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Instrumental Activities of Daily Living in Older People with Severe Aortic Stenosis
The 20th Annual Scientific Meeting
YIA-HT1 Assessment of Both Energy Intake and Nutritional Status Predicts Functional Recovery after Cardiac Rehabilitation in Elderly Inpatients with Heart Failure Satoshi Katano1, Akiyoshi Hashimoto2,3, Katsuhiko Ohori3,4, Yoshitaka Kiyofuji1, Takefumi Fujito 3 , Ayako Watanabe 5 , Rimi Yanase 5 , Remi Honma 5 , Kazufumi Tsuchihashi2,3, Tetsuji Miura3; 1Division of Rehabilitation, Sapporo Medical University Hospital, Sapporo, Japan; 2Department of Health Care Administration and Management, Sapporo Medical University, Sapporo, Japan; 3Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University, Sapporo, Japan; 4Department of Cardiology, Hokkaido Cardiovascular Hospital, Sapporo, Japan; 5Division of Nursing, Sapporo Medical University Hospital, Sapporo, Japan Purpose: We examined whether assessment of energy intake (EI) combined with nutritional status can predict functional recovery after cardiac rehabilitation (CR) in elderly heart failure (HF) patients. Methods: Nutritional status assessed by the Mini Nutritional Assessment Short Form (MNA-SF) and total EI were evaluated at the start of CR in 142 consecutive elderly inpatients (mean age 76 ± 7 years). Primary outcome was functional status at discharge assessed using Barthel Index (BI) score. Results: The median period of CR was 21 days (interquartile range 16–35). Sixty-four patients had favorable functional recovery after CR (BI score at discharge ≥90). Multivariate logistic regression analysis identified EI (odds ratio [OR] 1.11, P < .01) and MNASF score (OR 1.26, P < .05) as independent predictors of the favorable functional recovery. In ROC analysis, cutoff values of EI and MNA-SF score to predict the favorable functional recovery were 24.7 kcal/kg/day (sensitivity 0.61, specificity 0.72) and 8 (sensitivity 0.61, specificity 0.66), respectively. Odds ratios (OR) for achieving favorable functional recovery after CR were significantly lower in patients with low EI (<24.7 kcal/ kg/day) and low MNA-SF score (<8) and patients with low EI and high MNA-SF score (≥8) (OR 0.17, 0.14, respectively, P < .01) than in patients with high EI and high MNASF score. Conclusion: Assessment of EI combined with MNA-SF is useful for predicting functional recovery after CR in elderly HF inpatients.
YIA-HT2 Instrumental Activities of Daily Living in Older People with Severe Aortic Stenosis Shogo Fukui1,2, Kentaro Hayashida2,3; 1Department of Rehabilitation, Keio University School of Medicine, Tokyo, Japan; 2Keio University Graduate School of Health Management, Kanagawa, Japan; 3Department of Cardiology, Keio University School of Medicine, Tokyo, Japan The aim of this study was to examine factors related to the instrumental activities of daily living (IADL) in older people with severe aortic stenosis (AS). 112 people (average age 84.6 ± 4.2 years old, woman 73%) with severe AS who were referred to our hospital as possible candidates for transcatheter aortic valveimplantation (TAVI) were enrolled. IADL was assessed by Frenchay Activities Index (FAI). Factors likely related to IADL, including cardiac function, nutritional and metabolic status, kidney function, medical history, and comorbidities, were evaluated. After simple linear regression analysis, multiple regression analysis (the variable increase method) used to examine which factors were related to IADL. The score of FAI in this population was 19.4 ± 8.9 points. As a result of simple linear regression analysis, age, New York Heart Association class, Left ventricular ejection fraction, Body Mass Index, serum albumin, estimated glemerular filtration rate, short physical performance battery (SPPB), Mini-Mental State Examination, Mini Nutritional Assessment Short-Form, history of heart failure, history of cerebrovascular disease were entered into the multiple regression analysis. Multiple regression analysis revealed that history of heart failure (sβ = 0.284, P < .01), history of cerebrovascular disease (sβ = 0.194, P < .05), SPPB (sβ = 0.421, P < .01) were independent factors to IADL (R2 = 0.385). The IADL in older people with severe AS were related with history of heart failure and cerebrovascular disease and physical frailty.
