Elderly Heart Failure Research Articles

Abstract 4118332: Suvorexant is associated with the reduced risk of feart failure rehospitalization in elderly patients with heart failure and insomnia

Background: Research that compares the safety of orexin receptor antagonists and other types of hypnotics prescribed to elderly patients with heart failure (HF) and insomnia remains lacking. This study aimed to compare an orexin receptor antagonist, Suvorexant, with benzodiazepines or Z-drugs for insomnia treatment and investigate the risk of HF-related rehospitalization in elderly patients with HF and insomnia. Methods: A national administrative claims database from April 2008 to December 2020 was utilized and analyzed. The study population, consisting of 1,159,937 patients aged ≥65 years, was randomly sampled from the database. Patients were then selected based on specific inclusion and exclusion criteria. Exposures were identified based on the classification of the first prescribed hypnotic. The follow-up period was continued considering the prescription interval and grace period. The end of follow-up was censored based on multiple criteria, including outcome occurrences (i.e., HF rehospitalization) and hypnotic classification changes. Kaplan–Meier survival analysis and Cox proportional hazards models were used. Hazard ratios were adjusted by propensity scores derived from patients’ background factors. Results: The analysis included 1,858 elderly who had their first HF-related hospitalization. They were categorized into Suvorexant, benzodiazepines and Z-drugs groups (N=490, 606 and 762, respectively). The average age for all participants was 82.7 ± 7.6 years, which is similar across three groups. Kaplan-Meier curves indicated a higher trend of HF-rehospitalization risk for benzodiazepines and Z-drugs groups than for Suvorexant. The adjusted hazard ratios were 2.77 (95% confidence intervals [CI]: 1.17-6.52) for benzodiazepines and 2.98 (95% CI: 1.33-6.68) for Z-drugs. Conclusion: Compared with benzodiazepines and Z-drugs, the use of suvorexant for insomnia treatment in elderly patients with HF indicates a potential for the reduced risk of rehospitalization due to HF exacerbation. The results of this study provide valuable information for the selection of hypnotics in elderly HF patients with concurrent insomnia.

Averaged Oxygen Desaturation Improves the Prognostic Value of the Six-Minute Walk Test in Elderly Patients with Heart Failure.

Heart failure (HF) is a major cause of hospitalization, and exercise capacity is a key prognostic marker. The six-minute walk test (6MWT) is widely used to assess exercise capacity, but six-minute walk distance (6MWD) varies among individuals, especially the elderly. This study aimed to assess the hypothesis that ΔSpO₂-Ex, the average oxygen desaturation during the 6MWT, could enhance the prognostic value of 6MWD in elderly HF patients for cardiovascular risk prediction. In this single-center, prospective observational study, 55 patients aged ≥ 65 years with acute HF were evaluated before discharge. Patients were divided into small and large ΔSpO₂-Ex groups and short and long 6MWD groups based on cut-off values of 6.7% and 220 m, respectively, obtained from the Receiver Operating Characteristics curve analysis. Patients were followed for one year to assess major adverse cardiovascular events, including rehospitalization for heart failure or cardiovascular death. The mean ΔSpO₂-Ex was 5.8 ± 4.3%, and the mean 6MWD was 237.5 ± 106.7 m. Patients with large ΔSpO₂-Ex had significantly higher event rates (HR 6.66, p < 0.001), while those with short 6MWD had HR of 2.40 (p = 0.03). Combining ΔSpO₂-Ex with 6MWD improved predictive accuracy (AUC 0.78) compared to either marker alone (AUC 0.72 for ΔSpO₂-Ex and 0.62 for 6MWD). Importantly, patients with both large ΔSpO₂-Ex and short 6MWD had the highest event rates, indicating the additive prognostic value of combining both markers. ΔSpO₂-Ex is a complementary marker to 6MWD, improving risk stratification in elderly HF patients.

