Older Heart Failure Patients Research Articles

Effectiveness and Approach of Rehabilitation in Patients With Acute Heart Failure: A Review.

Acute heart failure is associated with high mortality and frequent rehospitalization, resulting in enormous healthcare costs and declining physical function, activities of daily living, and quality of life. Cardiac rehabilitation has been recommended as one of the non-pharmacologic treatments for patients with heart failure. However, much of the evidence for cardiac rehabilitation interventions reported to date has been limited to chronic heart failure. In recent years, the effectiveness of rehabilitation intervention in patients with acute heart failure has been reported, led by the Rehabilitation Therapy in Older Acute Heart Failure Patients (REHAB-HF) trial. This review overviews the recent evidence of rehabilitation in patients with acute heart failure.

Echocardiography and impedance cardiography as determinants of successful slow levosimendan infusion in advanced older heart failure patients.

Echocardiography and impedance cardiography as determinants of successful slow levosimendan infusion in advanced older heart failure patients.

Understanding Barriers to Healthcare Access for Heart Failure Patients during the COVID-19 Pandemic

Early outpatient follow-up within two weeks after hospital discharge is an effective strategy for improving transitions of care in older patients with heart failure (HF). However, implementing timely follow-up care for HF patients has been challenging, especially during the COVID-19 pandemic. This convergent mixed-methods study identified patients’ barriers to accessing care and ascertained their recommendations for addressing these barriers. We enrolled 264 HF patients admitted to the Duke Heart Center between May 2020 and August 2021. A standardized survey and electronic health records (EHR) were used to collect patients’ sociodemographic, psychosocial, behavioral, and clinical data. For patients who reported some difficulty accessing their healthcare (n=30), semi-structured interviews were conducted to understand these barriers. Data were analyzed using rapid analysis techniques. Barriers to accessing care varied across participants, with scheduling an appointment being the most common barrier (12 of the 30 responses). Participants indicated that job-related conflicts, providers’ availability, or COVID-19 contributed most to the difficulty in scheduling an appointment. Some participants experienced more difficulties during the pandemic due to fewer appointments available for non-acute and non-COVID-19 related needs. Transportation was another critical barrier, which was often associated with the participants’ physical functional status. Participants identified the benefits of using telemedicine to address access to care barriers; however, they shared their concerns that telemedicine visits may not be sufficient to assess their HF conditions. Study findings highlight the need for more continual, tailored, and patient-centered interventions to improve access to care in older HF patients.

Trends in Frailty and Use of Evidence-Based Pharmacotherapy for Heart Failure in Australian Hospitalised Patients: An Observational Study.

Frailty increases morbidity and mortality in heart failure (HF) patients. Current risk-adjustment models do not include frailty-status and the relationship between frailty and pharmacotherapy is unclear. This study explored trends in frailty over time and its relationship with prescription of heart failure specific pharmacotherapy in hospitalised HF patients. We used the Hospital Frailty Risk Score (HFRS) to determine frailty status of patients ≥18 years admitted between 2015–2019 at two tertiary hospitals in Australia. Patients with an HFRS ≥ 5 were classified as frail. In the 3706 patients with a mean (SD) age of 76.1 (14.4) years, 876 (23.6%) were classified as frail. HFRS was weakly correlated with age (r = 0.16) and Charlson-index (r = 0.35) (both p values < 0.001). Whilst frailty was more common in older HF patients (28.9% of patients ≥80 years), 15.1% of patients ≤65 years of age were also found to be frail. The proportion of frail patients increased from 19.4% in 2015 to 29.2% in 2019 despite no significant change in age during this period. The proportion of patients who received heart failure specific pharmacotherapy decreased from 86.7% in 2015 to 82.9% in 2019 (p value = 0.03) and frail patients were significantly less likely to be prescribed HF specific pharmacotherapy than non-frail patients (77.4% vs. 85.9%, p < 0.001).

