment were statistically significant. The heart rate-adjusted mean SV and LVEF in both groups were also increased, which was significantly greater in the treatment group than in the control group. Conclusion In the elderly patients with heart failure and sick euthyroid syndrome, addition of thyroxine at a low dosage to the conventional treatment could effectively improve the low T3 state and cardiac function independent of changes of heart rate.展开更多
Quality of life (QOL), as a relevant area of research in the understanding of heart failure (HF) patient outcomes, has been increasingly studied during the last two decades. The purposes of this review article are to ...Quality of life (QOL), as a relevant area of research in the understanding of heart failure (HF) patient outcomes, has been increasingly studied during the last two decades. The purposes of this review article are to (1) describe QOL in older adults with HF, (2)identify and critique research designed to test interventions to improve QOL, (3) identify gaps in the literature, and (4) provide recommendations for future research. Seventeen studies describing QOL in older adults with HF were identified. Elderly HF patient QOL has been reported to be fair to poor and is worse as compared to a healthy control group. Furthermore, there is some evidence that suggests that QOL is better in older adults than younger adults and worse in women (both older and younger) than in men, although these findings are not consistent across studies. Predictors of QOL and its dimensions in older HF patients included demographic, clinical, and psychosocial variables. Sixteen interventional studies were identified that reported QOL as an outcome in older adults. Findings among randomized clinical trials (RCTs) to improve QOL outcomes in elderly HF patients do not allow strong conclusions about the benefits of the interventions. It must be noted, though, that while not all studies reported improvements in QOL (either significant or as a trend),no studies reported deterioration in QOL with randomization to an intervention versus control. These studies were limited by several methodological issues. While there has been some research of QOL in this elderly cohort, it is paramount that we address methodological issues and thereby improve the scientific rigor of our research, continue to explore QOL in elderly HF patients, and design intervention trials for elders at risk for poor QOL.展开更多
Heart failure with preserved left ventricular function is a common problem among elderly patients. Given that diastolic heart failure (DHF) occurs in up to 50% of all heart failure admissions, and that incidence incre...Heart failure with preserved left ventricular function is a common problem among elderly patients. Given that diastolic heart failure (DHF) occurs in up to 50% of all heart failure admissions, and that incidence increases with age, knowledge of current recommendations for its diagnosis and treatment are extremely important for the elderly population. Causes of DHF include the aging process itself, hypertension, left ventricular hypertrophy, aortic stenosis, and hypertrophic obstructive cardiomyopathy. The patient with DHF may present with signs and symptoms similar to those observed in systolic heart failure. Treatment goals for the patient with DHF include achieving normal volume status, improving relaxation of the left ventricle, regression of hypertrophy if possible, and management of any co-morbidities that may aggravate the clinical status of patients with DHF. Hopefully, in the future, further data from randomized clinical trials will allow a more defined approach to care in these patients.展开更多
Objective To investigate heart failure mortality compared between elderly and non-elderly Thai patients.Methods This study included patients at least 18 years of age who were admitted to the hospital with a primary di...Objective To investigate heart failure mortality compared between elderly and non-elderly Thai patients.Methods This study included patients at least 18 years of age who were admitted to the hospital with a primary diagnosis of heart failure(ICD-10-TM code:150.9)during 2008-2012 according to three major Thailand reimbursement systems(civil servant,social security,and universal coverage systems).Patients were categorized into either the elderly group(age>65 years)or the non-elderly group(age<65 years).Mortality rate and survival analysis were compared between groups.Demographic,underlying disease and comorbid condition data were collected.Cardiovascular and non-cardiovascular death was also analyzed.Results A total of 201,709 patients were included.The average age of patients was 64.9±14.8 years,and the gender proportion breakdown was 84,155(41.7%)males