Frailty and prognosis of older patients with chronic heart failure.

INTRODUCTION AND OBJECTIVES: Heart failure (HF) is prevalent in advanced ages. Our objective was to assess the impact of frailty on 1-year mortality in older patients with ambulatory HF. METHODS: Our data come from the FRAGIC study (Spanish acronym for "Study of the impact of frailty and other geriatric syndromes on the clinical management and prognosis of elderly outpatients with heart failure"), a multicenter prospective registry conducted in 16 Spanish hospitals including outpatients ≥ 75 years with HF followed up by cardiology services in Spain. RESULTS: We included 499 patients with a mean age of 81.4±4.3 years, of whom 193 (38%) were women. A total of 268 (54%) had left ventricular ejection fraction <40%, and 84.6% was in NYHA II functional class. The FRAIL scale identified 244 (49%) pre-frail and 111 (22%) frail patients. Frail patients were significantly older, were more frequently female (both, P <.001), and had higher comorbidity according to the Charlson index (P=.017) and a higher prevalence of geriatric syndromes (P <.001). During a median follow-up of 371 [361-387] days, 58 patients (11.6%) died. On multivariate analysis (Cox regression model), frailty detected with the FRAIL scale was marginally associated with mortality (HR=2.35; 95%CI, 0.96-5.71; P=.059), while frailty identified by the visual mobility scale was an independent predictor of mortality (HR=2.26; 95%CI, 1.16-4.38; P=.015); this association was maintained after adjustment for confounding variables (HR=2.13; 95%CI, 1.08-4.20; P=.02). CONCLUSIONS: In elderly outpatients with HF, frailty is independently associated with mortality at 1 year of follow-up. It is essential to identify frailty as part of the comprehensive approach to elderly patients with HF.

Left atrial strain improves echocardiographic classification of diastolic function in patients with metabolic syndrome and overweight-obesity.

BACKGROUND: Current recommendations for echocardiographic assessment of diastolic function (2016 guidelines of the American Society of Echocardiography (ASE)/European Association of Cardiovascular Imaging (EACVI) in patients with metabolic syndrome and overweight/obesity result in a significant number of patients with indeterminate diastolic dysfunction (LVDD). The aim of this article is to study whether the use of the left atrial strain criterion (LALS) reduces the number of indeterminate patients. METHODS: 229 patients were studied with a complete echocardiographic study that included left ventricular longitudinal strain (LVLS) analysis, LALS and a maximal ergospirometry test with assessment of oxygen uptake (VO2max). RESULTS: The mean age was 65 ±â€¯5 years, 153 (67%) males, with a mean EF of 60 ±â€¯5%. The mean LVLS was -19.4 ±â€¯2% and the LALS Reservoir was 23.8 ±â€¯7%. There were 140 patients who did not meet LVDD criteria and 82 who did meet the indeterminate LVDD criterion. When the left atrial volume index (LAVI) >34 ml/m2 criterion was replaced in the 2016 ASE/EACVI algorithm by LALS Reservoir ≤20%, the number of indeterminate patients was reduced from 36% to 23% (p < 0.001) at the expense of increasing normal studies (61% and 74%). Adding the LALS Reservoir criterion ≤23% in the 82 patients of the indeterminate group resulted in two groups with a different VO2max (11.6 ±â€¯3 and 18 ±â€¯5 ml/kg/min, p:0.081). CONCLUSIONS: This study confirms the low prevalence of diastolic dysfunction in overweight/obese patients with metabolic syndrome. Adding left atrial strain criterion to the current recommendations significantly reduces the number of indeterminate patients by reclassifying them as normal.

[Appropriateness of hospital stays in a pulmonology department]. / Adecuación de las estancias hospitalarias en un servicio de neumología.

OBJECTIVE: To analyze the number of inappropriate stays generated by patients admitted through a pulmonology department over a 1-year period and to identify the causes and predictors of those stays. PATIENTS AND METHODS: A representative sample of hospital stays corresponding to patients admitted by the pulmonology department at Hospital de Valme, Seville, Spain, in 2004 was analyzed retrospectively using the Appropriateness Evaluation Protocol. The review was conducted by 2 physicians who did not belong to the pulmonology department. Multiple linear regression analysis was performed to identify predictors of inappropriate stay. RESULTS: Of the 1166 stays analyzed, 1038 (89%) were judged to be appropriate and 128 (11%) inappropriate. The most common reason for inappropriate stay was the delay in performing diagnostic tests and receiving results (64%). The main justification for appropriate stay was the need for respiratory treatment (59.6%) and parenteral treatment (46.1%). The predictive model generated by multiple linear regression analysis identified the following predictors of inappropriate stay: stay on a ward other than the pulmonology ward, diagnosis on admission, and season of the year. CONCLUSIONS: The rate of inappropriate stay was low in comparison with other studies. The majority of inappropriate stays were attributed to delays in performing diagnostic tests and receiving results. Diagnosis on admission, season of the year, and stay on a ward other than the pulmonology ward were the strongest predictors of inappropriate stay.