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Physical Function, Frailty, Cognition, Depression, and Quality of Life in Hospitalized Adults ≥60 Years With Acute Decompensated Heart Failure With Preserved Versus Reduced Ejection Fraction: Insights From the REHAB-HF Trial
Open accessAbstract
Background: Older hospitalized acute decompensated heart failure (HF) patients have persistently poor outcomes and delayed recovery regardless of ejection fraction (EF). We hypothesized that impairments in physical function, frailty, cognition, mood, and quality of life (QoL) potentially contributing to poor clinical outcomes would be similarly severe in acute decompensated HF patients ≥60 years of age with preserved versus reduced EF (HFpEF and HFrEF). Methods and Results: In 202 consecutive older (≥60 years) hospitalized acute decompensated HF patients in a multicenter trial, we prospectively performed at baseline: short physical performance battery, 6-minute walk distance, frailty assessment, Geriatric Depression Scale, Montreal Cognitive Assessment, and QoL assessments. Older acute decompensated HFpEF (EF ≥45%, n=96) and HFrEF (EF <45%, n=106) patients had similar impairments in all physical function measures (short physical performance battery [5.9±0.3 versus 6.2±0.2]; 6-minute walk distance [184±10 versus 186±9 m]; and gait speed [0.60±0.02 versus 0.61±0.02 m/s]) and rates of frailty (55% versus 52%; P =0.70) and cognitive impairment (77% versus 81%; P =0.56) when adjusted for differences in sex, body mass index, and comorbidities. However, depression and QoL were consistently worse in HFpEF versus HFrEF. Depression was usually unrecognized clinically with 38% having Geriatric Depression Scale ≥5 and no documented history of depression. Conclusions: Patients ≥60 years hospitalized with acute decompensated HF patients have broad, marked impairments in physical function and high rates of frailty and impaired cognition: these impairments are similar in HFpEF versus HFrEF. Further, depression was common and QoL was reduced, and both were worse in HFpEF than HFrEF. Depression was usually unrecognized clinically. These findings suggest opportunities for novel interventions to improve these important patient-centered outcomes. Clinical Trial Registration: URL: https://www.clinicaltrials.gov . Unique identifier: NCT02196038.
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“Patients with heart failure with preserved ejection fraction have an especially high burden of symptoms and physical limitations, as well as a poor quality of life. 2,19,20”
From Semaglutide in Patients with Heart Failure with Preserved Ejection Fraction and Obesity (2023) · cites this paper as [20]
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Cites
The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment
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Frailty in Older Adults: Evidence for a Phenotype
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Heart Disease and Stroke Statistics—2017 Update: A Report From the American Heart Association
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2013 ACCF/AHA Guideline for the Management of Heart Failure
Yancy, C. W., Jessup, M., Bozkurt, B., Butler, J., Casey, D. E., Drazner, M. H., Fonarow, G. C., Geraci, S. A., Horwich, T., Januzzi, J. L., et al. (2013) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2013.05.019 · Cited by 12,536
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Studenski, S. (2011) · JAMA · doi:10.1001/jama.2010.1923 · Cited by 4,558
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Forecasting the Impact of Heart Failure in the United States
Heidenreich, P. A., Albert, N. M., Allen, L. A., Bluemke, D. A., Butler, J., Fonarow, G. C., Ikonomidis, J. S., Khavjou, O., Konstam, M. A., Maddox, T. M., et al. (2013) · Circulation Heart Failure · doi:10.1161/hhf.0b013e318291329a · Cited by 2,884
2013 ACCF/AHA Guideline for the Management of Heart Failure
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Semaglutide in Patients with Heart Failure with Preserved Ejection Fraction and Obesity
Kosiborod, M. N., Abildstrøm, S. Z., Borlaug, B. A., Butler, J., Rasmussen, S., Davies, M., Hovingh, G. K., Kitzman, D. W., Lindegaard, M. L., Møller, D. V., et al. (2023) · New England Journal of Medicine · doi:10.1056/nejmoa2306963 · Cited by 1,669
Self-citationNassif, M. E., Windsor, S. L., Borlaug, B. A., Kitzman, D. W., Shah, S. J., Tang, F., Khariton, Y., Malik, A. O., Khumri, T., Umpierrez, G., et al. (2021) · Nature Medicine · doi:10.1038/s41591-021-01536-x · Cited by 618
Self-citationArrigo, M., Jessup, M. L., Müllens, W., Reza, N., Shah, A. M., Sliwa, K. S., & Mebazaa, A. (2020) · Nature Reviews Disease Primers · doi:10.1038/s41572-020-0151-7 · Cited by 592
Physical rehabilitation for older patients hospitalized for heart failure
Kitzman, D. W., Whellan, D. J., Duncan, P., Pastva, A. M., Mentz, R. J., Reeves, G. R., Nelson, M. B., Chen, H., Upadhya, B., Reed, S. D., et al. (2021) · New England Journal of Medicine · doi:10.1056/nejmoa2026141 · Cited by 594
Self-citationFrailty Is Intertwined With Heart Failure
Pandey, A., Kitzman, D. W., & Reeves, G. R. (2019) · JACC Heart Failure · doi:10.1016/j.jchf.2019.10.005 · Cited by 365
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Metadata
- Authors
- Warraich, H. J., Kitzman, D. W., Whellan, D. J., Duncan, P. W., Mentz, R. J., Pastva, A. M., Nelson, M. B., Upadhya, B., & Reeves, G. R.
- Affiliations
- Duke University (US)
- Wake Forest University Health Sciences (US)
- Thomas Jefferson University (US)
- Atrium Health Wake Forest Baptist (US)
- ORCID
- Venue
- Circulation: Heart Failure
- Published
- 2018-11
- Volume
- 11
- Issue
- 11
- Pages
- e005254-e005254
- ISSN
- 1941-3289 (ISSN-L)
- 1941-3297
- PMC
- PMC6380360
- OpenAlex
- W2900728651
- Cited by
- 194
- References
- 55
- Citations by year
- 2026: 14 · 2025: 20 · 2024: 30 · 2023: 34 · 2022: 36 · 2021: 28 · 2020: 22 · 2019: 9 · 2018: 1
- FWCI
- 11.33
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Circulation Heart Failure (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health (UL1TR001420, KL2TR001421)
- National Institute on Aging (R01AG018915, R01AG045551, P30AG021332, U24AG059624, P30AG028716)
- National Center for Advancing Translational Sciences
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Failure Treatment and Management
- Health Sciences › Medicine › Geriatrics and Gerontology › Frailty in Older Adults
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Function and Risk Factors
- Keywords
- acute decompensated heart failure, heart failure with preserved ejection fraction, heart failure with reduced ejection fraction, older adults, physical function, frailty, cognitive impairment, depression, quality of life, hospitalized patients, Short Physical Performance Battery, 6-minute walk distance, walking speed, patient-centered outcomes
- MeSH terms
- Adult, Aged, Aged, 80 and over, Cognition, Depression, Female, Heart Failure, Hospitalization, Humans, Male, Middle Aged, Quality of Life, Stroke Volume, Ventricular Dysfunction, Left
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