and 117,554(58.3%)females.Just over half of patients(107,325 patients;53.2%)were elderly.Overall mortality rate was 50.8%.The mortality rate at one month,six months,one year,and three years was 11.0%,24.5%,32.5%,and 46.3%,respectively.Elderly patients had a higher rate of mortality compared to non-elderly patients with an adjusted odds ratio(OR)of 1.47(95%CI:1.46-1.49)for all-cause mortality,an OR of 1.25(95%CI:1.23-1.27)for cardiovascular death,and an OR of 1.72(95%CI:1.68-1.75)for non-cardiovascular death(all P<0.001).After adjusting for potential confounders,elderly status remained the second strongest factor associated with increased risk of mortality after heart failure hospitalization following chronic kidney disease.Conclusions The overall mortality rate after heart failure hospitalization was a very high 50.8%.Multivariate analysis revealed elderly status to be an independent predictor of mortality after hospitalization.This finding suggests that improvements are needed related to the quality of care and follow-up given to elderly Thai heart failure patients.展开更多
Objective:To determine the effect of self-management program on the health status of elderly patients with heart failure.Methods:The present study was a single-blind,randomized clinical trial,and conducted on 90 patie...Objective:To determine the effect of self-management program on the health status of elderly patients with heart failure.Methods:The present study was a single-blind,randomized clinical trial,and conducted on 90 patients with heart failure of stages Ⅱ-Ⅲ at one teaching hospital in eastern Iran in 2017.The participants were randomly assigned into two groups:the intervention group and the control groups,with 45 patients in each group.Self-management programs including awareness and recognition,problem-solving process,diet,exercise,and stress management were carried out.The participants were trained for six weeks and were followed for two months.Data of the health status were collected before,after and eight weeks after intervention by Kansas City Cardiomyopathy Questionnaire.Data analysis by chi-square,independent t-test,Fisher,ANOVA with repeated measures was conducted.Results:Patients in both groups were matched in terms of demographic characteristics before the intervention.There was no significant difference in the mean scores of health status between the two groups (P=0.1) before the intervention.However,the second measurement after intervention showed a significant difference in the mean scores between the two groups (P=0.001).Conclusions:Self-management program can improve the different dimensions of health (except in the subscale of sign and symptoms).Therefore,this supportive method can be used to improve the health of patients and manage problems caused by heart failure.展开更多
Amyloidosis is a multisystem disease that is characterized by deposition of fibrils in extracellular tissue,which mainly involves the kidney,heart,and autonomic nervous system.Two types of amyloidosis typically infilt...Amyloidosis is a multisystem disease that is characterized by deposition of fibrils in extracellular tissue,which mainly involves the kidney,heart,and autonomic nervous system.Two types of amyloidosis typically infiltrate the heart,including immunoglobulin light-chain(AL)and amyloid transthyretin(ATTR).ATTR is further subdivided into wild-type ATTR and variant ATTR caused by point mutations in the TTR gene.[1]Wild-type ATTR is considered as not uncommon in older patients with heart failure.Recently,a comprehensive set of consensus recommendations for the suspicion and diagnosis of ATTR was published,with particular focus on the combined application of noninvasive methods.[2]We present here a case of wild-type TTR cardiac amyloidosis(ATTRwt-CA),which was diagnosed by noninvasive modalities,and provide an overview of the recommended diagnostic approach of CA.Furthermore,to the best of our knowledge,this is the first Chinese case of ATTRwt-CA reported to date.展开更多
Heart failure(HF)has been defined as global disease of pandemic proportions,since it affects around 26 million people worldwide.[1]According to a recent study,age is the most important factor influencing the prevalenc...Heart failure(HF)has been defined as global disease of pandemic proportions,since it affects around 26 million people worldwide.[1]According to a recent study,age is the most important factor influencing the prevalence of HF,as it is for most other chronic conditions.[2]This means that,with the predicted aging of the population(the proportion of the world’s population aged 60 years and over will nearly double from 2015 to 2050),[3]there will be a growth in the total burden of HF,and a rise in the number of comorbidities in HF patients.According to a recent study,almost 86%of adults with HF have two or more comorbid conditions.[4]Comorbidity,defined as the co-existence of one or more additional conditions in individuals with a specified index medical condition,[5]adds to the complexity of treating elderly patients with HF.展开更多