Real-life data on the tolerability of SGLT2 inhibitors in elderly patients with heart failure

Abstract Introduction Sodium-glucose co-transporter 2 inhibitors (SGLT2i) have demonstrated their effectiveness in improving the prognosis of heart failure. However, there is some hesitation in clinical practice to prescribe them to elderly patients due to a lack of long-term safety data. The SafeGLT2 study aims to evaluate the tolerance of SGLT2i in elderly patients with heart failure in real-life settings. Methods This is a prospective study conducted in acute geriatric units in the Île-de-France region between February 2020 and May 2023. All patients admitted for acute heart failure (AHF), aged 75 years and older, were included. The diagnosis was confirmed by an expert committee, and patients were followed for one year. Treatments were recorded upon admission and discharge, along with demographic characteristics and medical history. SGLT2i tolerance data were collected and analyzed, including renal insufficiency, hypovolemia, genital infections, urinary infections, hypoglycemia, diabetic ketoacidosis, fractures, amputations, etc. A comparison of tolerance data between heart failure patients treated with SGLT2i and those not receiving SGLT2i was performed. Results 288 patients were included in the study with a mean age of 88 years, 53% (n=153) were female, and a median Charlson Comorbidity Index (CCI) of 8.77 [2.71]. 44.1% (n=127) of patients had neurocognitive disorders, 39.6% (n=114) were malnourished, 32.6% (n=94) were fallers, 53.8% (n=155) had renal insufficiency (eGFR &amp;lt; 60 ml/min), and 11.5% (n=33) lived in institutions. A total of 33% (n=95) were treated with SGLT2i upon discharge. No serious adverse effects were found in this very frail population receiving SGLT2i compared to the group not receiving SGLT2i (severe hypotension, hypovolemia, ketoacidosis, hypoglycemia, fracture, amputation). Beneficial effects on renal function (improvement of renal function at 6 months) were observed in the SGLT2i group despite a temporary decrease in glomerular filtration rate of less than 30% after SGLT2i initiation. However, a statistically significant increase in urinary tract infections (16.8% vs 4.15%), genital infections (12.6% vs 1.5%), and constipation (10% vs 1%) was found in the SGLT2i group compared to the group without SGLT2i. Conclusion These data indicate that SGLT2i are well tolerated in very elderly frail heart failure patients. However, the occurrence of urogenital infections appears to be more frequent in this population and requires particular surveillance.

Nutritional status and triglyceride-glucose index influence delirium in elderly heart failure patients

Malnutrition and insulin resistance are linked to complications like delirium, yet their impact on elderly heart failure patients remains underexplored. This study investigates how nutritional status and the triglyceride-glucose (TyG) index influence delirium in this population. We conducted a retrospective study involving patients aged 75 and older with decompensated heart failure. Delirium was assessed using the Confusion Assessment Method (CAM), and nutritional status was evaluated with the Mini Nutritional Assessment Scale-Short Form (MNA-SF). The TyG index was calculated as: TyG index = ln [triglycerides (mg/dL) × fasting glucose (mg/dL) / 2]. The study included 412 patients (mean age 84.30 ± 5.16 years; 56.31% male), with 24.03% experiencing delirium during hospitalization. After adjusting for confounders, a higher TyG index was significantly associated with increased delirium risk (OR = 1.549, 95% CI: 1.102–2.178, P = 0.012), while a higher MNA-SF score correlated with reduced risk (OR = 0.793, 95% CI: 0.662–0.949, P = 0.011). Kaplan-Meier analysis showed significant differences in cumulative survival based on nutritional status and TyG index (Log-Rank test: χ²= 65.604, P < 0.001). Mediation analysis indicated that nutritional status partially mediated the relationship between the TyG index and delirium, and vice versa. Malnutrition and elevated TyG index levels increase delirium risk in elderly heart failure patients, underscoring the need for effective nutritional management and metabolic regulation.

Effects of home disease management strategies based on the dyadic illness management theory on elderly patients with chronic heart failure and informal caregivers’ physical and psychological outcomes: protocol of a randomized controlled trial

BackgroundCurrently, most elderly chronic heart failure (CHF) patients go home for rehabilitation after certain treatment in hospitals. However, the results of their rehabilitation at home are not satisfactory. According to studies, dyadic treatments can increase the efficiency of home rehabilitation, enhance both partners' quality of life, lessen the caregiver's load of care, and alleviate the strain of medical resources. Thus, the aim of our research is to design a study protocol that included elderly CHF patients and their informal caregivers as an intervention unit and to explore the impact of the protocol on their health and physical outcomes.MethodsThis is a prospective randomized controlled trial conducted in a triple-A hospital. In total, 80 elderly CHF patients and informal caregivers (80 dyads) will be recruited with informed consent. Based on the randomized numbers, they are divided into a control group (40 dyads) and an intervention group (40 dyads), subjects in the control group will receive usual care, and subjects in the intervention group will receive a home-based disease management program based on the Theory of Dyadic Illness Management on the basis of the control group. The duration of the intervention is 3 months, and the follow-up is 6 months. Data is collected at enrolment, 3 months after the intervention, and 3 months after the end of the intervention. The primary outcome is patients’ quality of life and readmission. Secondary outcomes include patients’ self-management behaviors, anxiety, and depression and caregivers’ quality of life and care burden.DiscussionThis study focuses on whether this home-based disease management program can improve the quality of life of elderly patients with CHF, reduce the readmission rate, enhance their self-management capacity, reduce negative emotions, and reduce the burden of informal caregivers. It can provide a new perspective on home management and cardiac rehabilitation of heart failure disease in the elderly, as well as alleviate problems such as the burden of healthcare resources.Trial registrationChinese Clinical Trials Registry ChiCRT2300068026. Registered on 3 February 2023, manuscript Version: 1.0, https://www.chictr.org.cn/.