Economic Outcomes of Rehabilitation Therapy in Older Patients With Acute Heart Failure in the REHAB-HF Trial

In the Rehabilitation Therapy in Older Acute Heart Failure Patients (REHAB-HF) trial, a novel 12-week rehabilitation intervention demonstrated significant improvements in validated measures of physical function, quality of life, and depression, but no significant reductions in rehospitalizations or mortality compared with a control condition during the 6-month follow up. The economic implications of these results are important given the increasing pressures for cost containment in health care. To report the economic outcomes of the REHAB-HF trial and estimate the potential cost-effectiveness of the intervention. The multicenter REHAB-HF trial randomized 349 patients 60 years or older who were hospitalized for acute decompensated heart failure to rehabilitation intervention or a control group; patients were enrolled from September 17, 2014, through September 19, 2019. For this preplanned secondary analysis of the economic outcomes, data on medical resource use and quality of life (via the 5-level EuroQol 5-Dimension scores converted to health utilities) were collected. Medical resource use and medication costs were estimated using 2019 US Medicare payments and the Federal Supply Schedule, respectively. Cost-effectiveness was estimated using the validated Tools for Economic Analysis of Patient Management Interventions in Heart Failure Cost-Effectiveness Model, which uses an individual-patient simulation model informed by the prospectively collected trial data. Data were analyzed from March 24, 2019, to December 1, 2020. Rehabilitation intervention or control. Costs, quality-adjusted life-years (QALYs), and the lifetime estimated cost per QALY gained (incremental cost-effectiveness ratio). Among the 349 patients included in the analysis (183 women [52.4%]; mean [SD] age, 72.7 [8.1] years; 176 non-White [50.4%] and 173 White [49.6%]), mean (SD) cumulative costs per patient were $26 421 ($38 955) in the intervention group (excluding intervention costs) and $27 650 ($30 712) in the control group (difference, -$1229; 95% CI, -$8159 to $6394; P = .80). The mean (SD) cost of the intervention was $4204 ($2059). Quality of life gains were significantly greater in the intervention vs control group during 6 months (mean utility difference, 0.074; P = .001) and sustained beyond the 12-week intervention. Incremental cost-effectiveness ratios were estimated at $58 409 and $35 600 per QALY gained for the full cohort and in patients with preserved ejection fraction, respectively. These analyses suggest that longer-term benefits of this novel rehabilitation intervention, particularly in the subgroup of patients with preserved ejection fraction, may yield good value to the health care system. However, long-term cost-effectiveness is currently uncertain and dependent on the assumption that benefits are sustained beyond study follow-up, which needs to be corroborated in future trials in this patient population.

Abstract 9364: Caregiver Anxiety Significantly Reduced from Baseline to 24 Months After Surgery: Findings from the Sustaining Quality of Life of the Aged: Heart Transplant or Mechanical Circulatory Support ( Sustain-it) Study

Introduction: We previously reported higher health-related quality of life (HRQOL), lower depression scores, and decreased anxiety in caregivers (CGs) of older (60-80 years) heart failure (HF) patients (PTs) treated with destination therapy mechanical circulatory support (DT MCS) or heart transplantation (HT) from baseline (before surgery) to 12 months post-surgery. We expand the analysis of CGs’ HRQOL and symptoms of depression and anxiety through 24-months post-surgery. Methods: From 10/1/15-12/31/18, 13 U.S. centers enrolled 301 CGs of HF PTs: 193 awaiting HT (92 with MCS, 101 without MCS) and 108 DT MCS. At baseline and 24-months post-surgery, CGs completed the following instruments: EQ-5D-3L (Visual Analog Scale [VAS]: 0 [worst]-100 [best] imaginable health state); PHQ-8 (range=0-24; score &gt; 10=current depressive symptoms); and STAI-State (range=20-80, higher score=more anxiety). Analyses included paired t-tests and baseline-adjusted linear regression. Results: CGs average age was 60.9±10 years, 85% were Caucasian, 85% female, and 83% spouses. No significant differences in HRQOL and depressive symptoms were found between groups at baseline, nor were significant changes observed between baseline and 24-months within any group. At baseline, anxiety was higher for CGs of DT MCS PTs compared to CGs of HT MCS (p=0.026) and HT non-MCS PTs (p&lt;0.001; Figure). Between baseline and 24-months, STAI-State total scores were reduced among DT MCS and HT Non-MCS CGs (p=0.019 and p=0.001, respectively), but not among HT MCS CGs (p=0.86). At 24 months, significant between-group differences were observed in all scales: HRQOL was highest in HT non-MCS, depressive symptoms and anxiety highest in HT MCS CGs. Conclusions: Recognizing the impact of HT and DT MCS on CGs of older HF PTs may allow clinicians to provide targeted support to CGs, especially related to anxiety. These findings also may inform PT and CG decision making when considering surgical treatments for HF.

