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The Walking Ability is a Useful Predictor of Prognosis in Elderly Chronic Heart Failure Patients
S190 Journal of Cardiac Failure Vol. 22 No. 9S September 2016 ischemic etiology, a multivariate logistic analysis revealed that serum BNP level (P = .018) and eGFR (P = .030) were independent predictors of CRT responders (R2 = 0.22, P < .001). During follow-up period (872 ± 557 days), 32 patients (30%) had any cause death or hospitalization for worsening heart failure. According to Kaplan-Meier curve, patients with high serum BNP (<405 pg/ml: log-rank P < .001) and low eGFR (<43 ml/kg/1.73 m2: log-rank P = .01) group showed significantly poor prognosis after CRT compared with another group, respectively. (Conclusion) Basal high serum BNP level and renal dysfunction were poor prognostic predictors on worse clinical outcomes after CRT.
O26-5 Implantable Cardioverter Defibrillator and Mortality in the Elderly: A Retrospective Nationwide Study Sho Okada1, Hiroki Matsui2, Hideo Yasunaga2, Kiyohide Fushimi2; 1Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan; 2 Department of Clinical Epidemiology and Health Economics, School of Public Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan Background: Implantable cardioverter-defibrillator (ICD) is established as the firstline therapy in preventing sudden cardiac death among patients with heart failure (HF). However, its effectiveness among aged population is unknown due to rarity. This study aimed to determine whether ICD therapy is beneficial among elderly patients with HF, using a national inpatient database. Methods: Patients aged > = 60 years with or without ICD implantation for HF and fixed left ventricular dysfunction were identified from the Japanese Diagnosis Procedure Combination database between July 2010 and March 2014. Propensity score matching analysis was performed to compare mortality during the observed period between patients with and without ICD. Cox regression analysis was performed to calculate the hazard ratio of survival for the ICD group compared with the non-ICD group. Results: Eligible patients included those with ICD (n = 2,883) and without ICD (n = 102,512). Propensity score matching generated 2403 pairs with well-balanced patient backgrounds. There was almost equal mortality between the two groups (ICD group: 37 cases; non-ICD group: 38 cases). In the cox regression model, hazard ratio for the ICD group was 0.80 (95% CI, 0.51–1.26). Conclusion: The present study did not show the association between ICD therapy and reduced mortality among patients aged > = 60 with nonischemic HF.
O27-3 Impact of Delirium on Postoperative Frailty and Long Term Cardiovascular Events After Cardiac Surgery Masato Ogawa1,2, Kazuhiro Izawa2, Seimi Kobayashi3, Yasunori Tsuboi1,3, Kodai Komaki1, Yasuko Gotake4, Hiroshi Tanaka4, Ken-Ichi Hirata3, Yoshitada Sakai1, Yutaka Okita4; 1Division of Rehabilitation Medicine, Kobe University Hospital, Kobe, Japan; 2 Department of International Health, Graduate School of Health Sciences, Kobe University, Kobe, Japan; 3Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan; 4Division of Cardiovascular Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan Background: Postoperative delirium (POD) is a transient mental syndromes whose development is associated with high risk of mortality and long-term cognitive impairment. However, the contributing effect of POD to adverse long-term outcomes is unclear. This study aimed to assess the incidence of POD and its effect on clinical, functional, and long-term outcomes in patients who underwent cardiac surgery. Methods: We studied 233 consecutive patients who underwent cardiac surgery from December 2013 to June 2015. The assessment of delirium was conducted using the Intensive Care Delirium Screening Checklist. Postoperative functional decline was diagnosed with frailty criteria assessed by handgrip strength and gait speed. The primary composite endpoint was major adverse cardiac events (MACE) after cardiac surgery. Results: POD has developed in 37(15.9%) patients. The ratio of patients with frailty in the POD group was higher than that in the non-POD group (54.1% vs. 23.1%, P < .0001). After adjustment for potential cofounders, multivariate analysis showed the independent predictors of MACE to be POD (HR, 3.45; 95% CI, 1.62–6.90; P=.01) and postoperative frailty (HR, 3.40; 95% CI, 1.52–7.94; P=.004). Conclusion: POD appeared to be one trigger of the development of postoperative frailty. POD and postoperative frailty were strong predictors of MACE after cardiac surgery. Our results indicate that the risk stratification focused on POD is useful to predict outcomes of patients undergoing cardiac surgery.
