1/9/2024 0 Comments Functional depression![]() ![]() 3 The mechanisms contributing to these outcomes are not well understood. 12 After ADHF, all-cause outcomes for HFpEF are similarly adverse as for HFrEF but with differences in HF disease-specific outcomes. Furthermore, responses to interventions in chronic HFpEF frequently diverge markedly from those of HFrEF, where many therapies proven highly effective for HFrEF have shown little or no benefit for HFpEF. 11 The cardiovascular substrate of HFpEF differs significantly from HF with reduced EF (HFrEF), and the pathophysiology of HFpEF is not well understood. HFpEF is the most common form of HF in the elderly, accounting for ≈90% of incident HF among older women. 10Īmong subgroups of older ADHF patients, HF with preserved ejection fraction (HFpEF) is the most important phenotype. 8–10 However, the sample size in our pilot study was very small (n=27), limiting confidence in the point estimates and generalizability of our results, as well as precluding subgroup analyses. 7 It has been shown by our group and others that these impairments, which are often unrecognized and not addressed by current care pathways, could help account for the persistently poor outcomes after hospitalization among older ADHF patients. 6 These impairments were much more severe than those observed in age-matched patients with chronic stable HF and were similar in severity to patients with advanced HF awaiting left ventricular assist device implantation. In a small study of older hospitalized ADHF patients, we previously found severe impairments in multiple domains of physical function, including balance, strength, mobility, and endurance, and these were accompanied by high rates of frailty, cognitive dysfunction, and depression and were associated with poor QoL. 2–4 While these outcomes have received considerable attention, less is known about key patient-centered outcomes of physical function, frailty, cognition, depression, and quality of life (QoL) among older ADHF which are important to patients independent of mortality, and are also strong predictors of clinical events. 1 Acute decompensated HF (ADHF) is a leading cause of hospitalization among older Americans, and hospitalization is associated with markedly adverse outcomes, including increased mortality, morbidity, and health care expenditures. The burden of heart failure (HF) is increasing in the United States particularly among older adults, who comprise the majority of the HF population. Depression was usually unrecognized clinically with 38% having Geriatric Depression Scale ≥5 and no documented history of depression. However, depression and QoL were consistently worse in HFpEF versus HFrEF. 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 6-minute walk distance and gait speed ) 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. ![]() 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. Customer Service and Ordering Information.Stroke: Vascular and Interventional Neurology.Journal of the American Heart Association (JAHA).Circ: Cardiovascular Quality & Outcomes.Arteriosclerosis, Thrombosis, and Vascular Biology (ATVB).
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