Abstract 13852: Key Value of Inspiratory Muscle Performance and Training in a Home-Based Program to Improve Functional Capacity in Older Heart Failure Patients

Introduction: Patients with heart failure (HF) often have reduced exercise tolerance. Exercise training has putative value but is often limited by poor adherence or the effects of frailty. Baseline inspiratory muscle performance (IMP) may predict exercise limitation, and inspiratory muscle training (IMT) may have important clinical benefit, including offsetting the metaboreflex which may improve functional capacity by reducing sympathetic peripheral vasoconstriction induced by respiratory fatigue. We hypothesize that low IMP is an important predictor of exercise performance in older adults with HF and that IMT may be an effective home-based training program. Methods: Thirty-four male patients with HF (age and left ventricular ejection fraction of 69±7 years and 37±11%, respectively) were randomized into IMT (n=11) or aerobic and/or strength training (AST; n=23) for a 12-week home-based program. IMT was performed progressively from 50-85% of maximal inspiratory pressure (MIP) with the PrO 2 device (Smithfield, RI) which tracked data and adherence for comparison to AST regimens of cycle ergometry/walking and strength training individually advanced to achieve moderate to high intensities. Study endpoints included MIP, peak oxygen uptake (VO 2 ), 6-minute walk distance (6MWD), 30-second sit-to-stand (STS), grip strength, and leg strength (endurance, 1-rep max, and power). Results: IMT was well-tolerated with greater adherence (92±10% vs 79±34%) and a significantly greater MIP rise (25.3±25.0% vs 3.6±11.0%, p&lt;0.05). Baseline MIP greater than the median of 66 cmH 2 O across all exercise forms (n=18) was associated with significantly greater baseline and post-intervention peak VO 2 (16.4±5.0 vs 12.9±3.9 and 17.5±5.3 vs 13.4±3.1, p&lt;0.05) and was significantly correlated positively to change in 6MWD, STS, grip strength, and leg strength (r=0.352-0.504, p&lt;0.05). Conclusion: Home-based IMT significantly improved IMP and greater baseline IMP was associated with greater cardiorespiratory fitness, functional capacity, and trainability in older HF patients due likely to metaboreflex attenuation and greater adherence. Further study is needed to assess IMP and IMT performed alone or combined with AST regimens to address the growing HF population.

Clinical Characteristics of Older Heart Failure Patients With Hospital-Acquired Disability: A Preliminary, Single-Center, Observational Study.

BackgroundThis study investigated the clinical factors related to hospital-acquired disability (HAD) among 70 patients (median age, 78 years; interquartile range (IQR), 78 - 83) who were hospitalized for heart failure (HF) at Ayase Heart Hospital between December 2019 and October 2020.MethodsHAD was defined as a ≥ 5-point decrease in Barthel Index (BI) scores from admission to discharge. Twenty-nine HF patients (41%) developed HAD after admission.ResultsCompared to the non-HAD group, the HAD group had higher Kihon Checklist scores (14 points (IQR, 11 - 17) vs. 9 points (IQR, 6 - 13); P < 0.01) and prevalence of multi-faceted frailty (90% vs. 29%; P < 0.01), a longer urinary-catheter-placement period (3 days (IQR, 1 - 5] vs. 1 day (IQR, 0 - 2), P < 0.05), less daily number of steps (457 steps (IQR, 301 - 997) vs. 1,692 steps (IQR, 1,227 - 2,418); P < 0.01), and moderate-intensity physical activity time (0 min (IQR, 0 - 2] vs. 1 min (IQR, 0 - 3); P < 0.05).ConclusionIn conclusion, lower physical function and general physical activity and longer urinary-catheter-placement are associated with HAD.

Physical Rehabilitation in Older Patients Hospitalized with Acute Heart Failure and Diabetes: Insights from REHAB-HF