Approximately 50% of all heart failure patients in the US are above 75 years of age, which is almost similar to most European countries and the Middle and the Far East. Even though aging is an independent molecular pr...Approximately 50% of all heart failure patients in the US are above 75 years of age, which is almost similar to most European countries and the Middle and the Far East. Even though aging is an independent molecular process with a multitude of genetic predetermination and biochemical mediations, aging itself does not automatically result in cardiac insufficiency. On the other hand, with increasing age, cardioprotective mechanisms in response to stress are lost, and progressive cardiomyocyte degeneration with replace- ment fibrosis is often seen in older hearts, even though the exact triggers are not completely understood. Older patients with heart failure have distinct features that require special attention in diagnosis as well as therapy. The elderly more frequently suffer from multiple co-morbidities and might have atypical clinical presentations. Several precautions are essential in the treatment of heart failure in the elderly due to co-existing morbidities and the pharmacokinetic and pharmacodynamic changes related to increased age. Also, treatment expectations, compliance, mental status and cognitive function might play a major role regarding optimized treatment and monitoring options in the elderly suffering from heart failure. This review summarizes current issues of heart failure management in the elderly.展开更多
Objective Heart failure is an epidemic in the elderly, but there is a striking lack of data in this clinically important patient population. We investigated the demographics, cardiac performance, and medication manage...Objective Heart failure is an epidemic in the elderly, but there is a striking lack of data in this clinically important patient population. We investigated the demographics, cardiac performance, and medication management of a segment of the hospital popula- tion in at least their eighth decade of life. Methods We retrospectively reviewed 75 records of heart failure patients who were 80 years of age or older. Records were reviewed for demographic information, presence or absence of diastolic dysfunction, evaluation of ejection fraction, and medication usage including angiotensin-concerting enzyme (ACE) inhibitors, angiotensin receptor antagonists (ARBs), beta-adrenergic blockers, digoxin, and aldosterone antagonists. Assessment for contra-indications to ACE inhibitor or ARBs use was also performed to assess co-morbidities that limit treatment of heart failure. Results The population of very elderly with heart failure is heterogeneous. We found a higher proportion of females as well as higher rates of diastolic dysfunction in patients aged ≥ 90 years compared to patients between the ages of 80-89 years. Usage of ACE inhibitors, ARBs and beta-adrenergic blockers was strikingly low throughout the very elderly population. While co-morbid conditions limited use of agents in many cases, there was a lack of explicit contra-indication in most patients not on an ACE inhibitor or an ARB. Conclusions Heart failure is not a single disease processes, but a continuum of disease processes that vary with age. The elderly with heart failure are an undertreated population, in part due to the multitude of co-morbidities that affect them. Further prospective studies are needed to better understand the physiology and ideal treatment regiment in this growing population.展开更多
Heart failure(HF)is a condition of cardiac dysfunction and fluid overload.Neurohormonal activation via the reninangiotensin-aldosterone system and the sympathetic nervous system are the pathophysiological cornerstones...Heart failure(HF)is a condition of cardiac dysfunction and fluid overload.Neurohormonal activation via the reninangiotensin-aldosterone system and the sympathetic nervous system are the pathophysiological cornerstones.[1]Furthermore,HF is a disorder widely associated with grave adverse outcomes and poor prognosis.[2]A loop diuretic is the fundamental drug used to prevent multiorgan failure and improve symptoms in these patients.[3]展开更多
基金Supported by Zhejiang Medical and Health Science and Technology Program(Project Name:Construction and Application of Exercise Fear Intervention Program for Elderly Patients with Chronic Heart Failure Based on HBM and TPB Theory),No.2023KY180.
