Is heart failure associated with disability ?
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Is heart failure associated with disability?
European Academy for Medicine of Ageing, Martigny, January 24th 2013
Marius Myrstad
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Outline of the presentation
• Short review of epidemiological research
• Underlying mechanisms for disability
• Prevention of disability
• Take-home messages
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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..
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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.
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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.
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Major predictors for disability in HF
• Impaired gait speed• Depressive symptoms• Cognitive impairment
Chaudry S. J Card Fail 2011;17(9) :764-70..
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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
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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).
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Other contributing factors
Disability
Social factors
Malnutrition
Medication
Co-morbidity
Psychological factors
Muscle weaknesFatigue
Anemia
Reduced lung capacity
Cognitive impairment
Age-related functional decline
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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.
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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.
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Take-home messages
• HF is independently associated with disability
• Disability can be prevented
• HF patients should practice regular physical exercise
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Thanks for your attention!