BackgroundPrior studies showed an attenuated response to exercise training among patients with heart failure and type 2 diabetes mellitus. We explored the interaction between diabetes status and a novel, transitional, tailored, progressive rehabilitation intervention that improved physical function compared with usual care in the Rehabilitation Therapy in Older Acute Heart Failure Patients (REHAB-HF) trial. MethodsThe effect of the intervention on 3-month Short Physical Performance Battery (SPPB) (primary endpoint), 6-minute walk distance (6MWD), modified Fried frailty criteria, and quality-of-life scores (Kansas City Cardiomyopathy Questionnaire [KCCQ] and EuroQoL Visual Analogue Scale [VAS]) was compared between participants with and without diabetes. Differences in 6-month clinical outcomes were also explored. ResultsOf the 349 participants enrolled in REHAB-HF, 186 (53%) had diabetes. The prevalence of diabetes was higher in the intervention group (59% vs 48%). Participants with diabetes had worse baseline physical function by the SPPB and 6MWD, but similar frailty and quality-of-life scores. There was a consistent improvement with the intervention for 3-month SPPB, 6MWD, and VAS regardless of diabetes status (all interaction P value > .6), but participants with diabetes had significantly less improvement for frailty (P = .021) and a trend toward lower improvement in KCCQ (P = .11). There was no significant interaction by diabetes status for 6-month clinical event outcomes (all interaction P value > .3). ConclusionsParticipants with diabetes had worse baseline physical function but showed similar clinically meaningful improvements from the intervention. There was less benefit for frailty with the intervention in participants with diabetes.

Rehabilitation Intervention in Older Patients With Acute Heart Failure With Preserved Versus Reduced Ejection Fraction

ObjectivesThis study assessed for treatment interactions by ejection fraction (EF) subgroup (≥45% [heart failure with preserved ejection fraction (HFpEF); vs <45% [heart failure with reduced ejection fraction (HFrEF)]). BackgroundThe REHAB-HF trial showed that an early multidomain rehabilitation intervention improved physical function, frailty, quality-of-life, and depression in older patients hospitalized with acute decompensated heart failure (ADHF). MethodsThree-month outcomes were: Short Physical Performance Battery (SPPB), 6-min walk distance (6MWD), and Kansas City Cardiomyopathy Questionnaire (KCCQ). Six-month end points included all-cause rehospitalization and death and a global rank of death, all-cause rehospitalization, and SPPB. Prespecified significance level for interaction was P ≤ 0.1. ResultsAmong 349 total participants, 185 (53%) had HFpEF and 164 (47%) had HFrEF. Compared with HFrEF, HFpEF participants were more often women (61% vs 43%) and had significantly worse baseline physical function, frailty, quality of life, and depression. Although interaction P values for 3-month outcomes were not significant, effect sizes were larger for HFpEF vs HFrEF: SPPB +1.9 (95% CI: 1.1-2.6) vs +1.1 (95% CI: 0.3-1.9); 6MWD +40 meters (95% CI: 9 meters-72 meters) vs +27 (95% CI: −6 meters to 59 meters); KCCQ +9 (2-16) vs +6 (−2 to 14). All-cause rehospitalization rate was nominally lower with intervention in HFpEF but not HFrEF [effect size 0.83 (95% CI: 0.64-1.09) vs 0.99 (95% CI: 0.74-1.33); interaction P = 0.40]. There were significantly greater treatment benefits in HFpEF vs HFrEF for all-cause death [interaction P = 0.08; intervention rate ratio 0.63 (95% CI: 0.25-1.61) vs 2.21 (95% CI: 0.78-6.25)], and the global rank end point (interaction P = 0.098) with benefit seen in HFpEF [probability index 0.59 (95% CI: 0.50-0.68)] but not HFrEF. ConclusionsAmong older patients hospitalized with ADHF, compared with HFrEF those with HFpEF had significantly worse impairments at baseline and may derive greater benefit from the intervention. (A Trial of Rehabilitation Therapy in Older Acute Heart Failure Patients [REHAB-HF]; NCT02196038)

Highlights from Studies Presented at the Virtual American College of Cardiology Scientific Sessions 2021: Staying Updated with the Latest Advancements in Prevention.