文摘BACKGROUND With the intensification of social aging,the susceptibility of the elderly population to diseases has attracted increasing attention,especially chronic heart failure(CHF)that accounts for a large proportion of the elderly.AIM To evaluate the application value of health concept model-based detailed behavioral care in elderly patients with CHF.METHODS This study recruited 116 elderly CHF patients admitted from October 2018 to October 2020 and grouped them according to the nursing care that they received.The elderly patients who underwent health concept model-based detailed behavioral care were included in a study group(SG;n=62),and those who underwent routine detailed behavioral nursing intervention were included as a control group(CG;n=54).Patients’negative emotions(NEs),quality of life(QoL),and nutritional status were assessed using the self-rating anxiety/depression scale(SAS/SDS),the Minnesota Living with Heart Failure Questionnaire(MLHFQ),and the Modified Quantitative Subjective Global Assessment(MQSGA)of nutrition,respectively.Differences in rehabilitation efficiency,NEs,cardiac function(CF)indexes,nutritional status,QoL,and nursing satisfaction were comparatively analyzed.RESULTS A higher response rate was recorded in the SG vs the CG after intervention(P<0.05).After care,the left ventricular ejection fraction was higher while the left ventricular end-diastolic dimension and left ventricular end systolic diameter were lower in the SG compared with the CG(P<0.05).The post-intervention SAS and SDS scores,as well as MQSGA and MLHFQ scores,were also lower in the SG(P<0.05).The SG was also superior to the CG in the overall nursing satisfaction rate(P<0.05).CONCLUSION Health concept model-based detailed behavioral care has high application value in the nursing care of elderly CHF patients,and it can not only effectively enhance rehabilitation efficiency,but also mitigate patients’NEs and improve their CF and QoL.
文摘OBJECTIVE To assess the role of beta-blockers(BB)in patients with chronic kidney disease(CKD)aged≥75 years.METHODS AND RESULTS From January 2008 to July 2014,we included 390 consecutive patients≥75 years of age with ejection fraction≤35%and glomerular filtration rate(GFR)≤60 m L/min per 1.73 m^2.We analyzed the relationship between treatment with BB and mortality or cardiovascular events.The mean age of our population was 82.6±4.1 years.Mean ejection fraction was 27.9%±6.5%.GFR was 60-45 m L/min per 1.73 m^2 in 50.3%of patients,45-30 m L/min per 1.73 m^2 in 37.4%,and<30 m L/min per 1.73 m^2 in 12.3%.At the conclusion of follow-up,67.4%of patients were receiving BB.The median follow-up was28.04(IR:19.41-36.67)months.During the study period,211 patients(54.1%)died and 257(65.9%)had a major cardiovascular event(death or hospitalization for heart failure).BB use was significantly associated with a reduced risk of death(HR=0.51,95%CI:0.35-0.74;P<0.001).Patients receiving BB consistently showed a reduced risk of death across the different stages of CKD:stage IIIa(GFR=30-45 m L/min per 1.73 m^2;HR=0.47,95%CI:0.26-0.86,P<0.0001),stage IIIb(GFR 30-45 m L/min per 1.73 m^2;HR=0.55,95%CI:0.26-1.06,P=0.007),and stages IV and V(GFR<30 m L/min per 1.73 m~2;HR=0.29,95%CI:0.11-0.76;P=0.047).CONCLUSIONS The use of BB in elderly patients with HFr EF and renal impairment was associated with a better prognosis.Use of BB should be encouraged when possible.
文摘Heart failure (HF) is a major health problem for the geriatric population. In the United States, most of the 5 millions patients with HF are elderly.1 Seventy-five percent of HF hospitalizations occurred in patients older than 65 years and 50% in patients 75 years and older.1 In the Framingham population, the prevalence of HF increased eightfold among men from the fifth decade of life to the seventh decade.2 However, despite of considerable improvement in the treatment, the mortality of HF patients remained relatively constant between 1948 and 1997.
基金Beijing Municipal Administration of Hospitals Incubating Program,No.PX2018026.