YIA-HT3 The Increased Number of Drugs Without Guideline Recommendation is Associated with Poor Outcome in the Patients with Chronic Heart Failure Toshiyuki Shikata1, Koujiro Takamoto1, Jun-Ichi Sakamoto2, Satoyasu Ito3, Eri Manabe4, Miho Fukui4, Tohru Masuyama4, Takeshi Tsujino2,3,4; 1Department of Pharmacy, Hyogo College of Medicine Sasayama Hospital, Hyogo, Japan; 2Graduate School of Pharmacy, Hyogo University of Health Sciences, Hyogo, Japan; 3Department of Pharmacy, School of Pharmacy, Hyogo University of Health Sciences, Hyogo, Japan; 4Cardiovascular Division, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan Purpose: Polypharmacy is usually defined as the chronic use of five or more medications and very common in patients with chronic heart failure (CHF) because current clinical guidelines (GL) recommend many drugs as class I. The purpose of this study is to evaluate the impact of the number of drugs recommended in GL (ACEI, ARB, β-blocker, Anti-aldosterone, Aspirin, Statin, Warfarin: GLd) and drugs not recommended in GL (non-GLd) for outcome in CHF patients separately. Methods: Study population included CHF patients who attended Hyogo College of Medicine hospital and participated in the J-MELODIC study. The relationship between the number of drugs at the entry and the primary endpoint (cardiovascular death or heart failure hospitalization) were analyzed using log-rank test and Cox proportional hazards regression analysis. Results: A total of 136 subjects (male 95, mean age of 69.3 years) were enrolled in the study. The use of 9 or more drugs was associated with an increase in the
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primary endpoint (log-rank test, P < .002). In Cox proportional hazards regression analysis, the number of non-GLd (P = .02), not the number of GLd (P = .94), was associated with poor outcome. Conclusions: An increase in the number of non-GLd, not the number of GLd, was associated with poor outcome.
YIA-HT4 Higher Daily Physical Activity is Associated with Subsequent Prevented Decreasing Left Ventricular Diastolic Function in Patient with Ischemic Heart Disease Hidenori Kariya1, Toshiki Kutsuna1, Shinichi Obara1, Yumi Takahashi1, Emiko Sekine1, Chiharu Noda2, Atsuhiko Matsunaga3, Minako Yamaoka-Tojo3, Junya Ako2; 1Department of Rehabilitation, Kitasato University East Hospital, Sagamihara, Japan; 2Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Japan; 3 Department of Rehabilitation, School of Allied Health Sciences, Kitasato University, Sagamihara, Japan High daily physical activity prevents onset risk of heart failure. However, very few studies show preventive mechanism of the heart failure onset by high daily physical activity. We examined whether high daily activity is associated with prevented decreasing left ventricular function with ischemic heart disease (IHD). One hundred and seven outpatients were enrolled and followed for one year. Left ventricular ejection fraction and ratio of mitral peak velocity of early filling to early diastolic mitral annular velocity (E/e’) were measured as left ventricular systolic function and diastolic function by echocardiography. Patients were categorized based on tertile number of steps taken per day as having “low group” (less than 3751), “middle group” (3751 to less than 6458), and “high group” (more than 6458). Changes in E/e’ were significantly different between three subgroups adjusted for age, as assessed by two-way analysis of covariance (F = 3.3, P < .05). E/e’ of low and middle groups after one year was higher than baseline (respectively, P < .05). Whereas, E/e’ of high group after one year was unchanged compared with baseline. By stepwise multiple regression analysis, C-reactive protein, E/e’, and number of steps taken per day at baseline were independent factors of changing left ventricular diastolic function. Higher daily physical activity is associated with subsequent prevented decreasing left ventricular diastolic function with IHD.
YIA-HT5 A Conventional and Novel Screening Tool for Frailty Predicting a Poor Prognosis in Patients with Heart Failure Ryota Matsuzawa1, Kentaro Kamiya1, Shinya Tanaka2, Emi Maekawa3, Chiharu Noda3, Minako Yamaoka-Tojo3, Atsuhiko Matsunaga2,4, Takashi Masuda2,4, Junya Ako3; 1 Department of Rehabilitation, Kitasato University Hospital, Sagamihara, Japan; 2 Department of Cardiovascular Medicine, Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan; 3Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Japan; 4Department of Rehabilitation, School of Allied Health Sciences, Kitasato University, Sagamihara, Japan Background: Frailty affects many patients with heart failure (HF) and potentially predicts their prognosis. We investigated the association of frailty, as diagnosed based on a conventional and novel screening tool, with survival in HF patients. Methods: HF patients (n = 785; 65.7 ± 14.0 years; males, 68.3%) were followed for up to 5 years. Frailty was diagnosed based on one-leg standing time (OLST) of <10 seconds. The end-point was all-cause mortality. Results: Seventy patients died during follow-up (Figure). In multivariate Cox regression analysis adjusting for patients’ characteristics, the hazard ratio in the group with an OLST of <10 seconds was 1.77 (95% confidence interval = 1.02– 3.08) compared with that in the ≥10 second group. Conclusions: OLST is a simple clinical scale of frailty. Short OLST is strongly associated with poor prognosis in HF patients.
