Effects of health concept model-based detailed behavioral care on mood and quality of life in elderly patients with chronic heart failure

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.

Neutrophil-to-lymphocyte ratio compared to N-terminal pro-brain natriuretic peptide as a prognostic marker of adverse events in elderly patients with chronic heart failure

Background The neutrophil-to-lymphocyte （N/L） ratio has been associated with poor prognosis in patients with heart failure, but it has not been compared with N-terminal pro-brain natriuretic peptide （NT-proBNP） in elderly patients with chronic heart failure （CHF）. We sought to make this comparison. Methods A total of 1355 elderly patients with CHF were analyzed. A multivariate logistic regression model was used to analyze the variables associated with atrial fibrillation （AF）. Cox regression analysis was used to assess the multivariable rela- tionship between the N/L ratio, NT-proBNP level, and subsequent major cardiovascular events （MCE）. Results In the multiple logistic regression analysis, the N/L ratio was demonstrated as a risk factor for AF in elderly patients with CHF [odds ratio （OR）： 1.079, 95% confi- dence interval （CI）： 1.027-1.134, P = 0.003]. The median follow-up period was 18 months. In a multivariable model using tertiles of both variables, the highest tertile of the N/L ratio was significantly associated with MCE [hazard ratio （HR）： 1.407, 95% CI： 1.098-1.802, P = 0.007] compared with the lowest tertile. Similarly, the highest NT-proBNP tertile was also significantly associated with MCE （HR： 1.461, 95% CI： 1.104-1.934, P- 0.008）. Conclusions In elderly patients with CHF, the N/L ratio is one of the important risk factors for AF and it is an inexpensive and readily available marker with similar independent prognostic power to NT-proBNP. The risk of MCE increases 1.407-fold when the N/L ratio is elevated to the highest tertile.

Depression and chronic heart failure in the elderly： an intriguing relationship

Chronic heart failure and depressive disorders have a high prevalence and incidence in the elderly. Several studies have shown how depression tends to exacerbate coexisting chronic heart failure and its clinical outcomes and vice versa, especially in the elderly. The negative synergism between chronic heart failure and depression in the elderly may be approached only taking into account the multifaceted pathophysiological characteristics underlying both these conditions, such as behavioural factors, neurohormonal activation, inflammatory mediators, hypercoagulability and vascular damage. Nevertheless, the pathophysiological link between these two conditions is not well established yet. Despite the high prevalence of depression in chronic heart failure elderly patients and its negative prognostic value, it is often unrecognized especially because of shared symptoms. So the screening of mood disorders, using reliable questionnaires, is recommended in elderly patients with chronic heart failure, even if cannot substitute a diagnostic interview by mental health professionals. In this setting, treatment of depression requires a multidisciplinary approach including： psychotherapy, antidepressants, exercise training and electroconvulsive therapy. Pharmacological therapy with selective serotonin reuptake inhibitors, despite conflicting results, improves quality of life but does not guarantee better outcomes. Exercise training is effective in improving quality of life and prognosis but at the same time cardiac rehabilitation services are vastly underutilized.

Quality of life and palliative care needs of elderly patients with advanced heart failure

Objective To examine the quality of life and palliative care needs of elderly patients with advanced heart failure （HF）. Methods This was a correlation descriptive study conducted at a 650-bed sub-acute hospital. Patients who were aged 65 or over, diagnosed with HF of New York Heart Association Class III or IV symptoms, and mentally sound were eligible to the study. The Edmonton Symptom Assessment Scale, the overall quality of life single item scale, and the McQill Quality of Life Questionnaire （MQoL）, were used for measurement. Multi- ple regression analysis was performed to determine factors for predicting quality of life. Results A convenience sample of 112 patients was recruited. Their age was 81.5 ± 8.5 years. The three most distressing symptoms reported by the patients were tiredness （5.96 ± 2.78）, drowsiness （5.47± 2.93）, and shortness of breath （5.34 ± 2.96）. Their mean overall quality of life single item scale score was 4.72 ± 2.06 out of 10. The mean MQoL physical subscale score was the lowest （4.20 ± 1.767）, whereas their mean psychological subscale was the highest （7.14 ±2.39）. However, in a multivariate analysis model, quality of life was significantly associated with existential wellbeing, physical wellbeing, psychological wellbeing and educational level. Conclusions The findings highlight that spiritual concerns are significant palliative care needs among elderly patients with advanced HF, in addition to symptom management. This is in line with the argument that palliative care that places great emphasis on holistic care should be integrated to the care of this group of patients.