文摘BACKGROUND Frailty is prevalent in elderly patients with cardiovascular diseases.However,the association between frailty and in-hospital outcomes for elderly patients with heart failure and reduced ejection(HFrEF)remains unknown.AIM To evaluate the predictive efficacy of frailty,compared with pre-frailty,for adverse events in these patients.METHODS Elderly patients(≥60 years)with HFrEF were assessed.Frailty was evaluated with the Fried phenotype criteria,and physical performance was evaluated based on handgrip strength and the short physical performance battery(SPPB).The composite incidence of adverse events,including all-cause death,multiple organ failure,cardiac shock,and malignant arrhythmia,during hospitalization was recorded.RESULTS Overall,252 elderly individuals with HFrEF[mean age:69.4±6.7 years,male:169(67.0%)]were included.One hundred and thirty-five(53.6%)patients were frail and 93(36.9%)were pre-frail.Frail patients were older,more likely to be female,to have a lower blood pressure,and to present with left ventricular thrombosis(P all<0.05).Frail patients with HFrEF had a higher incidence of in-hospital mortality(11.9%vs 4.3%,P=0.048).Multivariate analyses showed that female gender(OR=0.422),aging(OR=1.090),poor cardiac functional class(OR=2.167),frailty(OR=2.379),and lower handgrip strength(OR=1.106)were independent predictors of in-hospital adverse events(P all<0.05).CONCLUSION Frailty may be associated with poor in-hospital outcomes for elderly patients with HFrEF.The influence of frailty on long-term prognosis in these patients deserves further investigation.
文摘Ms. BP is an 83 year old white female with a long history of congestive heart failure (HF). She is now symptomatic with minimal exertion, has a left ventricular ejection fraction (LVEF) of 20%. Her CHF is due to hypertension (HTN) plus coronary artery disease (CAD) and she is on angiotensin converting enzyme inhibitor (ACEI), furosemide, digoxin,spironolactone, low dose beta blocker and nitrates. Her beta-natriuretic peptide (BNP) in clinic is 3030 pg/ml, heart rate (HR) 100, blood pressure (BP) 89/43.
文摘 Heart failure (HF) affects 5 million Americans, of whom three-fourths are over age 65 and half are over age 75.1 HF is currently the leading cause of hospitalization among older adults in the U.S., and it is the most costly medical illness by a factor of almost two.……
文摘 Chronic heart failure (CHF) is a clinical syndrome as a common pathway at the end stage of cardiac diseases of different etiologies, and it is currently the only cardiovascular disease with an increasing prevalence in the developed countries. In the United States, the prevalence of CHF at age 50 years is 1.0%, whereas it reaches 7.5% at age 80years. In the United Kingdom, the prevalence of CHF is5.0% at age 60-70 years, and 10-20% at age 80 years. The situation is similar in Italy and Portugal. Despite being a developing country in Asia, China has experienced rapid progress in acquiring medical knowledge and advancing techniques in recent years. Due to the markedly declined mortality of acute myocardial infarction (AMI) as well as the aging of Chinese population, about four million Chinese have CHF with a prevalence of 0.9%, most of whom are 60 years of age and older.……
文摘The current issue of the Journal of Geriatric Cardiology contains an interesting paper by Dr. Yixin Song and colleagues raising important issues in the diagnosis and management of heart failure in elderly patients. Readers of this journal are in all likelihood aware that the epidemic of heart failure is of great impact medically and economically worldwide.
文摘Heart failure with preserved ejection fraction(HFpEF)is a clinical syndrome characterized by symptoms and sings of heart failure with elevated left ventricular filling pressures at rest or during exercise.It is the most common type of heart failure in the elderly and its prevalence increases with age and is higher in females at any given age.HFpEF is frequently accompanied of comorbid conditions such as diabetes mellitus,obesity,atrial fibrillation and renal dysfunction.The diagnosis relies in the integration of clinical information,laboratory data and interpretation of cardiac imaging and hemodynamic findings at rest and during exercise.Conditions that have a specific treatment such as coronary artery disease,valvular disease,cardiac amyloidosis and constrictive pericarditis should be considered and evaluated as appropriate.Aggressive management of comorbidities,optimization of blood pressure control and volume status using diuretics as needed are among the current treatment recommendations.There are no specific therapies that have shown to decrease mortality in HFpEF.In symptomatic patients with history of hospital admission for decompensated heart failure,the implantation of a wireless pulmonary artery pressure monitor should be considered.Finally,given the high mortality of this condition,goals of care discussion should be initiated early and involvement of palliative care medicine should be considered.
