Clinical and prognostic significance of domain approach in patients with chronic heart failure and senile asthenia

Aim. To characterize the features of the course of decompensated heart failure in hospitalized elderly patients depending on the domains (clinical, psychocognitive, functional and social), as well as to study the effect of the number of domains on the prognosis. Materials and methods. A prospective study included 150 patients over 75 years old [median age (IQR) 83.0 [77.8–87.0] years, 38% (n = 57) were men] admitted to a multidisciplinary hospital for chronic heart failure (CHF) decompensation, who were assessed for the prevalence of HFA-ESC domains (2019) – clinical, psychocognitive, functional and social. All patients underwent traditional laboratory and instrumental examination, NT-proBNP testing, echocardiographic examination, as well as body composition was assessed using bioimpedance analysis on the 5th day of hospitalization. The combined endpoint was a combination of death from all causes and repeated hospitalizations for CHF within 180 days. Results. 96.7% (n = 145) of senile patients with CHF 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 – 88.7% (n = 133) and 74.0% (n = 111), respectively, and clinical and functional domains were less common in 64.0% (n = 96) and 56.7% (n = 85) of patients, respectively. Patients with a large number of domains were characterized by an older age, a greater degree of physical activity restriction and the severity of CHF symptoms, were more often unmarried (including widowers, single and divorced), and most patients lived in a nursing home. A greater number of domains of senile asthenia was associated with a higher incidence of events for the combined endpoint – all-cause death and/or repeated hospitalization for CHF (Log Rank 10.76; p 0.03). In a comprehensive analysis, the presence of all four domains of fragility syndrome increases the risk of combined events from the primary endpoint by 2.5 times (odds ratio 2.5; 95% confidence interval 1.1–5.7, p 0.05), hospital mortality by 14.7 times (odds ratio 14.7, 95% confidence interval 3.3–66.4; p 0.05). Conclusion. A domain-based approach to determining the severity and prognosis of CHF in "fragile" senile patients seems to be a necessary and convenient tool for identifying a special group of patients at high risk of unfortunate outcome that requires a multidisciplinary approach together with a geriatric team.