is heart failure associated with disability ?

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

Thanks for your attention!