Heart failure in the elderly

Heart failure （HF） is a major public health problem worldwide entailing high morbidity and mortality as well as high costs. This chronic syndrome associates with a low functional status and quality of life. Most patients with HF are elderly, constituting up to 80% of patients suffering from this disease with both incidence and prevalence of the condition increasing with age. This is due to the progressive aging of the population as well as improved and better survival after cardiac insults, such as myocardial infarction,

Additive Benefits of Twice Forest Bathing Trips in Elderly Patients with Chronic Heart Failure

Chronic heart failure （CHF）, a clinical syndrome resulting from the consequences of various cardiovascular diseases （CVDs）, is increasingly becoming a global cause of morbidity and mortality. We had earlier demonstrated that a 4-day forest bathing trip can provide an adjunctive therapeutic influence on patients with CHF. To further investigate the duration of the impact and the optimal frequency of forest bathing trips in patients with CHF, we recruited those subjects who had experienced the first forest bathing trip again after 4 weeks and randomly categorized them into two groups, namely, the urban control group （city） and the forest bathing group （forest）. After a second 4-day forest bathing trip, we observed a steady decline in the brain natriuretic peptide levels, a biomarker of heart failure, and an attenuated inflammatory response as well as oxidative stress. Thus, this exploratory study demonstrated the additive benefits of twice forest bathing trips in elderly patients with CHF, which could further pave the way for analyzing the effects of such interventions in CVDs.

Prediction of sudden death in elderly patients with heart failure

Most heart failure （HF） related mortality is due to sudden cardiac death （SCD） and worsening HF, particularly in the case of reduced ejection fraction. Predicting and preventing SCD is an important goal but most works include no or few patients with advanced age, and the prevention of SCD in elderly patients with HF is still controversial. A recent reduction in the annual rate of SCD has been recently described but it is not clear if this is also true in advanced age patients. Age is associated with SCD, although physicians frequently have the perception that elderly patients with HF die mainly of pump failure, underestimating the importance of SCD. Other clinical variables that have been associated to SCD are symptoms, New York Heart Association functional class, ischemic cause, and comorbidities （chronic obstructive pulmonary disease, renal dysfunction and diabetes）. Some test results that should also be considered are left ventricular ejection fraction and diameters, natriuretic peptides, non-sustained ventricular tachycardias and autonomic abnormalities. The combination of all these markers is probably the best option to predict SCD. Different risk scores have been described and, although there are no specific ones for elderly populations, most include age as a risk predictor and some were developed in populations with mean age 〉 65 years. Finally, it is important to stress that these scores should be able to predict any type of SCD as, although most are due to tachyarrhythmias, bradyarrhythmias also play a role, particularly in the case of the elderly.

Precipitating factors leading to decompensation of chronic heart failure in the elderly patient in South-American community hospital

Background Exacerbations of heart failure appear frequently associated with precipitating factors not directly related to the evolution of cardiac disease. There still a paucity of data on the proportional distribution of precipitating factors specifically in elderly patients. The aim of this study was to examine prospectively the precipitating factors leading to hospitalization in elderly patients with heart failure in our community hospital. Methods We evaluate elderly patients who need admissions for decompensate heart failure. All patients were reviewed daily by the study investigators at the first 24 h and closely followed-up. Decompensation was defined as the worsening in clinical NYHA class associated with the need for an increase in medical treatment （at minimum intravenously diuretics）. Results We included 102 patients （mean age 79 ± 12 years）. Precipitating factors were identified in 88.5%. The decompensation was sudden in 35% of the cases. Noncompliance with diet was identified in 52% of the patients, lack of adherence to the prescribed medications amounted to 30%. Others precipitating factors were infections （29%）, arrhythmias （25%）, acute coronary ischemia （22%）, and uncontrolled hypertension （15%）, miscellaneous causes were detected in 18% of the cases （progression of renal disease 60%, anemia 30% and iatrogenic factors 10%）. Concomitant cause was not recognizable in 11.5%. Conclusions Large proportion heart failure hospitalizations are associated with preventable precipitating factors. Knowledge of potential precipitating factors may help to optimize treatment and provide guidance for patients with heart failure. The presence of potential precipitating factors should be routinely evaluated in patients presenting chronic heart failure.