YIA-HT1 Assessment of Both Energy Intake and Nutritional Status Predicts Functional Recovery after Cardiac Rehabilitation in Elderly Inpatients with Heart Failure Satoshi Katano1, Akiyoshi Hashimoto2,3, Katsuhiko Ohori3,4, Yoshitaka Kiyofuji1, Takefumi Fujito 3 , Ayako Watanabe 5 , Rimi Yanase 5 , Remi Honma 5 , Kazufumi Tsuchihashi2,3, Tetsuji Miura3; 1Division of Rehabilitation, Sapporo Medical University Hospital, Sapporo, Japan; 2Department of Health Care Administration and Management, Sapporo Medical University, Sapporo, Japan; 3Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University, Sapporo, Japan; 4Department of Cardiology, Hokkaido Cardiovascular Hospital, Sapporo, Japan; 5Division of Nursing, Sapporo Medical University Hospital, Sapporo, Japan Purpose: We examined whether assessment of energy intake (EI) combined with nutritional status can predict functional recovery after cardiac rehabilitation (CR) in elderly heart failure (HF) patients. Methods: Nutritional status assessed by the Mini Nutritional Assessment Short Form (MNA-SF) and total EI were evaluated at the start of CR in 142 consecutive elderly inpatients (mean age 76 ± 7 years). Primary outcome was functional status at discharge assessed using Barthel Index (BI) score. Results: The median period of CR was 21 days (interquartile range 16–35). Sixty-four patients had favorable functional recovery after CR (BI score at discharge ≥90). Multivariate logistic regression analysis identified EI (odds ratio [OR] 1.11, P < .01) and MNASF score (OR 1.26, P < .05) as independent predictors of the favorable functional recovery. In ROC analysis, cutoff values of EI and MNA-SF score to predict the favorable functional recovery were 24.7 kcal/kg/day (sensitivity 0.61, specificity 0.72) and 8 (sensitivity 0.61, specificity 0.66), respectively. Odds ratios (OR) for achieving favorable functional recovery after CR were significantly lower in patients with low EI (<24.7 kcal/ kg/day) and low MNA-SF score (<8) and patients with low EI and high MNA-SF score (≥8) (OR 0.17, 0.14, respectively, P < .01) than in patients with high EI and high MNASF score. Conclusion: Assessment of EI combined with MNA-SF is useful for predicting functional recovery after CR in elderly HF inpatients.
YIA-HT2 Instrumental Activities of Daily Living in Older People with Severe Aortic Stenosis Shogo Fukui1,2, Kentaro Hayashida2,3; 1Department of Rehabilitation, Keio University School of Medicine, Tokyo, Japan; 2Keio University Graduate School of Health Management, Kanagawa, Japan; 3Department of Cardiology, Keio University School of Medicine, Tokyo, Japan The aim of this study was to examine factors related to the instrumental activities of daily living (IADL) in older people with severe aortic stenosis (AS). 112 people (average age 84.6 ± 4.2 years old, woman 73%) with severe AS who were referred to our hospital as possible candidates for transcatheter aortic valveimplantation (TAVI) were enrolled. IADL was assessed by Frenchay Activities Index (FAI). Factors likely related to IADL, including cardiac function, nutritional and metabolic status, kidney function, medical history, and comorbidities, were evaluated. After simple linear regression analysis, multiple regression analysis (the variable increase method) used to examine which factors were related to IADL. The score of FAI in this population was 19.4 ± 8.9 points. As a result of simple linear regression analysis, age, New York Heart Association class, Left ventricular ejection fraction, Body Mass Index, serum albumin, estimated glemerular filtration rate, short physical performance battery (SPPB), Mini-Mental State Examination, Mini Nutritional Assessment Short-Form, history of heart failure, history of cerebrovascular disease were entered into the multiple regression analysis. Multiple regression analysis revealed that history of heart failure (sβ = 0.284, P < .01), history of cerebrovascular disease (sβ = 0.194, P < .05), SPPB (sβ = 0.421, P < .01) were independent factors to IADL (R2 = 0.385). The IADL in older people with severe AS were related with history of heart failure and cerebrovascular disease and physical frailty.