O27-5 Six-Minute Walking Distance Test Upon Discharge After Undergoing DOPPO Rehabilitation Determines One-Year Prognosis in Frail Elderly Akifumi Uehara1, Hiroaki Obata1,2, Sho Yamada2, Shiori Kourakata2, Kenji Yamaguchi2, Yuki Izumi2, Hiroshi Watanabe1, Satoru Abe1, Yorio Suzuki1,3, Tohru Izumi1; 1Division of Medicine, Niigataminami Hospital, Niigata, Japan; 2Division of Rehabilitaion, Niigataminami Hospital, Niigata, Japan; 3Division of Orthopedics, Niigataminami Hospital, Niigata, Japan
O27-1 The Walking Ability is a Useful Predictor of Prognosis in Elderly Chronic Heart Failure Patients Yuki Kanno, Takamasa Sato, Tetsuro Yokokawa, Satoshi Suzuki, Masayoshi Oikawa, Akiomi Yoshihisa, Yasuchika Takeishi; Department of Cardiovascular Medicine, Fukushima Medical University, Fukushima, Japan Purpose: We examined the relationship between walking ability and prognosis in elderly chronic heart failure (CHF) patients. Methods and Results: Consecutive 250 CHF patients with over 75 years who attended cardiac rehabilitation were enrolled. Patients wewre divided into three groups according to walking ability: group 1 (bedridden-standing position, n = 27), group 2 (<200 m walking, n = 100), and group 3 (>200 m walking, n = 123). Patients in group 1 had lower renal function, lower levels of hemoglobin and serum albumin than groups 2 and 3. In Kaplan-Meier analysis, Cumulative survival rate was higher in group 3 than in groups 1 and 2 (Fig.). Walking ability was an independent predictor of all-cause mortality by Cox proportional hazard model. Conclusion: Walking ability is a simple predictor of mortality in elderly CHF patients.
Introduction: Since 2013, our hospital has been working on the DOPPO project, which aims to provide ambulatory discharge for hospitalized frail elderly persons. Until now, 176 patients have taken part in this project. A close correlation between the results of the short physical performance battery (SPPB) and six-minute walking distance (6MWD) at the time of discharge has been confirmed. However, the relationship between the results of these tests and 1-year prognosis is not clear. Thus, we seek to determine a comprehensive factor to predict 1-year prognosis. Patients and Methods: We investigated 120 frail elderly people (male:female ratio, 55:65; average age, 82 years), including heart failure patients, who were eligible for ambulatory discharge. Physical function (SPPB, 10-m walking speed, 6MWD etc) was tested before and after undergoing DOPPO rehabilitation. After one year, the patients were reexamined. Results: Out of 77 patients, we could interview 71. We paid special attention to 37 patients who had performed the 6MWT at discharge. We observed a significant difference in the 1-year prognosis of patients who walked a shorter distance (<200 m) and those who walked a longer distance (>200m). The 1-year survival rates for the shorter and longer distance groups were 75.0% and 96.6%, respectively (P < .05). Conclusion: The 6MWT seems to be a strong predictor of a patient’s 1-year prognosis upon discharge after undergoing DOPPO rehabilitation.