Care manager role for older multimorbid heart failure patients' needs in relation to psychological distress and quality of life: a cross-sectional study.

There are few studies investigating patients' needs in healthcare focusing on disease severity and psychological characteristics of elderly heart failure (HF) patients with multimorbidity, specifically addressed by a care manager (CM). To explore the role of a CM dealing with elderly multimorbid HF patients' needs/preferences according to NYHA class, ejection fraction, psychological/psychosomatic distress and quality of life (QoL), utilizing a Blended Collaborative Care (BCC) approach (ESCAPE; Grant agreement No 945377). Cue cards, self-reported questionnaires, and a semi-structured interview were used to collect data. Twenty-five Italian patients (mean age ± SD = 77.5 ± 6.68) were enrolled between June 2021 and March 2022. The most relevant patients' needs to be addressed by a CM were: education (e.g., on medical comorbidities), individual treatment tailoring (e.g., higher number of appointments with cardiologists) and symptom monitoring. The study highlights the importance of targeting HF patients' needs according to psychological characteristics, whose healthcare requires person-centered care with CM assistance. In view of ESCAPE BCC intervention, a CM should consider specific patients' needs of elderly multimorbid HF patients with psychological, psychosomatic distress, particularly somatization, and lower QoL to achieve a more personalized health care pathway. The «Evaluation of a patient-centred biopsychosocial blended collaborative care pathway for the treatment of multi-morbid elderly patients» (ESCAPE) study has been registered at the University of Göttingen Medical Centre (UMG Reg. No 02853) and the German Clinical Trials Register (DRKS00025120).

The Impact of Cardiac Rehabilitation on Quality of Life in Elderly Heart Failure Patients-Literature Review

The research investigates how cardiac rehabilitation impacts life quality in elderly heart failure patients. Older patients often encounter distinctive issues, such as other health conditions and age-linked frailty, affecting their ability to join and gain from rehab programs. This study examines customized rehab plans to meet these needs, which entail using both traditional and new methods like telerehabilitation and activities such as Tai Chi and yoga. Results show that specific rehab programs notably improve functional ability and cut hospital stays for elderly heart failure patients. Also, home-based rehab plans, like the REACH-HF program, appear cost-effective, boosting life quality and reducing health problems. Telerehabilitation has shown to expand access to rehab services, especially aiding elderly patients who struggle to attend on-site programs. This study also asseses the improvement in quality of life, namely the physical and psychological health, such as the augmentation/improvement of patients’ exercise tolerance, participation in social activities or even the increased desire of taking care of themselves. The research highlights the significance of including risk understanding, precise nursing activities, and diverse physical exercises to enhance involvement and commitment, improving results and patient happiness. These findings support the ongoing creation and execution of patient-focused cardiac rehab strategies to better the overall health and well-being of elderly heart failure patients.

SHAP based predictive modeling for 1 year all-cause readmission risk in elderly heart failure patients: feature selection and model interpretation

