is heart failure associated with disability? european academy for medicine of ageing, martigny,...
TRANSCRIPT
Is heart failure associated with disability?
European Academy for Medicine of Ageing, Martigny, January 24th 2013
Marius Myrstad
Outline of the presentation
• Short review of epidemiological research
• Underlying mechanisms for disability
• Prevention of disability
• Take-home messages
Prevalence of Heart Failure (HF)
• 80 % of HF patients are 65 years or older
• 25 % of HF patients are 80 years or older
AHA Heart Disease and Stroke statistics 2006
Wong C. Am J Med 2011 ;124 :136-43..
Prevalence of disability in HF
• 54% with ≥ 1 basic ADL disability• Mobility disability (42%) most common limitation
• 57 % with mobility disability• 11 % any other ADL limitation• Proportion with disability stable over 20 years
Wong C. Am J Med 2011 ;124 :136-43...
Gure TR. J Gen Intern Med 2007.:23(1):70-76.
HF is associated with disability
Table: Crude and adjusted association of ADL and I-ADL limitations, by Heart disease category
Gure TR. J Gen Intern Med 2007.:23(1):70-76.
Major predictors for disability in HF
• Impaired gait speed• Depressive symptoms• Cognitive impairment
Chaudry S. J Card Fail 2011;17(9) :764-70..
Mechanisms for disability in HF
• Mobility disability– Muscle weakness Loncar G. Int J Cardiol 2013;162(2) :77-85.
– Reduced lung capacity– Reduced peripher oxygen consumption– Anemia– Fatigue
Mechanisms for disability in HF
• Cognitive impairment– Low cardiac output– Hypotension – Impaired cerebral vessel reactivity– Microembolism
Dardiotis E. Cardiol Res Pract 2012;2012:595821 (Epub).
Other contributing factors
Disability
Social factors
Malnutrition
Medication
Co-morbidity
Psychological factors
Muscle weaknesFatigue
Anemia
Reduced lung capacity
Cognitive impairment
Age-related functional decline
Prevention of disability in HF
• Optimal heart failure treatment• Angiotensin-converting enzyme inhibitors Zuccalà G. Eur Heart J 2005;26(3):226-233. Pedone C. J Gerontol A Biol Sci Med 2004;59(7):716-721
• Treatment of co-morbid conditions• Treatment of depression Vaccarino V. J Am Coll Cardiol 2001;38:199-205.
Prevention of disability in HF
• Regular physical exercise- prevents age-related decline in cardiac function
Molmen HE. Scand Cardiovasc Journ 2012;46(3):163-71
- increases muscle strength in HF patients Savage P. Med Sci Sports Exerc 2011;43(8):1379-1386.
- is safe in patiets with heart disease Rognmo Ø. Circulation 2012;126(12):1436-40.
Take-home messages
• HF is independently associated with disability
• Disability can be prevented
• HF patients should practice regular physical exercise