Association of Sitting Time With All-Cause and Cardiovascular Mortality: How Does Frailty Modify This Association?

To investigate how frailty modifies the association of sitting time with all-cause and cardiovascular mortality in Chilean adults. This prospective study included 2,604 participants aged ≥35 from the Chilean National Health Survey 2009-2010. Sitting time was self-reported, while frailty was assessed using a 36-item Frailty Index. Sitting time was categorized as low, medium, and high. Cox proportional hazard models were used to estimate the risk of mortality stratified for the sitting time categories. Over a median follow-up of 8.9 years, 311 participants died, 28% of them due to cardiovascular events. Frail people with prolonged sitting time were at higher risk of all-cause and cardiovascular mortality (hazard ratio 3.13; 95% confidence interval [2.06, 4.71] and hazard ratio 2.41; 95% confidence interval [1.50, 3.64], respectively). The observed risk was higher in women than men. Public health and individual strategies should be implemented to decrease sitting time across the population, with special attention on frail people.

[Frailty in patients admitted to hospital with acute decompensated heart failure]. / Factores asociados a fragilidad en pacientes hospitalizados con insuficiencia cardiaca descompensada.

BACKGROUND: Frailty is a geriatric syndrome characterized by a progressive impairment in the subjects’ ability to respond to environmental stress. Frailty is more commonly found in heart failure (HF) patients than in general population and it is an independent predictor of rehospitalization, emergency room visits and death. AIM: To estimate the prevalence of frailty in patients with decompensated HF admitted to four hospitals in Santiago, Chile. MATERIAL AND METHODS: Cross-sectional study. Subjects aged 60 or older consecutively admitted for decompensated HF to the study centers between August 2014 and March 2015 were included. Frailty was defined as the presence of three or more of the following criteria: unintended weight loss, muscular weakness, depression symptoms (exhaustion), reduced gait speed and low physical activity. Independent variables were tested for association using simple logistic regression. Variables associated with frailty (p < 0.05) were included in a multiple logistic regression model. RESULTS: Seventy-nine subjects were included. The prevalence of frailty was 50.6%. Frail patients were mostly female (52.6%) and older than non-frail subjects (73.7± 7.9 vs 68.2 ± 7.1; p < 0.003). Independent predictors of frailty were age (Odds raio (OR) 1.10; 95% confidence intervals (CI): 1.03-1.17), quality of life measured with the Minnesota Living with Heart Failure Questionnaire (OR 1.07; IC95%: 1.03-1.11), previous hospitalizations (OR 2.56; 95%CI: 1.02-6.43) and number of medications (OR 4.46; 95%CI: 1.11-17.32). CONCLUSIONS: The prevalence of frailty in patients admitted to the hospital for decompensated heart failure is high. Age, quality of life, hospitalizations and polypharmacy were factors associated with frailty in this group of participants.

[Prognostic value of noninvasive markers of coronary reperfusion compared to TIMI 3 flow in patients treated with primary angioplasty]. / Valor pronóstico de marcadores no invasivos de reperfusión coronaria frente a flujo TIMI 3 en pacientes tratados con angioplastia primaria.

INTRODUCTION AND OBJECTIVES: The aim of this study was to compare the prognostic value of TIMI 3 flow versus noninvasive markers of coronary artery reperfusion on the outcome of patients with a recent acute myocardial infarction (AMI) treated with primary angioplasty. PATIENTS AND METHOD We analyzed 172 consecutive patients with AMI and ST-segment elevation, who were treated with primary angioplasty within 12 hours of admission. Mean age was 6113 years, 77% were men, and 56% had a history of previous AMI. RESULTS: In-hospital mortality was 3.6%; 16.6% developed heart failure, and 11.1% had complex arrhythmias during their hospital stay. The noninvasive criterion for successful reperfusion was the presence of two or more markers of reperfusion based on ECG changes or CK levels after angioplasty. Reperfusion was successful in 87.7% of the patients, and TIMI 3 flow was achieved in 87%. There was no significant concordance between the two methods (kappa index = 0.012). Multivariate analysis showed that both successful reperfusion (OR=0.028; 95% CI, 0.003-0.268) and TIMI 3 flow (OR=0.104; 95% CI, 0.019-0.563) were protective for in-hospital mortality. However, in the multivariate analysis only successful reperfusion was a protective factor for heart failure and complex arrhythmias. CONCLUSION: Our findings confirm that both TIMI 3 flow and successful coronary reperfusion evaluated noninvasively show independent prognostic value in patients with AMI treated with primary angioplasty. Noninvasive markers of coronary reperfusion should be used as complementary to angiography in these patients.