Heart failure (HF) is a significant global public health concern with a high readmission rate, posing a serious threat to the health of the elderly population. While several studies have used machine learning (ML) to develop all-cause readmission risk prediction models for elderly patients with HF, few have integrated ML-selected features with those chosen by human experts to assess HF patients readmission. A retrospective analysis of 8396 elderly HF patients hospitalized at the Affiliated Hospital of North Sichuan Medical College from January 1, 2018 to December 31, 2021 was conducted. Variables selected by XGBoost, LASSO regression, and random forest constituted the machine group, while the human expert group comprised variables chosen by two experienced cardiovascular professors. The variables selected by both groups were combined to form a human–machine collaboration group. Model performance was evaluated using the area under the receiver operating characteristic curve (AUC). The SHapley Additive exPlanations (SHAP) method was used to elucidate the importance of each predictive feature, explain the impact of individual features on the model, and provide visual representation. A total of 73 features were included for model development. The human–machine collaboration model, utilizing CatBoost, achieved an AUC of 0.83617, an F1-score of 0.73521, and a Brier score of 0.16536 on the validation set. This model demonstrated superior predictive performance compared to those created solely by human experts or machine. The SHAP plot was then used to visually display the feature analysis of the human–machine collaboration model, revealing HGB, NT-proBNP, smoking history, NYHA classification, and LVEF as the 5 most important features. This study indicate that the human–machine collaboration model outperforms those relying solely on human expert selection or machine algorithm at predicting all-cause readmission in elderly HF patients. The application of the SHAP method enhanced the interpretability of the model outcomes, aiding clinicians in accurately pinpointing risk factors associated with HF readmission. This advancement enables the formulation of tailored treatment strategies, offering a more personalized approach to patient care.

Association of High apoB/apoA1 Ratio with Increased Erythrocytes, Platelet/Lymphocyte Ratio, D-dimer, Uric Acid and Cardiac Remodeling in Elderly Heart Failure Patients: A Retrospective Study.

Previous studies have confirmed that high apolipoprotein B/apolipoprotein A1 (apoB/apoA1) ratio was associated with increased mortality from heart failure (HF). Furthermore, the association of plasma apoB/apoA1 ratio with clinical characteristics and adverse cardiac remodeling is still limited in chronic HF with mildly reduced ejection fraction (HFmrEF) elderly patients. Therefore, this study investigated the association of apoB/apoA1 ratio with clinical characteristics and adverse cardiac remodeling in chronic HFmrEF elderly patients. A total of 587 Chinese elderly (≥65 years) with coronary heart disease (CHD), HFmrEF (EF 40-50%) and related blood biochemical data were collected retrospectively. The cross-sectional data of echocardiographic and blood parameters were compared between binary apoB/apoA1 groups. In the elderly CHD patients with chronic HFmrEF, the univariate correlation analysis showed that apoB/apoA1 was correlated with younger age, increased prevalence of type 2 diabetes, erythrocytes, platelet/lymphocyte ratio (PLR), D-dimer, fibrinogen, high sensitivity C-reactive protein and uric acid, and adverse cardiac remodeling (All P < 0.05). However, multivariate logistic binary regression analysis found that high apoB/apoA1 ratio (≥0.62) was independently correlated with younger age, increased erythrocytes, PLR, D-dimer and uric acid, and adverse cardiac remodeling (All P < 0.05). In this retrospective study, the high apoB/apoA1 ratio is found to be associated with younger age, increased erythrocytes, PLR, D-dimer and uric acid, and adverse cardiac remodeling in Chinese CHD elderly with chronic HFmrEF.

A study of the mediating effect of decreased intrinsic capacity between symptoms and activities of daily living in elderly patients with heart failure

ObjectiveTo investigate the mediating effect of decreased Intrinsic capacity(IC) between symptoms and ability to perform activities of daily living(ADL) in elderly patients with Heart failure(HF). MethodsUsing a convenience sampling method, 237 elderly patients with HF in the cardiology department of a Grade A Tertiary Hospital in Suzhou, China were selected from January 2022 to November 2022, and the General Information Questionnaire, Symptom Status Questionnaire-Heart Failure (SSQ-HF), Barthel Index Scale (BI), and IC Assessment Tool were applied to investigate the mediating effect of IC between HF symptoms and ADL using structural equation modeling. ResultsHF symptoms and decreased IC were associated with patients' ability to perform ADL (P=0.005, P<0.001), and decreased IC partially mediated the effect between HF symptoms and ADL, indirectly negatively predicting ADL with a mediating effect of -0.412, accounting for 59.11% of the total effect. ConclusionDecreased IC in elderly patients with HF is a mediating variable between HF symptoms and ADL. Healthcare professionals can use the multidimensional assessment framework of IC to identify early the risk of impaired ADL in elderly HF patients and to provide targeted rehabilitation interventions for this group of patients.

Study on the construction of nomogram prediction model for prognostic assessment of heart failure patients based on serological markers and echocardiography.