YIA-HT3 The Increased Number of Drugs Without Guideline Recommendation is Associated with Poor Outcome in the Patients with Chronic Heart Failure Toshiyuki Shikata1, Koujiro Takamoto1, Jun-Ichi Sakamoto2, Satoyasu Ito3, Eri Manabe4, Miho Fukui4, Tohru Masuyama4, Takeshi Tsujino2,3,4; 1Department of Pharmacy, Hyogo College of Medicine Sasayama Hospital, Hyogo, Japan; 2Graduate School of Pharmacy, Hyogo University of Health Sciences, Hyogo, Japan; 3Department of Pharmacy, School of Pharmacy, Hyogo University of Health Sciences, Hyogo, Japan; 4Cardiovascular Division, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan Purpose: Polypharmacy is usually defined as the chronic use of five or more medications and very common in patients with chronic heart failure (CHF) because current clinical guidelines (GL) recommend many drugs as class I. The purpose of this study is to evaluate the impact of the number of drugs recommended in GL (ACEI, ARB, β-blocker, Anti-aldosterone, Aspirin, Statin, Warfarin: GLd) and drugs not recommended in GL (non-GLd) for outcome in CHF patients separately. Methods: Study population included CHF patients who attended Hyogo College of Medicine hospital and participated in the J-MELODIC study. The relationship between the number of drugs at the entry and the primary endpoint (cardiovascular death or heart failure hospitalization) were analyzed using log-rank test and Cox proportional hazards regression analysis. Results: A total of 136 subjects (male 95, mean age of 69.3 years) were enrolled in the study. The use of 9 or more drugs was associated with an increase in the
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primary endpoint (log-rank test, P < .002). In Cox proportional hazards regression analysis, the number of non-GLd (P = .02), not the number of GLd (P = .94), was associated with poor outcome. Conclusions: An increase in the number of non-GLd, not the number of GLd, was associated with poor outcome.
YIA-HT4 Higher Daily Physical Activity is Associated with Subsequent Prevented Decreasing Left Ventricular Diastolic Function in Patient with Ischemic Heart Disease Hidenori Kariya1, Toshiki Kutsuna1, Shinichi Obara1, Yumi Takahashi1, Emiko Sekine1, Chiharu Noda2, Atsuhiko Matsunaga3, Minako Yamaoka-Tojo3, Junya Ako2; 1Department of Rehabilitation, Kitasato University East Hospital, Sagamihara, Japan; 2Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Japan; 3 Department of Rehabilitation, School of Allied Health Sciences, Kitasato University, Sagamihara, Japan High daily physical activity prevents onset risk of heart failure. However, very few studies show preventive mechanism of the heart failure onset by high daily physical activity. We examined whether high daily activity is associated with prevented decreasing left ventricular function with ischemic heart disease (IHD). One hundred and seven outpatients were enrolled and followed for one year. Left ventricular ejection fraction and ratio of mitral peak velocity of early filling to early diastolic mitral annular velocity (E/e’) were measured as left ventricular systolic function and diastolic function by echocardiography. Patients were categorized based on tertile number of steps taken per day as having “low group” (less than 3751), “middle group” (3751 to less than 6458), and “high group” (more than 6458). Changes in E/e’ were significantly different between three subgroups adjusted for age, as assessed by two-way analysis of covariance (F = 3.3, P < .05). E/e’ of low and middle groups after one year was higher than baseline (respectively, P < .05). Whereas, E/e’ of high group after one year was unchanged compared with baseline. By stepwise multiple regression analysis, C-reactive protein, E/e’, and number of steps taken per day at baseline were independent factors of changing left ventricular diastolic function. Higher daily physical activity is associated with subsequent prevented decreasing left ventricular diastolic function with IHD.
YIA-HT5 A Conventional and Novel Screening Tool for Frailty Predicting a Poor Prognosis in Patients with Heart Failure Ryota Matsuzawa1, Kentaro Kamiya1, Shinya Tanaka2, Emi Maekawa3, Chiharu Noda3, Minako Yamaoka-Tojo3, Atsuhiko Matsunaga2,4, Takashi Masuda2,4, Junya Ako3; 1 Department of Rehabilitation, Kitasato University Hospital, Sagamihara, Japan; 2 Department of Cardiovascular Medicine, Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan; 3Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Japan; 4Department of Rehabilitation, School of Allied Health Sciences, Kitasato University, Sagamihara, Japan Background: Frailty affects many patients with heart failure (HF) and potentially predicts their prognosis. We investigated the association of frailty, as diagnosed based on a conventional and novel screening tool, with survival in HF patients. Methods: HF patients (n = 785; 65.7 ± 14.0 years; males, 68.3%) were followed for up to 5 years. Frailty was diagnosed based on one-leg standing time (OLST) of <10 seconds. The end-point was all-cause mortality. Results: Seventy patients died during follow-up (Figure). In multivariate Cox regression analysis adjusting for patients’ characteristics, the hazard ratio in the group with an OLST of <10 seconds was 1.77 (95% confidence interval = 1.02– 3.08) compared with that in the ≥10 second group. Conclusions: OLST is a simple clinical scale of frailty. Short OLST is strongly associated with poor prognosis in HF patients.