Prevalence of Falls and Musculoskeletal Pain in Older Adults with Chronic Heart Failure

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Heart, Lung and Circulation 2012;21:S1–S142

CSANZ 2012 Abstracts

ABSTRACTS

study was to identify factors that may influence titration achievement to assist with developing interventions to improve care. The sample consisted of 229 patients newly accepted into three heart failure disease management programs in Brisbane, who were not on target doses of medication when discharged from hospital in two six month periods (July to December 2009 and 2010). Age was 71 (±14.6) years and 63% were male; patients had 5 (±3) comorbidities and 10 (±4.8) medications. Logistic regression analysis found that possession of a titration plan and age were significant predictors of target achievement (p < 0.05). Patients with a detailed titration plan had 2.42 times greater odds (95% CI: 1.10–5.31) of achieving target dose at six months post discharge compared to patients with no plan. Increasing age reduced the odds of achieving target; for every 10 year increase in age, the odds of achieving target was reduced by 30% (OR = 0.7, 95% CI: 0.55–0.89). Hospital records were unclear about who was managing titration post discharge in 40% of patients. GPs were nominated as responsible in 32% of patients, followed by physicians (20%) and nurses (8%). This study demonstrates that information regarding titration can assist patients in achieving optimal doses. Findings will inform the development of communication tools to be tested in the larger project. http://dx.doi.org/10.1016/j.hlc.2012.05.222 213 Prevalence and Prognostic Importance of Combined Depression and Cognitive Impairment in Typically Older Patients with Chronic Heart Failure Y. Chan ∗ , M. Carrington, A. Calderone, S. Stewart Baker IDI Heart and Diabetes Institute, Melbourne, Australia Background: Depressive symptoms (DS) and cognitive impairment (Cog-I) are known to adversely influence health outcomes in chronic heart failure (CHF). However, few studies have examined the combined prevalence and impact of DS and Cog-I. Methods: Data derived from a prospective, multi-centre randomised trial with blinded endpoint adjudication comprising 280 hospitalised individuals with CHF (mean age 71 ± 14 years, 73% male). We examined the prevalence and prognostic importance of DS and Cog-I alone and in combination in the study cohort. DS was identified using the ARROL score and CES-D scale and Cog-I using the Montreal Cognitive Assessment tool. All patients were subject to 12–18 months follow-up post index hospitalisation. Results: Overall, 35% displayed DS and 45% Cog-I. Those with DS were more likely to display Cog-I (OR 2.04; 95% CI: 1.21–3.43; p = 0.007). Compared to the rest, those with DS were older (73 ± 13 versus 69 ± 13 years; p = 0.03), lived alone (OR 1.54; 95% CI: 0.94–2.55; p = 0.07) and reported poorer health status by self-report measures of EQ-5D (0.59 ± 0.2 versus 0.78 ± 0.16; p < 0.05) and the Minnesota Living with HF questionnaire (39 ± 19 versus

61 ± 17; p < 0.05). The combination of DS and Cog-I (prevalence of 21%) was an independent predictor of mortality (adjusted HR 1.80; 95% CI: 1.06–3.07; p = 0.031). Conclusion: These data suggest that DS are associated with poorer cognition in typically older patients with CHF. Moreover, the combination of DS and Cog-I is independently associated with a worse prognosis – with implications for screening and management. http://dx.doi.org/10.1016/j.hlc.2012.05.223 214 Prevalence of Falls and Musculoskeletal Pain in Older Adults with Chronic Heart Failure E. van der Ham 1,∗ , A. Mandrusiak 1 , A. Krumins 2 , J. Adsett 3 , R. Hwang 2 , S. Kuys 4,5 1 The

University of Queensland, Brisbane, Australia Alexandra Hospital, Australia 3 Royal Brisbane and Women’s Hospital, Australia 4 The Prince Charles Hospital, Australia 5 Griffith University, Australia 2 Princess

Background: It is likely that people with chronic heart failure (CHF) suffer a high falls risk as they are typically aged over 65 years and experience many of the known falls risk factors such as musculoskeletal pain, dizziness, a high number of prescribed medications and low levels of physical activity. Aim: To determine the prevalence of falls and known falls risk factors in older adults with CHF; and to determine any relationship between falls rate and risk factors. Methods: Participants were recruited from three tertiary referral hospitals with established Heart Failure Services. Questionnaires were sent to people with CHF living in the community to assess falls and known risk factors. Clinical and demographical information was collected from hospital records. Results: Of 212 distributed questionnaires, 96 (45%) were returned. Thirty-four (36%) reported they had fallen. Fallers more frequently reported dizziness upon standing (p < 0.01) and took more medications (mean = 10) compared to non-fallers (mean 9). The majority (91%) of respondents reported musculoskeletal pain during the last 12 months. Most prevalent reported areas included lower back (60%), ankles and feet (59%), shoulders (54%) and knees (54%). No difference was found between fallers and non-fallers for the prevalence of musculoskeletal pain or physical activity level. Conclusion: This group of older adults with CHF reported a high falls rate with significant risk factors including dizziness and number of medications. It appears that musculoskeletal pain is common in this group. However, further investigation is needed to explore this. http://dx.doi.org/10.1016/j.hlc.2012.05.224