We aimed to construct a nomogram prediction model for prognostic assessment of patients with heart failure (HF) based on serological markers and echocardiography. A total of 200 HF patients admitted to the Second Affiliated Hospital of Nanchang University from January 2018 to January 2020 were selected as the research objects. According to the New York Heart Association (NYHA) cardiac function classification, they were divided into 3 groups, including 65 cases of grade II, 97 cases of grade III, and 38 cases of grade IV. Three groups of echocardiographic parameters were compared [including left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter (LVEDD), left ventricular end-systolic diameter (LVESD), left ventricular end-systolic volume (LVESV)], differences in serum markers brain natriuretic peptide (BNP), soluble growth-stimulating expression gene 2 (sST2) and the Modified Early Warning Score (MEWS). The patients were divided into two groups according to their clinical outcomes during the follow-up period, including 52 cases in the death group and 148 cases in the survival group. The clinical data of the two groups were compared, and multi-factor logistic regression analysis was performed to screen out the independent risk factors affecting the patient's death. A nomogram model of the patient's mortality risk was constructed based on the independent risk factors. Receiver operating characteristic (ROC) curves and calibration curves were used to evaluate the discrimination and accuracy of the nomogram model. As the cardiac function class of elderly chronic heart failure (CHF) patients increases, LVEDD, LVESD, sST2, and MEWS increase and LVEF decreases (p<0.05). Multifactor analysis results showed that LVEF, LVEDD, sST2, and MEWS were independent factors affecting the clinical outcome of patients. The AUCs predicted using LVEF, LVEDD, sST2, and MEWS alone were 0.738, 0.775, 0.717, 0.831, and 0.768, respectively. There is a certain degree of discrimination, and the model has extremely high accuracy. MEWS, LVEDD, and sST2 increase as the NYHA cardiac function grade of HF patients increases and LVEF decreases, which can reflect the severity of the disease to a certain extent. Additionally, the nomogram model established based on this has a high predictive value for the long-term prognosis of patients and can formulate effective intervention measures for quantitative values.

Healthcare needs in elderly patients with chronic heart failure in view of a personalized blended collaborative care intervention: a cross sectional study.

Few studies explored healthcare needs of elderly heart failure (HF) patients with comorbidities in view of a personalized intervention conducted by Care Managers (CM) in the framework of Blended Collaborative Care (BCC). The aims of the present study were to: (1) identify perceived healthcare needs/preferences in elderly patients with HF prior to a CM intervention; (2) investigate possible associations between healthcare needs/preferences, sociodemographic variables (age; sex) and number of comorbidities. Patients aged 65 years or more affected by HF with at least 2 medical comorbidities were enrolled in the study. They were assessed by structured interviewing with colored cue cards that represented six main topics including education, individual tailoring of treatment, monitoring, support, coordination, and communication, related to healthcare needs and preferences. Thirty-three patients (Italy = 21, Denmark = 7, Germany = 5; mean age = 75.2 ± 7.7 years; males 63.6%) were enrolled from June 2021 to February 2022. Major identified needs included: HF information (education), patients' involvement in treatment-related management (individual tailoring of treatment), regular checks of HF symptoms (monitoring), general practitioner update by a CM about progression of symptoms and health behaviors (coordination), and telephone contacts with the CM (communication). Regarding communication modalities with a CM, males preferred phone calls (χ2 = 6.291, p = 0.043) and mobile messaging services (χ2 = 9.647, p = 0.008), whereas females preferred in-person meetings and a patient dashboard. No differences in needs and preferences according to age and number of comorbidities were found. The findings highlight specific healthcare needs and preferences in older HF multimorbid patients, allowing a more personalized intervention delivered by CM in the framework of BCC.

Modulation of Vitamin D- Fibroblast Growth Factor 23/Fibroblast Growth Factor Receptor 1-Klotho Axis by Astragalus in Elderly Heart Failure Patients

Heart failure is a geriatric syndrome, often accompanied by a high disability rate, complex comorbidities, and a poor prognosis. This study aimed to assess the effect of Astragalus on the vitamin D- fibroblast growth factor 23/fibroblast growth factor receptor 1-KLOTHO axis in elderly heart failure patients using a bioinformatics approach. Thirteen active ingredients and 159 targets were identified based on network pharmacology, and 500 HF targets were obtained using GeneCards database. A predicted target set was established using 22 core targets, and a diagram of the active component-target network was constructed using Cytoscape software (version 3.7.2); a protein-protein interaction network was constructed for analysis, and the Gene Ontology and Kyoto Encyclopedia of Genes and Genomes pathway enrichment were analyzed using DAVID software. Bioinformatics analyses revealed that 22 targets were mainly involved in the Ras and PI3K-Akt signaling pathways. Molecular docking for fibroblast growth factor receptor 1 revealed that the active components HMM7 and HMM13 demonstrated better binding stability with the target gene. This study may help explain the molecular mechanism of effects on vitamin D- fibroblast growth factor 23/fibroblast growth factor receptor 1-KLOTHO axis and promote clinical application.