文摘Objective To assess the prognostic utility of serum albumin among elderly patients admitted for acute decompensated heart failure(ADHF)in terms of all-cause mortality and also to identify the predictors of hypoalbuminemia.Methods Retrospective cohort study of 119 elderly patients admitted for ADHF.Elderly patients were defined as patients over the age of 65 years.The patients were followed up for approximately 11 years.Patients with advanced renal failure,liver disease not due to HF,cancer and other causes of low life expectancy were excluded.Hypoalbuminemia was defined as serum albumin≤2.9 g/dL.Results The study was made up of 65 females and 54 males with age ranging from 65 to 96 years.Of the 119 elderly patients with ADHF,there were 26 deaths.A significantly higher proportion of patients in the mortality group had an admission serum albumin level of≤2.9 g/dL than those surviving(P=0.011).After Cox’s logistic regression,low albumin(P=0.016),elevated direct bilirubin(P=0.03),age greater than 85(P=0.008),lack of use of beta blockers(P=0.0001)and left ventricular ejection fraction less than 35%(P=0.005)increased the risk of death.Elevated serum creatinine(P=0.0357)was the only predictor of hypoalbuminemia following multiple linear regression.Conclusions Hypoalbuminemia may be an unrecognized marker of death in elderly patients with ADHF.
文摘Objectives To evaluate the effect of thyroid hormone therapy with low dose of thyroxin on cardiac function in elderly patients with heart failure and sick euthyroid syndrome. Methods Forty-seven patients (33 males and 14 females, mean age 85.9+4.6 years,ranging from 80 to 99 years) with chronic heart failure (NYHA Ⅱ-Ⅳ) and low triiodothyronine (T3) state were randomly allocated to the treatment group or control group. The treatment group patients received oral administration of levothyroxine sodium (Euthyrox) 25-50mg/d in addition to conventional therapy of heart failure, whereas patients in control group were given conventional therapy only. Serum level of total T3 (TT3), free T3 (FT3), total thyroxine (TT4), free thyroxine (FT4), and thyroid-stimulating hormone (TSH) were determined. For both groups, left ventricular ejection fraction (LVEF) and stroke volume (SV) were assessed by two-dimensional echocardiography before and at 8 weeks after treatment. The changes of these parameters after the treatment were evaluated by adjusting heart rate in the two groups. Results The reduced serum T3 level in the treatment group was corrected after thyroid hormone therapy,and these patients had a significant improvement in cardiac function after treatment. By contrast, in the control group only changes of serum TT3 and TT4 levels and SV and LVEF after treatment were statistically significant. The heart rate-adjusted mean SV and LVEF in both groups were also increased, which was significantly greater in the treatment group than in the control group. Conclusion In the elderly patients with heart failure and sick euthyroid syndrome, addition of thyroxine at a low dosage to the conventional treatment could effectively improve the low T3 state and cardiac function independent of changes of heart rate.
文摘Quality of life (QOL), as a relevant area of research in the understanding of heart failure (HF) patient outcomes, has been increasingly studied during the last two decades. The purposes of this review article are to (1) describe QOL in older adults with HF, (2)identify and critique research designed to test interventions to improve QOL, (3) identify gaps in the literature, and (4) provide recommendations for future research. Seventeen studies describing QOL in older adults with HF were identified. Elderly HF patient QOL has been reported to be fair to poor and is worse as compared to a healthy control group. Furthermore, there is some evidence that suggests that QOL is better in older adults than younger adults and worse in women (both older and younger) than in men, although these findings are not consistent across studies. Predictors of QOL and its dimensions in older HF patients included demographic, clinical, and psychosocial variables. Sixteen interventional studies were identified that reported QOL as an outcome in older adults. Findings among randomized clinical trials (RCTs) to improve QOL outcomes in elderly HF patients do not allow strong conclusions about the benefits of the interventions. It must be noted, though, that while not all studies reported improvements in QOL (either significant or as a trend),no studies reported deterioration in QOL with randomization to an intervention versus control. These studies were limited by several methodological issues. While there has been some research of QOL in this elderly cohort, it is paramount that we address methodological issues and thereby improve the scientific rigor of our research, continue to explore QOL in elderly HF patients, and design intervention trials for elders at risk for poor QOL.