O27-6 Low Appendicular Skeletal Muscle Mass is Associated With Adverse Outcomes in Patients With Acute Decompensated Heart Failure Eiichi Akiyama, Masaaki Konishi, Toshiaki Ebina, Kazuo Kimura; Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan Background: Skeletal muscle plays an important role in pathogenesis of exercise intolerance in patients with chronic heart failure (HF). However, the clinical significance of skeletal muscle mass in patients with acute decompensated HF (ADHF) remains unclear. Methods: We assessed lean body mass by dual energy X-ray absorptiometry in 108 patients with ADHF (age 72 ± 11, left ventricular ejection fraction 37 ± 15%, B-type natriuretic peptide levels on admission 732 [394–1315] pg/ml). Low appendicular skeletal muscle mass index (ASMI, appendicular skeletal muscle mass/ height2) was defined according to the Asia Working Group for Sarcopenia criteria (<7.0 kg/m2 in male, <5.4 kg/m2 in female). ADHF patients were followed until occurring CV events (CV death, nonfatal myocardial infarction, ischemic stroke, unstable angina, HF re-hospitalization, or coronary revascularization). Results: Forty eight patients developed CV events (median follow-up, 17 months). Kaplan-Meier analysis demonstrated a significantly higher probability of CV events in the low ASMI group than those in
O26-5 Implantable Cardioverter Defibrillator and Mortality in the Elderly: A Retrospective Nationwide Study Sho Okada1, Hiroki Matsui2, Hideo Yasunaga2, Kiyohide Fushimi2; 1Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan; 2 Department of Clinical Epidemiology and Health Economics, School of Public Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan Background: Implantable cardioverter-defibrillator (ICD) is established as the firstline therapy in preventing sudden cardiac death among patients with heart failure (HF). However, its effectiveness among aged population is unknown due to rarity. This study aimed to determine whether ICD therapy is beneficial among elderly patients with HF, using a national inpatient database. Methods: Patients aged > = 60 years with or without ICD implantation for HF and fixed left ventricular dysfunction were identified from the Japanese Diagnosis Procedure Combination database between July 2010 and March 2014. Propensity score matching analysis was performed to compare mortality during the observed period between patients with and without ICD. Cox regression analysis was performed to calculate the hazard ratio of survival for the ICD group compared with the non-ICD group. Results: Eligible patients included those with ICD (n = 2,883) and without ICD (n = 102,512). Propensity score matching generated 2403 pairs with well-balanced patient backgrounds. There was almost equal mortality between the two groups (ICD group: 37 cases; non-ICD group: 38 cases). In the cox regression model, hazard ratio for the ICD group was 0.80 (95% CI, 0.51–1.26). Conclusion: The present study did not show the association between ICD therapy and reduced mortality among patients aged > = 60 with nonischemic HF.
O27-3 Impact of Delirium on Postoperative Frailty and Long Term Cardiovascular Events After Cardiac Surgery Masato Ogawa1,2, Kazuhiro Izawa2, Seimi Kobayashi3, Yasunori Tsuboi1,3, Kodai Komaki1, Yasuko Gotake4, Hiroshi Tanaka4, Ken-Ichi Hirata3, Yoshitada Sakai1, Yutaka Okita4; 1Division of Rehabilitation Medicine, Kobe University Hospital, Kobe, Japan; 2 Department of International Health, Graduate School of Health Sciences, Kobe University, Kobe, Japan; 3Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan; 4Division of Cardiovascular Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan Background: Postoperative delirium (POD) is a transient mental syndromes whose development is associated with high risk of mortality and long-term cognitive impairment. However, the contributing effect of POD to adverse long-term outcomes is unclear. This study aimed to assess the incidence of POD and its effect on clinical, functional, and long-term outcomes in patients who underwent cardiac surgery. Methods: We studied 233 consecutive patients who underwent cardiac surgery from December 2013 to June 2015. The assessment of delirium was conducted using the Intensive Care Delirium Screening Checklist. Postoperative functional decline was diagnosed with frailty criteria assessed by handgrip strength and gait speed. The primary composite endpoint was major adverse cardiac events (MACE) after cardiac surgery. Results: POD has developed in 37(15.9%) patients. The ratio of patients with frailty in the POD group was higher than that in the non-POD group (54.1% vs. 23.1%, P < .0001). After adjustment for potential cofounders, multivariate analysis showed the independent predictors of MACE to be POD (HR, 3.45; 95% CI, 1.62–6.90; P=.01) and postoperative frailty (HR, 3.40; 95% CI, 1.52–7.94; P=.004). Conclusion: POD appeared to be one trigger of the development of postoperative frailty. POD and postoperative frailty were strong predictors of MACE after cardiac surgery. Our results indicate that the risk stratification focused on POD is useful to predict outcomes of patients undergoing cardiac surgery.