Impact of Frailty on Heart Failure Prognosis: Is Sex Relevant?

Heart failure (HF) is one of the most frequent causes of hospital admission in elderly patients, especially in women, who present a high prevalence of geriatric syndromes like frailty. Studies have suggested that frailty and its impact may also differ between males and females. Understanding how frailty may differently affect HF patients depending on sex is therefore imperative for providing personalized care. The aim of this review is to summarize the role of sex in the prognostic impact of frailty in HF patients. Numerous studies have identified frailty as a significant predictor of all-cause mortality and hospital readmissions. A recent study of elderly HF out-patients demonstrated that while women had a higher prevalence of frailty, it was an independent predictor of mortality and readmission only in men. Moreover, another study revealed that physical frailty was associated with time to first clinical event among men but not among women. These results raise the question about why frailty affects differently HF prognosis in men and women. Women with HF present a higher prevalence of frailty, especially when it is considered as physical decline. Nevertheless, frailty affects differently HF prognosis in men and women. Women with HF present lower mortality than men and frailty is related with prognosis only in men. The different severity of HF between men and women and other hormonal, psychosocial, and clinical factors might be involved in this fact.

Correlation between Neutrophil-to-Lymphocyte Ratio, Platelets-to-Lymphocyte Ratio, C-Reactive Protein-to-Albumin Ratio and Clinical Picture of Elderly Chronic Heart Failure Patients.

Neutrophil-to-lymphocyte ratio (NLR), platelets-to-lymphocyte ratio (PLR) and C-reactive protein-to-albumin ratio (CAR) are believed to be potential inflammatory markers that are closely related to the prognosis and course of cardiovascular diseases. The main goal of this study was the evaluation of NLR, PLR and CAR as factors reflecting the clinical picture and the prognosis of elderly chronic heart failure (CHF) patients. In 150 elderly patients with newly diagnosed CHF, the NLR, PLR and CAR were correlated with cardiac, laboratory and nutritional parameters. Systemic inflammatory ratios were correlated with selected patient's parameters. CAR was associated with an unfavorable clinical picture of CHF-a reduced EF (p = 0.007), an elevated PASP (p = 0.014), an increased LVESD in both males and females (p = 0.032 and 0.024, respectively) and a decreased TAPSE (p = 0.023). CAR allowed us to distinguish between NYHA I-III and NYHA IV classes with AUC of 0.830. By analyzing the five-year mortality rate in patients with different CAR values, the greater death rate was recorded for patients with high CAR values-one-year death rate (40.3% vs. 17.2%) and five-year death rate (80% vs. 58.3%) (p = 0.002). Both NLR and PLR correlated only with selected parameters. An analysis of inflammatory markers, mainly CAR, allows the management of CHF, because its value can reflect the cardiac and nutritional status of patients with a prognostic value. NLR and PLR can serve as supplementary examinations for CAR evaluation.

Clinical outcomes and anticoagulation therapy in elderly non-valvular atrial fibrillation and heart failure patients.

