https://doi.org/10.4081/monaldi.2022.2447
Frailty and rehabilitation outcome in older patients with cardiorespiratory disease: preliminary multidimensional data
Submitted: October 3, 2022
Accepted: November 28, 2022
Published: December 1, 2022
Accepted: November 28, 2022
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All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
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Chronic heart failure (CHF) and chronic obstructive pulmonary disease (COPD) are two clinical conditions often associated with cognitive dysfunctions, psychological distress, poor quality of life (QoL), and functional worsening. In addition, since patients suffering from these conditions are often older adults, frailty syndrome represents a further and important issue to be investigated. The present preliminary study aimed to perform a multidimensional assessment of CHF and/or COPD older patients (age ≥65) undergoing cardiac or pulmonary rehabilitation. The characteristics of the included patients (30 CHF and 30 COPD) resulted almost similar, except for the COPD patients’ longer duration of illness and better performances in Addenbrooke’s cognitive examination III subtests and short physical performance battery (SPPB). No significant differences were found in the frailty evaluation, but a consistent number of patients resulted to be frail (CHF=36.7% vs COPD=26.6%). After the rehabilitation program, a significant improvement was found in the whole sample concerning the executive functions (14.34±2.49 vs 15.62±2.22, p=0.001), quality of life (58.77±18.87 vs 65.82±18.45, p=0.003), depressive and anxious symptoms (6.27±4.21 vs 3.77±3.39, p=0.001 and 5.17±3.40 vs 3.38±3.21, p=0.001), frailty status [4.00 (3.00,5.00) vs 3.00 (3.00,5.00) p=0.035] and functional exercise abilities [SPPB, 7.40±3.10 vs 9.51±3.67, p=0.0002; timed up and go test, 14.62±4.90 vs 11.97±4.51, p<0.0001; 6-minute walking test, 353.85±127.62 vs 392.59±123.14, p=0.0002]. Preliminary results showed a substantial homogeneity of CHF and COPD older patients’ cognitive, psychosocial, frailty, and functional characteristics. Nevertheless, the specific rehabilitation intervention appears promising in both clinical populations. This trial has been registered with the ClinicalTrials.gov, NCT05230927 registration number (clinicaltrials.gov/ct2/show/NCT05230927).
GOLD. Global Strategy for Prevention, Diagnosis and Management of COPD. 2022. Available from: https://goldcopd.org/2022-gold-reports/
McDonagh TA, Metra M, Adamo M, et al. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J 2021;42:3599-26.
DOI: https://doi.org/10.1093/eurheartj/ehab670
Singh D, Agusti A, Anzueto A, et al. Global Strategy for the diagnosis, management, and prevention of chronic obstructive lung disease: the GOLD science committee report 2019. Eur Respir J 2019;53:1900164.
DOI: https://doi.org/10.1183/13993003.00164-2019
Ostojić J, Pintarić H. Chronic obstructive pulmonary disease and heart failure: Closer than close. Acta Clin Croat 2017;56:269–76.
DOI: https://doi.org/10.20471/acc.2017.56.02.10
Cannon JA, Moffitt P, Perez-Moreno AC, et al. Cognitive impairment and heart failure: Systematic review and meta-analysis. J Card Fail 2017;23:464–75.
DOI: https://doi.org/10.1016/j.cardfail.2017.04.007
Cameron J, Gallagher R, Pressler SJ. Detecting and managing cognitive impairment to improve engagement in heart failure self-care. Curr Heart Fail Rep 2017;14:13–22.
DOI: https://doi.org/10.1007/s11897-017-0317-0
Kakkera K, Padala KP, Kodali M, Padala PR. Association of chronic obstructive pulmonary disease with mild cognitive impairment and dementia. Curr Opin Pulm Med 2018;24:173–8.
DOI: https://doi.org/10.1097/MCP.0000000000000458
Millán-Calenti JC, Maseda A, Rochette S, et al. Mental and psychological conditions, medical comorbidity and functional limitation: differential associations in older adults with cognitive impairment, depressive symptoms and co-existence of both. Int J Geriatr Psychiatry 2011;26:1071–9.