文摘Heart failure with preserved left ventricular function is a common problem among elderly patients. Given that diastolic heart failure (DHF) occurs in up to 50% of all heart failure admissions, and that incidence increases with age, knowledge of current recommendations for its diagnosis and treatment are extremely important for the elderly population. Causes of DHF include the aging process itself, hypertension, left ventricular hypertrophy, aortic stenosis, and hypertrophic obstructive cardiomyopathy. The patient with DHF may present with signs and symptoms similar to those observed in systolic heart failure. Treatment goals for the patient with DHF include achieving normal volume status, improving relaxation of the left ventricle, regression of hypertrophy if possible, and management of any co-morbidities that may aggravate the clinical status of patients with DHF. Hopefully, in the future, further data from randomized clinical trials will allow a more defined approach to care in these patients.
文摘Objective To investigate heart failure mortality compared between elderly and non-elderly Thai patients.Methods This study included patients at least 18 years of age who were admitted to the hospital with a primary diagnosis of heart failure(ICD-10-TM code:150.9)during 2008-2012 according to three major Thailand reimbursement systems(civil servant,social security,and universal coverage systems).Patients were categorized into either the elderly group(age>65 years)or the non-elderly group(age<65 years).Mortality rate and survival analysis were compared between groups.Demographic,underlying disease and comorbid condition data were collected.Cardiovascular and non-cardiovascular death was also analyzed.Results A total of 201,709 patients were included.The average age of patients was 64.9±14.8 years,and the gender proportion breakdown was 84,155(41.7%)males and 117,554(58.3%)females.Just over half of patients(107,325 patients;53.2%)were elderly.Overall mortality rate was 50.8%.The mortality rate at one month,six months,one year,and three years was 11.0%,24.5%,32.5%,and 46.3%,respectively.Elderly patients had a higher rate of mortality compared to non-elderly patients with an adjusted odds ratio(OR)of 1.47(95%CI:1.46-1.49)for all-cause mortality,an OR of 1.25(95%CI:1.23-1.27)for cardiovascular death,and an OR of 1.72(95%CI:1.68-1.75)for non-cardiovascular death(all P<0.001).After adjusting for potential confounders,elderly status remained the second strongest factor associated with increased risk of mortality after heart failure hospitalization following chronic kidney disease.Conclusions The overall mortality rate after heart failure hospitalization was a very high 50.8%.Multivariate analysis revealed elderly status to be an independent predictor of mortality after hospitalization.This finding suggests that improvements are needed related to the quality of care and follow-up given to elderly Thai heart failure patients.
文摘Objective:To determine the effect of self-management program on the health status of elderly patients with heart failure.Methods:The present study was a single-blind,randomized clinical trial,and conducted on 90 patients with heart failure of stages Ⅱ-Ⅲ at one teaching hospital in eastern Iran in 2017.The participants were randomly assigned into two groups:the intervention group and the control groups,with 45 patients in each group.Self-management programs including awareness and recognition,problem-solving process,diet,exercise,and stress management were carried out.The participants were trained for six weeks and were followed for two months.Data of the health status were collected before,after and eight weeks after intervention by Kansas City Cardiomyopathy Questionnaire.Data analysis by chi-square,independent t-test,Fisher,ANOVA with repeated measures was conducted.Results:Patients in both groups were matched in terms of demographic characteristics before the intervention.There was no significant difference in the mean scores of health status between the two groups (P=0.1) before the intervention.However,the second measurement after intervention showed a significant difference in the mean scores between the two groups (P=0.001).Conclusions:Self-management program can improve the different dimensions of health (except in the subscale of sign and symptoms).Therefore,this supportive method can be used to improve the health of patients and manage problems caused by heart failure.
基金the National Key Research and Development Program of China(2016YFC0901500).