Purpose of ReviewThis review highlights late-breaking science presented at the Virtual American College of Cardiology Scientific Sessions 2021 that demonstrated advancements in preventative cardiology and introduced novel therapeutic modalities for the management of chronic kidney disease, heart failure, and COVID-19.Recent FindingsThe studies reviewed include clinical trials that assessed the use of dapagliflozin in patients with respiratory failure due to COVID-19 (DARE-19 trial); evinacumab for patients with severe hypertriglyceridemia and pancreatitis; effect of genotype-guided oral P2y12 inhibitors vs conventional clopidogrel on long-term ischemic outcomes after percutaneous coronary intervention (TAILOR-PCI trial); anticoagulation in patients hospitalized with COVID-19 (ACTION trial); atorvastatin vs placebo in patients with COVID-19 admitted to the ICU (INSPIRATION-S trial); rehabilitation therapy in older acute heart failure patients (REHAB-HF trial); and aspirin dosing: a patient-centric trial assessing benefits and long-term effectiveness (ADAPTABLE trial). In addition, we review the results of the American College of Cardiology Global Heart Attack Initiative (GHATI). Finally, we discuss the secondary analysis of the STRENGTH trial assessing the association of achieved levels of omega-3 fatty acid levels and major cardiovascular outcomes.SummaryThe studies presented at the virtual American College of Cardiology Scientific Session 2021 represent remarkable contributions in the field of cardiovascular disease and prevention.

Relationship between average daily rehabilitation time and decline in instrumental activity of daily living among older patients with heart failure: A preliminary analysis of a multicenter cohort study, SURUGA-CARE.

BackgroundLimitation of instrumental activity of daily living (IADL) is independently associated with an adverse prognosis in older heart failure (HF) patients.AimsThis multicenter study aims to examine the relationship between average daily rehabilitation time (ADRT) and risk of IADL decline during acute hospitalization in older patients with HF.MethodsFour hundred eleven older patients who were hospitalized due to acute HF and underwent rehabilitation were divided into three groups based on the tertile of the ADRT: short, intermediate, and long groups. IADL was assessed by the National Center for Geriatrics and Gerontology Activities of Daily Living (NCGG-ADL) scale. Change in NCGG-ADL (Δ NCGG-ADL) was calculated by subtracting the pre-hospitalization score from the at-discharge score and IADL decline was defined as Δ NCGG-ADL < = −1 point. Logistic regression analysis was carried out examining the association between ADRT and occurrence of IADL decline.ResultsThe ADRT was 23.9, 32.0, and 38.6 minutes in short, intermediate, and long group, respectively. The proportion of patients with IADL decline during hospitalization was 21% among all subjects and short group had the highest proportion of IADL decline (33%) and long group had the lowest proportion (14%). The long group had significantly lower odds of IADL decline compared with the short group (OR:0.475, 95% CI:0.231–0.975, P = 0.042). Among the items of NCGG-ADL scale, significant decreases in the “go out by oneself”, “travel using a bus or train”, “shop for necessities”, “vacuum”, and “manage medication” were observed at discharge compared to pre-hospitalization in the short group (p<0.01, p<0.01, p<0.01, p<0.05, and p<0.05).ConclusionsThe present study demonstrated that short of ADRT may be associated with the risk of IADL decline during hospitalization in older patients with HF.

The Effectiveness of Transition Care Interventions from Hospital to Home on Rehospitalization in Older Patients with Heart Failure: An Integrative Review

Heart failure (HF) is one of the common causes of rehospitalization in older people leading to an increase in the number of mortalities, disabilities, and readmission rates. However, there has been a lack of literature reviews on current evidence regarding the effects of transition care interventions (TCI) on rehospitalization before discharge from hospital to home. The current review aims to examine the effectiveness of transition care interventions on rehospitalization within 30-days for older patients with HF. The current review of international knowledge employs the PRISMA guidelines and includes primary studies published between 2011 and 2021 taken from PubMed, CINAHL, PsycINFO, Cochrane, and Scopus. Our review identified 15 relevant studies that together examined 10,701 patients with HF. We found that the effectiveness of TCIs could reduce rehospitalization rates and costs of care. The findings asserted that nurses, pharmacists, and multidisciplinary teams were predominantly provided transition care interventions. In principle, transition care intervention could inform policymakers to develop the current discharge planning practices in older HF patients. Therefore, interdisciplinary healthcare teams and caregivers should develop the transition care interventions with long-term periods before discharge from hospital to their home, particularly for older patients with HF in order to improve their capacity for self-care, quality of care, and promote continuing care.