O27-5 Six-Minute Walking Distance Test Upon Discharge After Undergoing DOPPO Rehabilitation Determines One-Year Prognosis in Frail Elderly Akifumi Uehara1, Hiroaki Obata1,2, Sho Yamada2, Shiori Kourakata2, Kenji Yamaguchi2, Yuki Izumi2, Hiroshi Watanabe1, Satoru Abe1, Yorio Suzuki1,3, Tohru Izumi1; 1Division of Medicine, Niigataminami Hospital, Niigata, Japan; 2Division of Rehabilitaion, Niigataminami Hospital, Niigata, Japan; 3Division of Orthopedics, Niigataminami Hospital, Niigata, Japan
O27-1 The Walking Ability is a Useful Predictor of Prognosis in Elderly Chronic Heart Failure Patients Yuki Kanno, Takamasa Sato, Tetsuro Yokokawa, Satoshi Suzuki, Masayoshi Oikawa, Akiomi Yoshihisa, Yasuchika Takeishi; Department of Cardiovascular Medicine, Fukushima Medical University, Fukushima, Japan Purpose: We examined the relationship between walking ability and prognosis in elderly chronic heart failure (CHF) patients. Methods and Results: Consecutive 250 CHF patients with over 75 years who attended cardiac rehabilitation were enrolled. Patients wewre divided into three groups according to walking ability: group 1 (bedridden-standing position, n = 27), group 2 (<200 m walking, n = 100), and group 3 (>200 m walking, n = 123). Patients in group 1 had lower renal function, lower levels of hemoglobin and serum albumin than groups 2 and 3. In Kaplan-Meier analysis, Cumulative survival rate was higher in group 3 than in groups 1 and 2 (Fig.). Walking ability was an independent predictor of all-cause mortality by Cox proportional hazard model. Conclusion: Walking ability is a simple predictor of mortality in elderly CHF patients.
Introduction: Since 2013, our hospital has been working on the DOPPO project, which aims to provide ambulatory discharge for hospitalized frail elderly persons. Until now, 176 patients have taken part in this project. A close correlation between the results of the short physical performance battery (SPPB) and six-minute walking distance (6MWD) at the time of discharge has been confirmed. However, the relationship between the results of these tests and 1-year prognosis is not clear. Thus, we seek to determine a comprehensive factor to predict 1-year prognosis. Patients and Methods: We investigated 120 frail elderly people (male:female ratio, 55:65; average age, 82 years), including heart failure patients, who were eligible for ambulatory discharge. Physical function (SPPB, 10-m walking speed, 6MWD etc) was tested before and after undergoing DOPPO rehabilitation. After one year, the patients were reexamined. Results: Out of 77 patients, we could interview 71. We paid special attention to 37 patients who had performed the 6MWT at discharge. We observed a significant difference in the 1-year prognosis of patients who walked a shorter distance (<200 m) and those who walked a longer distance (>200m). The 1-year survival rates for the shorter and longer distance groups were 75.0% and 96.6%, respectively (P < .05). Conclusion: The 6MWT seems to be a strong predictor of a patient’s 1-year prognosis upon discharge after undergoing DOPPO rehabilitation.
O27-6 Low Appendicular Skeletal Muscle Mass is Associated With Adverse Outcomes in Patients With Acute Decompensated Heart Failure Eiichi Akiyama, Masaaki Konishi, Toshiaki Ebina, Kazuo Kimura; Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan Background: Skeletal muscle plays an important role in pathogenesis of exercise intolerance in patients with chronic heart failure (HF). However, the clinical significance of skeletal muscle mass in patients with acute decompensated HF (ADHF) remains unclear. Methods: We assessed lean body mass by dual energy X-ray absorptiometry in 108 patients with ADHF (age 72 ± 11, left ventricular ejection fraction 37 ± 15%, B-type natriuretic peptide levels on admission 732 [394–1315] pg/ml). Low appendicular skeletal muscle mass index (ASMI, appendicular skeletal muscle mass/ height2) was defined according to the Asia Working Group for Sarcopenia criteria (<7.0 kg/m2 in male, <5.4 kg/m2 in female). ADHF patients were followed until occurring CV events (CV death, nonfatal myocardial infarction, ischemic stroke, unstable angina, HF re-hospitalization, or coronary revascularization). Results: Forty eight patients developed CV events (median follow-up, 17 months). Kaplan-Meier analysis demonstrated a significantly higher probability of CV events in the low ASMI group than those in