DOI: https://doi.org/10.1002/gps.2646
Pierobon A, Granata N, Torlaschi V, et al. Psychomotor speed as a predictor of functional status in older chronic heart failure (CHF) patients attending cardiac rehabilitation. PLoS One 2020;15:e0235570.
DOI: https://doi.org/10.1371/journal.pone.0235570
Ilari S, Russo P, Proietti S, et al. DNA damage in dementia: Evidence from patients affected by severe chronic obstructive pulmonary disease (COPD) and meta-analysis of most recent literature. Mutat Res Toxicol Environ Mutagen 2022;878:503499.
DOI: https://doi.org/10.1016/j.mrgentox.2022.503499
Moradi M, Daneshi F, Behzadmehr R, et al. Quality of life of chronic heart failure patients: a systematic review and meta-analysis. Heart Fail Rev 2020;25:993-1006.
DOI: https://doi.org/10.1007/s10741-019-09890-2
Kharbanda S, Anand R. Health-related quality of life in patients with chronic obstructive pulmonary disease: A hospital-based study. Indian J Med Res 2021;153:459–64.
DOI: https://doi.org/10.4103/ijmr.IJMR_1812_18
Marcolongo F, Scarlata S, Tomino C, et al. Psycho-cognitive assessment and quality of life in older adults with chronic obstructive pulmonary disease-carrying the rs4713916 gene polymorphism (G/A) of gene FKBP5 and response to pulmonary rehabilitation: a proof of concept study. Psychiatr Genet 2022;32:116–24.
DOI: https://doi.org/10.1097/YPG.0000000000000308
Sommaruga M, Angelino E, Della Porta P, et al. Best practice in psychological activities in cardiovascular prevention and rehabilitation: Position Paper. Monaldi Arch Chest Dis 2018;88:966.
DOI: https://doi.org/10.4081/monaldi.2018.966
Fattirolli F, Bettinardi O, Angelino E, et al. What constitutes the ‘Minimal Care’ interventions of the nurse, physiotherapist, dietician and psychologist in Cardiovascular Rehabilitation and secondary prevention: A position paper from the Italian Association for Cardiovascular Prevention, Rehabilitat. Eur J Prev Cardiol 2018;25:1799–810.
DOI: https://doi.org/10.1177/2047487318789497
Pierobon A, Sini Bottelli E, Ranzini L, et al. COPD patients’ self-reported adherence, psychosocial factors and mild cognitive impairment in pulmonary rehabilitation. Int J Chron Obstruct Pulmon Dis 2017;12:2059–67.
DOI: https://doi.org/10.2147/COPD.S133586
Xue Q-L. The frailty syndrome: Definition and natural history. Clin Geriatr Med 2011;27:1-15.
DOI: https://doi.org/10.1016/j.cger.2010.08.009
Fried LP, Ferrucci L, Darer J, et al. Untangling the concepts of disability, frailty, and comorbidity: implications for improved targeting and care. J Gerontol A Biol Sci Med Sci 2004;59:255–63.
DOI: https://doi.org/10.1093/gerona/59.3.M255
Gobbens RJJ, Luijkx KG, Wijnen-Sponselee MT, Schols JMGA. In search of an integral conceptual definition of frailty: opinions of experts. J Am Med Dir Assoc 2010;11:338–43.
DOI: https://doi.org/10.1016/j.jamda.2009.09.015
Rockwood K, Song X, MacKnight C, et al. A global clinical measure of fitness and frailty in elderly people. CMAJ 2005;173:489–95.
DOI: https://doi.org/10.1503/cmaj.050051
McCarthy B, Casey D, Devane D, et al. Pulmonary rehabilitation for chronic obstructive pulmonary disease. Cochrane Database Syst Rev 2015;(29)CD003793.