Atrial fibrillation (AF) and heart failure (HF) often coexist. Older age is strongly associated with stroke, HF, and mortality. The association between coexistence of HF and a risk of clinical outcomes and the effectiveness of anticoagulation therapy including direct oral anticoagulants (DOACs) in elderly patients with AF and HF have not been investigated. We aimed to evaluate 2years of outcomes and to elucidate the efficacy of DOACs or warfarin in elderly AF patients in the All Nippon AF In the Elderly (ANAFIE) Registry with and without a history of HF. The ANAFIE Registry is a multicentre, prospective observational study following elderly non-valvular AF patients aged ≥75years for 2years. Hazard ratios (HRs) were calculated based on the presence or absence of an HF diagnosis and DOAC or warfarin use at enrolment. Among 32275 eligible patients, 12116 (37.5%) had been diagnosed with HF. Patients with HF had significantly higher rates of HF hospitalization or cardiovascular death (HR 1.94, P<0.001), cardiovascular events (HR 1.59, P<0.001), cardiovascular death (HR 1.49, P<0.001), all-cause death (HR 1.32, P<0.001), and net clinical outcome including stroke/systemic embolism, major bleeding, and all-cause death (HR 1.23, P<0.001), compared with those without HF; however, HRs for stroke/systemic embolism (HR 0.96, P=0.56) and major bleeding (HR 1.14, P=0.13) were similar. DOAC use was associated with a low risk of stroke/systemic embolism (HR 0.86, P=0.19 in HF; HR 0.79, P=0.016 in non-HF; P for interaction=0.56), major bleeding (HR 0.71, P=0.008 in HF; HR 0.75, P=0.016 in non-HF; P for interaction=0.74), HF hospitalization or cardiovascular death (HR 0.81, P<0.001 in HF; HR 0.78, P<0.001 in non-HF; P for interaction=0.26), cardiovascular events (HR 0.83, P<0.001 in HF; HR 0.82, P=0.001 in non-HF; P for interaction=0.65), cardiovascular death (HR 0.84, P=0.12 in HF; HR 0.75, P=0.035 in non-HF; P for interaction=0.18), all-cause death (HR 0.89, P=0.082 in HF; HR 0.80, P=0.001 in non-HF; P for interaction=0.091), and net clinical outcome (HR 0.88, P=0.019 in HF; HR 0.81, P<0.001 in non-HF; P for interaction=0.21) compared with warfarin, irrespective of the presence or absence of HF. Analysis using the propensity score matching method showed similar associations. Non-valvular AF patients aged ≥75years with a history of HF had higher risks of cardiovascular events and mortality. DOACs were favourable to warfarin regardless of the coexistence of HF. These results might encourage the use of DOACs in elderly patients with non-valvular AF with or without HF.

The Predictive Value of Hemoglobin to Red Cell Blood Distribution Width Ratio Combined with Serum Sodium for MACE of Acute Heart Failure with Preserved Ejection Fraction in Elderly Patients.

To investigate the predictive value of hemoglobin (Hb) to red blood cell distribution width (RDW) (Hb/RDW) ratio in combination with serum sodium for major adverse cardiovascular events (MACE) in elderly acute heart failure patients with preserved ejection fraction at 30 days after discharge. 130 elderly acute heart failure patients with preserved ejection fraction were enrolled and followed up at 30 days after discharge. They were classified into the MACE group (n=11) and none-MACE group (n=119). On the day of admission, clinical baseline characteristics were measured and results from laboratory tests were gathered. The correlation and predictive value of Hb/RDW and serum sodium with the occurrence of MACE at 30 days after discharge in acute heart failure patients with preserved ejection fraction in the elderly were analyzed. Spearman correlation analysis showed that the occurrence of MACE was negatively correlated with Hb/RDW, serum sodium (r=-0.209, r=0.291, p<0.05) and Hb/RDW (OR=0.484, 95% CI:0.254, 0.922), serum sodium (OR=0.779, 95% CI:0.646,0.939) were independent risk factors (p<0.05) analyzed by multifactorial logistic. Receiver operating characteristic curves (ROC) analysis showed that the area under the curve (AUC) for the prediction of MACE by Hb/RDW was 0.73, with an optimal threshold of 9.28, sensitivity 81.80%, specificity 70.60%, positive predictive value (PPV) 20.50%, negative predictive value (NPV) 97.70%; the AUC of serum sodium for predicting the occurrence of MACE was 0.76, with an optimal threshold of 140.35 mmol/L, sensitivity 90.90%, specificity 57.10%, PPV 16.40%, NPV 98.60%; and the AUC of Hb/RDW combined serum sodium to predict the occurrence of MACE was 0.83, with sensitivity 90.90%, specificity 78.20%, PPV 27.80% and NPV 98.90%. Hb/RDW and serum sodium had negative correlation with MACE and were independent risk factors of 30-day MACE; Hb/RDW combined with serum sodium can predict 30-day MACE occurrence in elderly acute heart failure patients with preserved ejection fraction.

Association of Early Tolvaptan Treatment and Length of In Hospital Stay in Elderly Patients with Acute Decompensated Heart Failure.

