The Impact of Acute Heart Failure on Frailty Degree and Outcomes in Elderly Patients with Severe Aortic Stenosis and Chronic Heart Failure with Preserved Ejection Fraction

• Published in: Journal of cardiovascular development and disease Vol. 11; no. 5; p. 150
• Main Authors: Esposito, Augusto, Foffa, Ilenia, Vecoli, Cecilia, Bastiani, Luca, Berti, Sergio, Mazzone, Annamaria
• Format: Journal Article
• Language: English
• Published: Switzerland MDPI AG 01-05-2024
• Subjects: Activities of daily living; acute heart failure; Aged patients; Aortic stenosis; Aortic valve stenosis; Cardiovascular disease; Cognitive ability; Comorbidity; Coronary heart disease; Diabetes; Ejection fraction; elderly patients; Frailty; Geriatrics; Heart failure; hospitalization; Kidney diseases; Malnutrition; Medical prognosis; Mortality; multidisciplinary approach; Nutritional status; Older people; Patient outcomes; Patients; Quality of life; Regression analysis; severe aortic stenosis; elderly patients; frailty; multidisciplinary approach; severe aortic stenosis; hospitalization; mortality; acute heart failure
• DOI: 10.3390/jcdd11050150
• EISSN: 2308-3425

Frailty degree plays a critical role in the decision-making and outcomes of elderly patients with severe aortic stenosis (AS). Acute heart failure (AHF) results in a severely worse clinical hemodynamic status in this population. This study aimed to evaluate the impact of AHF on frailty degree and outcomes in older patients referred for tailored interventional treatment due to AS. A total of 109 patients (68% female; mean age 83.3 ± 5.4), evaluated by a multidisciplinary path for "frailty-based management" of valve disease, were divided into two groups, one with (AHF+) and one without AHF (AHF-) and preserved ejection fraction (mean value EF: 57.4 ± 8.6). AHF occurred a mean value of 55 days before geriatric, clinical, and surgical assessment. A follow-up for all-cause mortality and readmission was conducted at 20 months. AHF+ patients showed a higher frequency of advanced frailty (53.3% vs. 46.7%, respectively), rehospitalization (35.5% vs. 12.8;
= 0.007), and death (41.9% vs. 12.8%;
< 0.001). In stepwise logistic regression analysis, AHF emerged as an independent risk factor for advanced frailty (OR: 3.8 CI 1.3-10.7;
= 0.01) and hospital readmission (OR: 3.6 CI 1.1-11.6;
= 0.03). In addition, preceding AHF was an independent determinant associated with a higher risk of mortality (HR 2.65; CI 95% 1.04-6.74;
-value 0.04). AHF is independently associated with advanced frailty and poor outcomes in elderly patients with severe AS. So, this population needs careful clinical and geriatric monitoring and the implementation of interventional therapy for AS in the early stages of frailty to avoid the occurrence of AHF and poor outcomes.