Factores asociados a fragilidad en pacientes hospitalizados con insuficiencia cardiaca descompensada / Frailty in patients admitted to hospital with acute decompensated heart failure

Background: Frailty is a geriatric syndrome characterized by a progressive impairment in the subjects’ ability to respond to environmental stress. Frailty is more commonly found in heart failure (HF) patients than in general population and it is an independent predictor of rehospitalization, emergency room visits and death. Aim: To estimate the prevalence of frailty in patients with decompensated HF admitted to four hospitals in Santiago, Chile. Material and Methods: Cross-sectional study. Subjects aged 60 or older consecutively admitted for decompensated HF to the study centers between August 2014 and March 2015 were included. Frailty was defined as the presence of three or more of the following criteria: unintended weight loss, muscular weakness, depression symptoms (exhaustion), reduced gait speed and low physical activity. Independent variables were tested for association using simple logistic regression. Variables associated with frailty (p < 0.05) were included in a multiple logistic regression model. Results: Seventy-nine subjects were included. The prevalence of frailty was 50.6%. Frail patients were mostly female (52.6%) and older than non-frail subjects (73.7± 7.9 vs 68.2 ± 7.1; p < 0.003). Independent predictors of frailty were age (Odds raio (OR) 1.10; 95% confidence intervals (CI): 1.03-1.17), quality of life measured with the Minnesota Living with Heart Failure Questionnaire (OR 1.07; IC95%: 1.03-1.11), previous hospitalizations (OR 2.56; 95%CI: 1.02-6.43) and number of medications (OR 4.46; 95%CI: 1.11-17.32). Conclusions: The prevalence of frailty in patients admitted to the hospital for decompensated heart failure is high. Age, quality of life, hospitalizations and polypharmacy were factors associated with frailty in this group of participants.

Valor pronóstico de marcadores no invasivos de reperfusión coronaria frente a flujo TIMI 3 en pacientes tratados con angioplastia primaria / Prognostic value of noninvasive markers of coronary reperfusion compared to TIMI 3 flow in patients treated with primary angioplasty

Introducción y objetivos. La angioplastia primaria ha resultado ser el tratamiento más eficaz para pacientes con infarto agudo de miocardio (IAM). Tanto la obtención de un flujo coronario óptimo, grado TIMI 3, como la asociación de indicadores no invasivos de reperfusión coronaria han demostrado ser métodos útiles para predecir el pronóstico inmediato y a medio plazo de pacientes con IAM tratados con trombólisis o angioplastia primaria. El objetivo es comparar el valor pronóstico del flujo TIMI 3 con la asociación de indicadores no invasivos de reperfusión coronaria (disminución del supradesnivel del segmento ST > 50 por ciento a los 90 min, inversión de la onda T dentro de las 24 h y elevación máxima de la creatincinasa [CK] 70 por ciento, valor máximo de CK) demostró que tanto la reperfusión exitosa como el flujo TIMI 3 resultaron ser protectores frente a la mortalidad intrahospitalaria (odds ratio [OR] = 0,028; intervalo de confianza [IC] del 95 por ciento, 0,003-0,268, y OR = 0,104; IC del 95 por ciento, 0,019-0,563, respectivamente). Sin embargo, sólo la reperfusión exitosa resultó ser protectora frente a la insuficiencia cardíaca y las arritmias complejas en la evolución intrahospitalaria y en la mortalidad a medio plazo al ajustar por ambos criterios en el análisis multivariado. Conclusión. Se confirma que tanto el flujo TIMI 3 como la reperfusión coronaria exitosa evaluada a través de indicadores no invasivos tienen un valor pronóstico independiente en pacientes con IAM tratados con angioplastia primaria. Sin embargo, la reperfusión coronaria exitosa resultó ser un indicador de pronóstico independiente para la mortalidad intrahospitalaria y a medio plazo, el desarrollo de insuficiencia cardíaca y arritmias complejas. Los indicadores no invasivos de reperfusión coronaria debieran emplearse en forma complementaria a la angiografía en estos pacientes (AU)