Control of blood pressure in older patients with heart failure and the risk of mortality: a population-based prospective cohort study.

treatment goals for blood pressure (BP) lowering in older patients with heart failure (HF) are unclear. to assess whether BP control < 140/90mmHg is associated with a decreased risk of mortality in older HF patients. population-based prospective cohort study. participants of the Berlin Initiative Study, a prospective cohort of community-dwelling older adults launched in 2009. Clinical information was obtained in face-to-face interviews and linked to administrative healthcare data. Cox proportional hazards models estimated adjusted hazard ratios (HRs) with 95% confidence intervals (CIs) of cardiovascular death and all-cause mortality associated with normalised BP (systolic BP < 140mmHg and diastolic BP < 90mmHg) compared with non-normalised BP (systolic BP ≥ 140mmHg or diastolic BP ≥ 90mmHg) in HF patients. The primary analysis considered only baseline BP ('time-fixed'); an additional analysis updated BP during follow-up ('time-dependent'). at baseline, 544 patients were diagnosed with HF and treated with antihypertensive drugs (mean age 82.8years; 45.4% female). During a median follow-up of 7.5years and compared with non-normalised BP, normalised BP was associated with similar risks of cardiovascular death (HR, 1.24; 95% CI, 0.84-1.85) and all-cause mortality (HR, 1.16; 95% CI, 0.89-1.51) in the time-fixed analysis but with increased risks of cardiovascular death (HR, 1.79; 95% CI, 1.23-2.61) and all-cause mortality (HR, 1.48; 95% CI, 1.15-1.90) in the time-dependent analysis. BP control < 140/90mmHg was not associated with a decreased risk of mortality in older HF patients. The increased risk in the time-dependent analysis requires further corroboration.

Effect of an Emergency Department Care Bundle on 30-Day Hospital Discharge and Survival Among Elderly Patients With Acute Heart Failure

Clinical guidelines for the early management of acute heart failure in the emergency department (ED) setting are based on only moderate levels of evidence, with subsequent low adherence to these guidelines. To test the effect of an early guideline-recommended care bundle on short-term prognosis in older patients with acute heart failure in the ED. Stepped-wedge cluster randomized trial in 15 EDs in France of 503 patients 75 years and older with a diagnosis of acute heart failure in the ED from December 2018 to September 2019 and followed up for 30 days until October 2019. A care bundle that included early intravenous nitrate boluses; management of precipitating factors, such as acute coronary syndrome, infection, or atrial fibrillation; and moderate dose of intravenous diuretics (n = 200). In the control group, patient care was left to the discretion of the treating emergency physician (n = 303). Each center was randomized to the order in which they switched to the "intervention period." After the initial 4-week control period for all centers, 1 center entered in the intervention period every 2 weeks. The primary end point was the number of days alive and out of hospital at 30 days. Secondary outcomes included 30-day all-cause mortality, 30-day cardiovascular mortality, unscheduled readmission, length of hospital stay, and kidney impairment. Among 503 patients who were randomized (median age, 87 years; 298 [59%] women), 502 were analyzed. In the intervention group, patients received a median (interquartile range) of 27.0 (9-54) mg of intravenous nitrates in the first 4 hours vs 4.0 (2.0-6.0) mg in the control group (adjusted difference, 23.8 [95% CI, 13.5-34.1]). There was a significantly higher percentage of patients in the intervention group treated for their precipitating factors than in the control group (58.8% vs 31.9%; adjusted difference, 31.1% [95% CI, 14.3%-47.9%]). There was no statistically significant difference in the primary end point of the number of days alive and out of hospital at 30 days (median [interquartile range], 19 [0- 24] d in both groups; adjusted difference, -1.9 [95% CI, -6.6 to 2.8]; adjusted ratio, 0.88 [95% CI, 0.64-1.21]). At 30 days, there was no significant difference between the intervention and control groups in mortality (8.0% vs 9.7%; adjusted difference, 4.1% [95% CI, -17.2% to 25.3%]), cardiovascular mortality (5.0% vs 7.4%; adjusted difference, 2.1% [95% CI, -15.5% to 19.8%]), unscheduled readmission (14.3% vs 15.7%; adjusted difference, -1.3% [95% CI, -26.3% to 23.7%]), median length of hospital stay (8 d in both groups; adjusted difference, 2.5 [95% CI, -0.9 to 5.8]), and kidney impairment (1% in both groups). Among older patients with acute heart failure, use of a guideline-based comprehensive care bundle in the ED compared with usual care did not result in a statistically significant difference in the number of days alive and out of the hospital at 30 days. Further research is needed to identify effective treatments for acute heart failure in older patients. ClinicalTrials.gov Identifier: NCT03683212.

The roles of health literacy and social support in improving adherence to self-care behaviours among older adults with heart failure.