DOI: https://doi.org/10.1002/14651858.CD003793.pub3
Abete P, Basile C, Bulli G, et al. The Italian version of the “frailty index” based on deficits in health: a validation study. Aging Clin Exp Res 2017;29:913–26.
DOI: https://doi.org/10.1007/s40520-017-0793-9
Strini V, Schiavolin R. [Assessment instruments for frail elders: a literature review].[Article in Italian]. Assist Inferm Ric 2019;38:87–98.
Pandey A, Kitzman D, Whellan DJ, et al. Frailty Among older decompensated heart failure patients: Prevalence, association with patient-centered outcomes, and efficient detection methods. JACC Hear Fail 2019;7:1079–88.
DOI: https://doi.org/10.1016/j.jchf.2019.10.003
Maddocks M, Kon SSC, Canavan JL, et al. Physical frailty and pulmonary rehabilitation in COPD: A prospective cohort study. Thorax 2016;71:988–95.
DOI: https://doi.org/10.1136/thoraxjnl-2016-208460
Vigorito C, Abreu A, Ambrosetti M, et al. Frailty and cardiac rehabilitation: A call to action from the EAPC Cardiac Rehabilitation Section. Eur J Prev Cardiol 2017;24:577–90.
DOI: https://doi.org/10.1177/2047487316682579
Magni E, Binetti G, Bianchetti A, et al. Mini-mental state examination: a normative study in Italian elderly population. Eur J Neurol 1996;3:198–202.
DOI: https://doi.org/10.1111/j.1468-1331.1996.tb00423.x
Pigliautile M, Chiesi F, Stablum F, et al. Italian version and normative data of Addenbrooke’s Cognitive Examination III. Int Psychogeriatr 2019;31:241-9.
DOI: https://doi.org/10.1017/S104161021800073X
Appollonio I, Leone M, Isella V, et al. The frontal assessment battery (FAB): normative values in an Italian population sample. Neurol Sci 2005;26:108–16.
DOI: https://doi.org/10.1007/s10072-005-0443-4
EuroQol [Internet]. EQ-5D. Accessed: 2021 Aug 24. Available from: https://euroqol.org/
Spitzer RL, Kroenke K, Williams JBW, Löwe B. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med 2006;166:1092–7.
DOI: https://doi.org/10.1001/archinte.166.10.1092
Pfizer [Internet]. Patient Health Questionnaire (PHQ) screeners. Accessed: 2022 Nov 25. Available from: https://www.phqscreeners.com/
Spitzer RL, Kroenke K, Williams JBW. Validation and utility of a self-report version of PRIME-MD: the PHQ primary care study. Primary care evaluation of mental disorders. Patient Health Questionnaire. JAMA 1999;282:1737–44.
DOI: https://doi.org/10.1001/jama.282.18.1737
Rizzo R, Piccinelli M, Mazzi MA, et al. The Personal Health Questionnaire: a new screening instrument for detection of ICD-10 depressive disorders in primary care. Psychol Med 2000;30:831–40.
DOI: https://doi.org/10.1017/S0033291799002512
Guralnik JM, Simonsick EM, Ferrucci L, et al. A short physical performance battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission. J Gerontol 1994;49:M85–94.
DOI: https://doi.org/10.1093/geronj/49.2.M85
Perracini MR, Mello M, de Oliveira MR, et al. Diagnostic accuracy of the short physical performance battery for detecting frailty in older people. Phys Ther 2020;100:90-8.
DOI: https://doi.org/10.1093/ptj/pzz154
Podsiadlo D, Richardson S. The timed “up & go”: A test of basic functional mobility for frail elderly persons. J Am Geriatr Soc 1991;39:142–8.
DOI: https://doi.org/10.1111/j.1532-5415.1991.tb01616.x
ATS Committee on Proficiency Standards for Clinical Pulmonary Function Laboratories. ATS statement: guidelines for the six-minute walk test. Am J Respir Crit Care Med 2002;166:111–7. Erratum in: Erratum: ATS Statement: Guidelines for the Six-Minute Walk Test. Am J Respir Crit Care Med 2016;193:1185.