Long hospital stay is associated with high costs and poor quality of life in elderly patients with heart failure (HF). This study aimed to investigate the association of early administration of tolvaptan with length of hospital stay among elderly patients with HF. The cohort included elderly patients (age ≥ 75 years) admitted to Shinonoi General Hospital between July 2016 and December 2018 with a primary diagnosis of acute decompensated HF treated with tolvaptan. Patients who died during hospitalization, patients who had acute coronary syndrome, patients who required treatment in the intensive care unit, and patients who had already taken tolvaptan before admission were excluded. Patients were divided into two groups according to the median duration of admission to tolvaptan administration: those who received tolvaptan within 1 day (24 h) after admission (early treatment group) and those for whom tolvaptan was prescribed after 1 day (24 h) or more from hospitalization (add-on group). We compared the length of hospital stay between the two groups and investigated the relationship between early tolvaptan administration and length of hospital stay. Of 110 enrolled patients (median age 85 years), 56 (51%) received tolvaptan within 1 day (24 h) after admission. The median length of hospital stay was 22 [14-35] days. The length of hospital stay was significantly shorter in the early treatment group (16 [11-22] days vs. 30 [21-46] days, p < 0.001). On multivariable regression analysis, early tolvaptan was associated with shorter hospital stay after adjusting for age, sex, serum creatinine, B-type natriuretic peptide, continuous dobutamine, and whether they live alone (partial regression coefficient -16.213, p < 0.001). Linear regression analysis showed a positive relationship between time of tolvaptan administration and length of hospital stay (R2 = 0.564, p < 0.001). Early tolvaptan administration was associated with reduced length of hospital stay in elderly HF.

Efficacy of combined use of Tetradium ruticarpum (A. juss.) patch and Chinese massage (tuina) for the treatment of insomnia in elderly chronic heart failure patients

Introduction/Objective. The objective of the paper was to evaluate the efficacy of Tetradium ruticarpum (A. Juss.) patch (TRP) in combination with Chinese massage (tuina) for the treatment of insomnia in elderly patients with chronic heart failure (CHF). Methods. A cohort of 320 elderly CHF patients with comorbid insomnia, treated at the Zhejiang University of Traditional Chinese Medicine Affiliated Wenzhou Hospital from January 2019 to July 2022, were enrolled and equally divided into four groups (80 patients per group). The control group received standard pharmacological intervention with eszopiclone. Patients in the TRP group received TRP alone, while those in the tuina group received tuina therapy alone. Patients in the combined treatment group received both TRP and tuina therapy. All treatments lasted 14 days. Sleep quality was assessed at baseline and then on days 7 and 14 after treatment using the Pittsburgh Sleep Quality Index Scale (PSQI). Results. There were significant reductions in total PSQI scores in all groups on day 7 compared to baseline (p &lt; 0.05). On day 14, the combined treatment, tuina, and TRP groups showed significantly reduced total PSQI scores relative to baseline, while a reversal of this trend was seen in the control group (p &lt; 0.05). The combined treatment group had the lowest total PSQI scores on both days 7 and 14. Conclusion. The combined use of tuina and TRP may be effective in alleviating insomnia in elderly CHF patients. It resulted in consistent and sustained efficacy, potentially reducing the likelihood of drug resistance.

The Association Between Geriatric Nutritional Risk Index and Readmission Within Six Months in Elderly Heart Failure Patients: A Retrospective Cohort Study: Geriatric Nutritional Risk Index for Heart Failure Readmission Within 6 Months.

Background: The geriatric nutritional risk index (GNRI) is a valuable tool that may predict the prognosis of elderly patients with heart failure (HF). Malnutrition and low GNRI scores have been associated with a higher risk of hospitalization and mortality. This study aimed to investigate the association between GNRI and 6-month readmission for HF in elderly Chinese patients. Materials and Methods: The study utilized data from hospitalized HF patients by combining electronic medical records from the PhysioNet restricted health data database with external outcome data. In our study, we used the GNRI as the independent variable and assessed its association with the risk of readmission within 6 months. The main analytical methods were multivariable Cox regression, stratified analysis with interaction, threshold effect analysis, and Kaplan-Meier survival curves. Results: This study involved 767 elderly HF patients, 61.3% of whom had malnutrition. In the threshold analysis, HF patients' 6-month readmission risk was significantly reduced with increasing GNRI, with a hazard ratio (HR) and 95% confidence interval (CI) of 0.99 (0.97.1). Malnutrition group was associated with a higher risk of readmission within 6 months for HF patients in analyses that were controlled for confounding factors, with HRs and their 95% CI of 1.17 (0.99, 1.38), 1.18 (1, 1.4), and 1.44 (1.08,1.93), respectively. Subgroup analysis showed that GNRI levels had a consistent impact on outcome events, unaffected by covariates. Conclusions: GNRI was negatively correlated with the outcome event of readmission within 6 months in elderly HF patients. Malnutrition group showed a higher risk of readmission within 6 months.