Thyroxine treatment for elderly patients with heart failure and sick euthyroid syndrome

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(NYHAⅡ-Ⅳ)and low triiodothyronine(T_(3))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 T_(3)(TT_(3)),free T_(3)(FT_(3)),total thyroxine(TT_(4)),free thyroxine(FT_(4)),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 T_(3) 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 TT_(3) and TT_(4) 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 T_(3) state and cardiac function independent of changes of heart rate.

Beta-blocker therapy in elderly patients with renal dysfunction and heart failure

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.

A new clinical entity: multi-etiological heart failure in the elderly and its therapeutic implication

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.

Heart failure in the elderly

The aging of the population is, currently, a major phenomenon, drawing the attention of a number of investigators. The significant increase of life expectancies over the past few decades, in addition to social and economic consequences, has lead to a major change in the morbidity and mortality profile of elders. Heart failure （HF） is a condition in which the heart can not pump enough blood to meet the body＇s needs. HF is predominantly a disorder of the elderly with rates increasing exponentially. The prevalence of HF approximately doubles with each decade of life. As people live longer, the occurrence of HF rises, as well as other conditions that complicate its treatment. Impaired heart function implies a reduced duration of survival. Fortunately, many factors that can prevent HF and improve outcome are known and can be applied at any stage. This review emphasizes the importance of factors inherent in aging itself, focusing on heart disease, particularly as a disease of aging, can help critically refine management of this acute and chronic disease, as well as foster preventive strategies to reduce the incidence of this common malady.

Association of frailty with in-hospital outcomes in elderly patients with heart failure

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.

Cardiac resynchronization therapy in the elderly heart failure patient

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.

Heart failure in the elderly:a U.S.perspective

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.……

Multifactor heart failure in the elderly:a proposal for cooperative research

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.……

Understanding heart failure in the elderly with respect to diastolic dysfunction and role for natriuretic peptides

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.

Heart failure with preserved ejection fraction in the elderly: pathophysiology, diagnostic and therapeutic approach

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.

The relevance of serum albumin among elderly patients with acute decompensated heart failure

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.

Testosterone level and mortality in elderly men wit systolic chronic heart failure

Previous studies on the prognostic significance of serum levels of androgens in patients with chronic heart failure （CHF） have yielded conflicting results. The aim of this study was to examine the relationship between serum concentration of testosterone and mortality in men with systolic CHF. A total of 175 elderly men （age ≥60 years） with CHF were recruited. Total testosterone （TI＇） and sex hormone-binding globulin （SHBG） were measured, and estimated free testosterone （eFT） was calculated. The median follow-up time was 3.46 years. Of these patients, 17 had a TT level below 8 nmol I^-1 （230 ng dI^-1）, 27 had an eFT level below 0.225 nmol I^-1 （65 pg ml^-1） and 12 had both. Using the age-specific tenth percentiles of TT and eFT in healthy men in our laboratory as cutoff points, the prevalences of TT and eFT deficiency was 21.7% （38/175） and 27.4% （48/175）, respectively. Both TT and eFT were inversely associated with left ventricular ejection fraction （LVEF） and N-terminal pro-brain natriuretic peptide （NT-pro-BNP） （all P〈0.01）. Kaplan-Meier curves for patients in low, medium and high tertiles according to TT and eFT level showed significantly different cumulative survival rate （both P〈0.01 by log-rank test）. However, after adjustment for clinical variables, there were no significant associations of either TT or eFT levels with survival time （0R=0.97, 95% CI： 0.84-1.12, P=0.28 and 0R=0.92, 95% CI： 0.82-1.06, P=0.14, respectively）. Our study showed that levels of TT and eFT are commonly decreased in elderly patients with systolic CHF and related to disease severity, but they are not independent predictors for mortality.