DOI: https://doi.org/10.1164/ajrccm.166.1.at1102
Vigorè M, Granata N, Braga SS, et al. Cognitive impairment, frailty and rehabilitation outcome in older cardiorespiratory patients. DEC_FRAinRIAB: Study protocol. PLoS One 2022;17:e0272132.
DOI: https://doi.org/10.1371/journal.pone.0272132
Piepoli MF, Hoes AW, Agewall S, et al. 2016 European Guidelines on cardiovascular disease prevention in clinical practice: The Sixth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of 10 societies and by invited experts)Developed with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation (EACPR). Eur Heart J 2016;37:2315–81.
DOI: https://doi.org/10.1093/eurheartj/ehw106
Wang Z, Hu X, Dai Q. Is it possible to reverse frailty in patients with chronic obstructive pulmonary disease? Clinics (Sao Paulo) 2020;75:e1778.
DOI: https://doi.org/10.6061/clinics/2020/e1778
Fattirolli F, Pratesi A. Cardiovascular prevention and rehabilitation in the elderly: evidence for cardiac rehabilitation after myocardial infarction or chronic heart failure. Monaldi Arch Chest Dis 2016;84:731.
DOI: https://doi.org/10.4081/monaldi.2015.731
Guan C, Niu H. Frailty assessment in older adults with chronic obstructive respiratory diseases. Clin Interv Aging 2018;13:1513–24.
DOI: https://doi.org/10.2147/CIA.S173239
Ziaeian B, Fonarow GC. Epidemiology and aetiology of heart failure. Nat Rev Cardiol 2016;13:368–78.
DOI: https://doi.org/10.1038/nrcardio.2016.25
Savarese G, Lund LH. Global public health burden of heart failure. Card Fail Rev 2017;3:7–11.
DOI: https://doi.org/10.15420/cfr.2016:25:2
Ntritsos G, Franek J, Belbasis L, et al. Gender-specific estimates of COPD prevalence: a systematic review and meta-analysis. Int J Chron Obstruct Pulmon Dis 2018;13:1507–14.
DOI: https://doi.org/10.2147/COPD.S146390
Iribarren ME, Pérez TA, Gómez Punter RM, et al. Smoking habit in COPD patients. Eur Respir J 2019;54:PA4488.
Vitacca M, Paneroni M. Rehabilitation of patients with coexisting COPD and heart failure. COPD. England; 2018;15:231–7.
DOI: https://doi.org/10.1080/15412555.2018.1468427
Neder JA, Rocha A, Berton DC, O’Donnell DE. Clinical and physiologic implications of negative cardiopulmonary interactions in coexisting chronic obstructive pulmonary disease-heart failure. Clin Chest Med 2019;40:421–38.
DOI: https://doi.org/10.1016/j.ccm.2019.02.006
Yohannes AM, Chen W, et al. Cognitive impairment in chronic obstructive pulmonary disease and chronic heart failure: A systematic review and meta-analysis of observational studies. J Am Med Dir Assoc 2017;18:451.e1-451.e11.
DOI: https://doi.org/10.1016/j.jamda.2017.01.014
Langa KM, Levine DA. The diagnosis and management of mild cognitive impairment: a clinical review. JAMA 2014;312:2551–61.
DOI: https://doi.org/10.1001/jama.2014.13806
Ranzini L, Schiavi M, Pierobon A, et al. From mild cognitive impairment (MCI) to Dementia in chronic obstructive pulmonary disease. Implications for clinical practice and disease management: A mini-review. Front Psychol 2020;11:337.
DOI: https://doi.org/10.3389/fpsyg.2020.00337
Denfeld QE, Winters-Stone K, Mudd JO, et al. The prevalence of frailty in heart failure: A systematic review and meta-analysis. Int J Cardiol 2017;236:283–9.
