Domains of senile asthenia syndrome in chronic heart failure: clinical and prognostic significance

Introduction

The aging of the population leads to an increase in the number of patients with chronic heart failure (CHF), who often experience multiple cognitive, social and physical impairments that make up the senile asthenia syndrome. These disorders can significantly affect the clinical course of the disease and the prognosis. However, the prognostic value in patients with CHF, depending on the severity of the domains of senile asthenia (CA), has not been determined.

Aim

To evaluate the prognostic value of CA domains in hospitalized patients with CHF.

Materials and methods

250 patients over 75 years of age who were hospitalized for CHF decompensation were prospectively included, the median age was 83.0 [77.0 86.0] years, 41.6% (n=104) were male. In addition to traditional laboratory and instrumental studies, all patients underwent an assessment of 4 CA domains: clinical (comorbidity, Mini Nutritional Assessment – MNA), cognitive (Montreal Cognitive Assessment – MoSA), social (Makizako social frailty index) and physical (Short Physical Performance Battery – SPPB, Bartel scale).

Results

In the included cohort of patients, preserved left ventricular ejection fraction (LVEF) was the most common — 63.2% (n=158). Moderately reduced LVEF was observed in 17.2% (n=43), and low LVEF was observed in 19.6% (n=49). 95.6% (n=239) of senile patients with HF had at least one domain of senile asthenia, the presence of all four domains was observed in more than a third of patients. Disorders in the psychocognitive and social spheres were the most common – 73.2% (n=183) and 69.6% (n=174), respectively, and clinical and functional domains were less common in 60.8% (n=152) and 61.2% (n=153) of patients, respectively.

A greater number of domains of senile asthenia were associated with a higher incidence of events for the combined endpoint – all-cause death and/or repeated hospitalization for CHF (Log Rank 10.87, p=0.02). In a comprehensive analysis, the presence of all four domains of fragility syndrome increases the risk of combined events from the primary endpoint by 2.9 times (OR 2.9; 95% CI 1.7-5.1, p<0.05), hospital mortality by 10.7 times (OR 10.7; 95% CI 4.7-24.2, p<0.05).

Conclusion

The study found that in patients with CHF, most of the observed CA domains are associated with an increased risk of adverse outcomes. The association with the presence of all four domains of fragility syndrome is particularly pronounced, which increases the risk of mortality and re-hospitalization. These data emphasize the importance of a comprehensive assessment of the condition of senile patients with CHF for timely identification of high risk and optimization of treatment strategy.