AimTo describe the associations between health literacy, social support and self‐care behaviours in older adults with heart failure.DesignA cross‐sectional descriptive study.MethodsA total of 252 older adults were recruited from a tertiary care hospital from September 2018–February 2019. Structured questionnaires and medical record reviews were used for data collection. Two steps of hierarchical regression analysis were employed to determine the predictors of self‐care behaviours.ResultsHealth literacy (β = 0.27, p < .001) and social support (β = 0.32, p < .001) were significant determinants of self‐care behaviours in older adults with heart failure. Together, they explained 22% of the variance in self‐care behaviours.ConclusionHealth literacy and perceived social support were positively associated with self‐care behaviours among older heart failure patients. Our findings can help health professionals develop heart failure self‐care interventions to enhance health literacy skills and social support for older adults.

Cognitive impairment measured by Mini-Cog provides additive prognostic information in elderly patients with heart failure

BackgroundThere has been no study elucidating whether cognitive impairment (CI) can provide additive prognostic information besides that provided by preexisting prognostic factors in elderly patients with heart failure. This study examined whether CI can provide additive prognostic information in elderly patients with heart failure. MethodsThis multicenter retrospective study included 352 patients with heart failure aged ≥75 years. We administered the Mini-Mental State Examination (MMSE) and Mini-Cog test to assess CI. The Meta-Analysis Global Group in Chronic Heart Failure (MAGGIC) risk score was used as a model to incorporate the preexisting prognostic factors. All-cause mortality was considered the prognostic outcome. ResultsThe median age was 85 years old, 47.7% were male. According to MMSE and Mini-Cog, 167 (47.4%) and 159 (45.2%) patients had CI, respectively. The agreement between MMSE and Mini-Cog was fairly low (Cohen’s kappa coefficient 0.37). During the follow-up period of median 346 days, 53 patients (15.1%) died. In multivariate Cox regression analysis, CI defined by MMSE and Mini-cog were individually associated with worse prognosis in older heart failure patients even after adjustment for MAGGIC risk model and log B-type natriuretic peptide levels [CI defined by MMSE, HR: 2.05 (95%CI: 1.16−3.61); and CI defined by Mini-Cog, HR:2.57 (95%CI: 1.46–4.53)]. The area under the curve of receiver operator characteristics curve was numerically greater for Mini-Cog than for MMSE (0.59 vs. 0.52, p = 0.109). Moreover, significant net reclassification improvement was observed when CI defined by Mini-Cog, but not on CI defined by MMSE, was added to the MAGGIC score, and when Mini-Cog, instead of MMSE, was used as a CI assessment tool (0.41, p = 0.004). ConclusionsAmong elderly hospitalized patients with heart failure, CI should be considered as a critical factor for prognosis prediction. Mini-Cog is a potentially preferable tool to assess CI in terms of providing prognostically relevant information compared to MMSE.

Psychomotor speed as a predictor of functional status in older chronic heart failure (CHF) patients attending cardiac rehabilitation.

BackgroundThe association among psychological, neuropsychological dysfunctions and functional/clinical variables in Chronic Heart Failure (CHF) has been extensively addressed in literature. However, only a few studies investigated those associations in the older population.PurposeTo evaluate the psychological/neuropsychological profile of older CHF patients, to explore the interrelation with clinical/functional variables and to identify potential independent predictors of patients’ functional status.MethodsThis study was conducted with a multi-center observational design. The following assessments were performed: anxiety (Hospital Anxiety and Depression Scale, HADS), depression (Geriatric Depression Scale, GDS), cognitive impairment (Addenbrooke’s Cognitive Examination Revised, ACE-R), executive functions (Frontal Assessment Battery, FAB), constructive abilities (Clock Drawing Test, CDT), psychomotor speed and alternated attention (Trail Making Test, TMT-A/B), functional status (6-minute walking test, 6MWT) and clinical variables (New York Heart Association, NYHA; Brain Natriuretic Peptide, BNP; left ventricular ejection fraction, LVEF; left ventricular end diastolic diameter, LVEDD; left ventricular end diastolic volume, LVEDV; tricuspid annular plane systolic excursion, TAPSE).Results100 CHF patients (mean age: 74.9±7.1 years; mean LVEF: 36.1±13.4) were included in the study. Anxious and depressive symptoms were observed in 16% and 24,5% of patients, respectively. Age was related to TMT-A and CDT (r = 0.49, p<0.001 and r = -0.32, p = 0.001, respectively), Log-BNP was related to ACE-R-Fluency subtest, (r = -0.22, p = 0.034), and 6MWT was related to ACE-R-Memory subtest and TMT-A (r = 0.24, p = 0.031 and r = -0.32, p = 0.005, respectively). Both anxiety and depression symptoms were related to ACE-R-Total score (r = -0.25, p = 0.013 and r = -0.32, p = 0.002, respectively) and depressive symptoms were related to CDT (r = -0.23, p = 0.024). At multiple regression analysis, Log-BNP and TMT-A were significant and independent predictors of functional status: worse findings on Log-BNP and TMT-A were associated with shorter distance walked at the 6MWT.ConclusionsPsychological and neuropsychological screening, along with the assessment of psychomotor speed (TMT-A), may provide useful information for older CHF patients undergoing cardiac rehabilitation.