DOI: https://doi.org/10.1016/j.ijcard.2017.01.153
Marengoni A, Vetrano DL, Manes-Gravina E, et al. The relationship between COPD and frailty: A systematic review and meta-analysis of observational studies. Chest 2018;154:21-40.
DOI: https://doi.org/10.1016/j.chest.2018.02.014
Mohan D, Benson VS, Allinder M, et al. Short physical performance battery: What does each sub-test measure in patients with chronic obstructive pulmonary disease? Chronic Obstr Pulm Dis 2020;7:13–25.
DOI: https://doi.org/10.15326/jcopdf.7.1.2019.0144
Zaharias E, Cataldo J, Mackin L, Howie-Esquivel J. Simple measures of function and symptoms in hospitalized heart failure patients predict short-term cardiac event-free survival. Nurs Res Pract 2014;2014:815984.
DOI: https://doi.org/10.1155/2014/815984
Alosco ML, Spitznagel MB, Cohen R, et al. Cardiac rehabilitation is associated with lasting improvements in cognitive function in older adults with heart failure. Acta Cardiol 2014;69:407-14.
DOI: https://doi.org/10.1080/AC.69.4.3036657
Blervaque L, Préfaut C, Forthin H, et al. Efficacy of a long-term pulmonary rehabilitation maintenance program for COPD patients in a real-life setting: a 5-year cohort study. Respir Res 2021;22:79.
DOI: https://doi.org/10.1186/s12931-021-01674-3
Deley G, Culas C, Blonde M-C, et al. Physical and psychological effectiveness of cardiac rehabilitation: Age is not a limiting factor! Can J Cardiol 2019;35:1353–8.
DOI: https://doi.org/10.1016/j.cjca.2019.05.038
Dong J, Li Z, Luo L, Xie H. Efficacy of pulmonary rehabilitation in improving the quality of life for patients with chronic obstructive pulmonary disease: Evidence based on nineteen randomized controlled trials. Int J Surg 2020;73:78–86.
DOI: https://doi.org/10.1016/j.ijsu.2019.11.033
Kim M, Cho C, Lee C, Kohzuki M. Effects of cardiac rehabilitation on executive function in sedentary older adults. Asian J Hum Serv. 2016;11:98–110.
DOI: https://doi.org/10.14391/ajhs.11.98
Fonteles Ritt L, Matos e Oliveira F, Santos Pereira Ramos JV, et al. Impact of a cardiovascular rehabilitation program on frailty indicators in elderly patients with heart disease. Eur J Prev Cardiol 2021;28:zwab061.037.
DOI: https://doi.org/10.1093/eurjpc/zwab061.037
Taylor RS, Walker S, Ciani O, et al. Exercise-based cardiac rehabilitation for chronic heart failure: the EXTRAMATCH II individual participant data meta-analysis. Health Technol Assess 2019;23:1–98.
DOI: https://doi.org/10.3310/hta23250
Yohannes AM, Dryden S, Casaburi R, Hanania NA. Long-term benefits of pulmonary rehabilitation in patients with COPD: A 2-year follow-up study. Chest 2021;159:967–74.
DOI: https://doi.org/10.1016/j.chest.2020.10.032
Park MO, Oh HS, Seo WS. Effects of a cognitive rehabilitation programme on cognitive function, self-management and quality of life in patients with chronic obstructive pulmonary disease. Int J Nurs Pract 2021;27:e12932.
DOI: https://doi.org/10.1111/ijn.12932
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Italian National funding (5x1000)How to Cite
Vigorè, Martina, Nicolo Granata, Giovanna Callegari, Raffaella Vaninetti, Simona Conti, Roberto Maestri, Giancarlo Piaggi, Gioele Cremonese, and Antonia Pierobon. 2022. “Frailty and Rehabilitation Outcome in Older Patients With Cardiorespiratory Disease: Preliminary Multidimensional Data”. Monaldi Archives for Chest Disease 93 (4). https://doi.org/10.4081/monaldi.2022.2447.
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