文摘Amyloidosis is a multisystem disease that is characterized by deposition of fibrils in extracellular tissue,which mainly involves the kidney,heart,and autonomic nervous system.Two types of amyloidosis typically infiltrate the heart,including immunoglobulin light-chain(AL)and amyloid transthyretin(ATTR).ATTR is further subdivided into wild-type ATTR and variant ATTR caused by point mutations in the TTR gene.[1]Wild-type ATTR is considered as not uncommon in older patients with heart failure.Recently,a comprehensive set of consensus recommendations for the suspicion and diagnosis of ATTR was published,with particular focus on the combined application of noninvasive methods.[2]We present here a case of wild-type TTR cardiac amyloidosis(ATTRwt-CA),which was diagnosed by noninvasive modalities,and provide an overview of the recommended diagnostic approach of CA.Furthermore,to the best of our knowledge,this is the first Chinese case of ATTRwt-CA reported to date.
文摘Heart failure(HF)has been defined as global disease of pandemic proportions,since it affects around 26 million people worldwide.[1]According to a recent study,age is the most important factor influencing the prevalence of HF,as it is for most other chronic conditions.[2]This means that,with the predicted aging of the population(the proportion of the world’s population aged 60 years and over will nearly double from 2015 to 2050),[3]there will be a growth in the total burden of HF,and a rise in the number of comorbidities in HF patients.According to a recent study,almost 86%of adults with HF have two or more comorbid conditions.[4]Comorbidity,defined as the co-existence of one or more additional conditions in individuals with a specified index medical condition,[5]adds to the complexity of treating elderly patients with HF.
文摘Approximately 50% of all heart failure patients in the US are above 75 years of age, which is almost similar to most European countries and the Middle and the Far East. Even though aging is an independent molecular process with a multitude of genetic predetermination and biochemical mediations, aging itself does not automatically result in cardiac insufficiency. On the other hand, with increasing age, cardioprotective mechanisms in response to stress are lost, and progressive cardiomyocyte degeneration with replace- ment fibrosis is often seen in older hearts, even though the exact triggers are not completely understood. Older patients with heart failure have distinct features that require special attention in diagnosis as well as therapy. The elderly more frequently suffer from multiple co-morbidities and might have atypical clinical presentations. Several precautions are essential in the treatment of heart failure in the elderly due to co-existing morbidities and the pharmacokinetic and pharmacodynamic changes related to increased age. Also, treatment expectations, compliance, mental status and cognitive function might play a major role regarding optimized treatment and monitoring options in the elderly suffering from heart failure. This review summarizes current issues of heart failure management in the elderly.
文摘Objective Heart failure is an epidemic in the elderly, but there is a striking lack of data in this clinically important patient population. We investigated the demographics, cardiac performance, and medication management of a segment of the hospital popula- tion in at least their eighth decade of life. Methods We retrospectively reviewed 75 records of heart failure patients who were 80 years of age or older. Records were reviewed for demographic information, presence or absence of diastolic dysfunction, evaluation of ejection fraction, and medication usage including angiotensin-concerting enzyme (ACE) inhibitors, angiotensin receptor antagonists (ARBs), beta-adrenergic blockers, digoxin, and aldosterone antagonists. Assessment for contra-indications to ACE inhibitor or ARBs use was also performed to assess co-morbidities that limit treatment of heart failure. Results The population of very elderly with heart failure is heterogeneous. We found a higher proportion of females as well as higher rates of diastolic dysfunction in patients aged ≥ 90 years compared to patients between the ages of 80-89 years. Usage of ACE inhibitors, ARBs and beta-adrenergic blockers was strikingly low throughout the very elderly population. While co-morbid conditions limited use of agents in many cases, there was a lack of explicit contra-indication in most patients not on an ACE inhibitor or an ARB. Conclusions Heart failure is not a single disease processes, but a continuum of disease processes that vary with age. The elderly with heart failure are an undertreated population, in part due to the multitude of co-morbidities that affect them. Further prospective studies are needed to better understand the physiology and ideal treatment regiment in this growing population.
基金the Swedish Heart-Lung Foundation and the Swedish SUS Funds。
文摘Heart failure(HF)is a condition of cardiac dysfunction and fluid overload.Neurohormonal activation via the reninangiotensin-aldosterone system and the sympathetic nervous system are the pathophysiological cornerstones.[1]Furthermore,HF is a disorder widely associated with grave adverse outcomes and poor prognosis.[2]A loop diuretic is the fundamental drug used to prevent multiorgan failure and improve symptoms in these patients.[3]
