Senile Asthenia Syndrome in Patients With Acute Decompensation of Heart Failure: Prevalence, Impact on Quality of Life, Management Tactics, Prognosis

Aim      To study the prevalence of senile frailty syndrome (FS), its impact on the functional activity, quality of life, management tactics, and prognosis in patients with acute decompensated heart failure (ADHF).

Material and methods  The study included 108 patients (58 men and 50 women, mean age 69.2±10.7 years) admitted for ADHF. FS was diagnosed based on the presence of the clinical signs of ADHF requiring intravenous therapy with diuretics, vasodilators or inotropic drugs. Screening for FS was performed using the "Age is Not a Hindrance" questionnaire. Patients who scored ≥3 performed a brief array of physical functioning tests (BAPFT) to assess the functional activity, and took the Mini-Cog test to assess the psycho-emotional state. A BAPFT score ≤7 and/or Mini-Cog score <3 were criteria of FS.

Results The prevalence of FS was 39.8%. "Fragile" patients were older than individuals without FS (mean age 75.5±7.7 vs. 65.0±10.4 years, respectively; p<0.0001). Among them, there were more women (65.0 and 33.8%, respectively; p=0.006), higher prevalences of arterial hypertension (AH) (97.7 and 7.7%, respectively; p=0.0351), ischemic heart disease (IHD) (69.8 and 49.2%, respectively; p=0.03), iron deficiency (97.7 and 72.3%, respectively; p<0.0001), and hypocalcemia (16.3 and 1.5%, respectively; p=0.013). FS patents had lower exercise tolerance (distance covered in a 6-min walk test, 141.6±42.4 and 215.7±73.0 m, respectively; p<0.0001) and lower quality of life according to the visual analogue scale (score 32.8±12.0 and 40.8±17.8, respectively; p=0.011). “Fragile” patients were more frequently prescribed angiotensin II receptor blockers (20.9 and 4.6%, respectively; p=0.017); the frequency of dosing and target doses of other drug groups did not differ. The following factors associated with an unfavorable one-year prognosis after an episode of ADHF were identified: FS (relative risk, RR 2.94; 95% confidence interval, CI 1.46-5.94; p = 0.003), valve stenosis (RR 3.44; 95% CI 1.60-7.39; p = 0.001), history of acute cerebrovascular accident (RR 3.98; 95% CI 1.65-7.39; p = 0.002), leukocytosis (RR 2.83; 95% CI 1.34-5.97; p = 0.007), and a concentration of N-terminal fragment of pro-B-type natriuretic peptide (NT-proBNP) >5000 pg/ml (RR 2.47; 95% CI 1.24-4.91; p=0.010).

Conclusion      The prevalence of senile FS among patients hospitalized with ADHF was 39.8%. "Fragile" patients had higher prevalences of AH, IHD, iron deficiency, and hypocalcemia. The presence of FS impaired the exercise tolerance, quality of life, prognosis, and did not influence approaches to the drug therapy for ADHF.

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