Exercise Training Effects on the Relationship of Physical Function and Health-Related Quality of Life Among Older Heart Failure Patients With Preserved Ejection Fraction.

Although exercise training (ET) has been shown to improve both physical function and health-related quality of life (HRQOL) in older patients with heart failure and preserved ejection fraction (HFpEF), the relationship between changes in these important patient-centered outcome measures has not been adequately investigated. Patients (n = 116) with HFpEF (from 2 previous randomized controlled trials) were assigned to either 16 wk of endurance ET or attention control (CON). The ET in both trials consisted of ≤ 60 min of moderate-intensity endurance ET 3 time/wk. Peak exercise oxygen uptake (V˙o2peak) and other exercise capacity measures were obtained from a cardiopulmonary exercise test on an electronically braked cycle ergometer and 6-min walk test (6MWT). HRQOL was assessed using the Minnesota Living with Heart Failure (MLHF) Questionnaire and the 36-item Short Form Health Survey (SF-36). Compared with CON, the ET group demonstrated significant improvement in measures of physical function (V˙o2peak and 6MWT) at 16 wk of follow-up. There were no significant differences observed between the groups for MLHF scores, but the ET group showed significant improvements on the SF-36. There were no significant correlations between change in any of the physical function and HRQOL measures in the ET group. While endurance ET improved both physical function and some domains of HRQOL, the lack of significant correlations between changes in these measures suggests the effects of ET on physical function and HRQOL are largely independent of one another. Since these measures assess important and unique patient-centered outcomes in HFpEF patients, both physical function and HRQOL should be assessed in exercise-based programs and clinical trials.

4545 Identifying Symptom Pattern Trajectories among Heart Failure Patients in a Palliative Care Trial: A Work In Progress

OBJECTIVES/GOALS: This work-in-progress aims to: 1) identify and differentiate symptom pattern trajectories in a sample of older adult heart failure (HF) patients over 24 weeks, and 2) examine associations between sociodemographic/clinical/physiological characteristics, dyadic health, and symptom trajectories. METHODS/STUDY POPULATION: ENABLE CHF-PC, a palliative care RCT (NCT02505425), was conducted at a Southeastern US medical center. Between 2016-2018, 415 older adult HF patients and 159 family caregivers were randomized to receive a psychoeducational intervention or usual care. Baseline sociodemographic information (age, gender, rurality, etc.) were collected. Outcome variables of interest include symptoms (Kansas City Cardiomyopathy Questionnaire (KCCQ), Functional Assessment of Chronic Illness Therapy-Palliative 14, Hospital Anxiety and Depression Scale (HADS)) and dyadic health (PROMIS-SF Global Health). We have calculated baseline descriptive statistics. Future work includes latent growth mixture modeling to identify distinct symptom trajectories and univariate associations with patient level factors. RESULTS/ANTICIPATED RESULTS: Of 415 patient participants, mean age was 64, 53% were male; 55% were African American; 26% were rural dwellers; 46% had +15.8) and low anxiety (6.7+3.6) and depressive symptoms (5.7+4.3) on the HADS. Of 159 family caregivers participants, the mean age was 57.9, 85.4% were female, 51.9% were African-American, and 65.2% were the patient’s spouse/partner. DISCUSSION/SIGNIFICANCE OF IMPACT: Limited data describes HF symptom pattern trajectories.How co-occurring symptoms affect quality of life or are affected by personal or situational factors are not well-understood. This study will help to identify factors and symptom phenotypes that may serve as targets for future interventions.