Comprehensive geriatric assessment identifies multidimensional vulnerabilities in older adults with heart failure

Area of Science:

• Geriatric Medicine
• Cardiology
• Internal Medicine

Background:

• Heart failure (HF) in older adults often co-occurs with geriatric syndromes missed by standard cardiac evaluations.
• Older adults exhibit vulnerabilities in physical, functional, nutritional, cognitive, and mental health domains, particularly those with HF.

Purpose of the Study:

• To investigate geriatric syndromes in older adults with and without heart failure (HF).
• To identify vulnerabilities related to muscle strength, physical performance, functional capacity, frailty, nutrition, cognition, mood, anxiety, polypharmacy, and comorbidity using comprehensive geriatric assessment (CGA).

Main Methods:

• A cross-sectional study involving 420 adults aged ≥60 years (92 with HF) across two academic outpatient clinics.
• Data collection included sociodemographics, anthropometrics, and various CGA parameters (e.g., handgrip strength, FTSST, SPPB, ADL, IADL, FRAIL scale, MNA-SF, Mini-Cog, GDS-SF, GAD-7).
• Univariate and multivariate regression analyses were performed to identify associations.

Main Results:

• HF participants demonstrated slower Five-Times Sit-to-Stand Test (FTSST) and lower Short Physical Performance Battery (SPPB) scores.
• The HF group had significantly lower Instrumental Activities of Daily Living (IADL) scores, indicating higher IADL impairment.
• Prevalence of frailty, malnutrition, cognitive impairment, and polypharmacy was significantly higher in the HF group.
• Independent factors associated with HF included low lower extremity muscle strength, impaired IADL, and higher comorbidity burden.

Conclusions:

• Older adults with HF exhibit significant deficits in functional capacity, frailty, nutrition, and cognition.
• Integrating comprehensive geriatric assessment (CGA) into HF management can uncover unrecognized vulnerabilities.
• CGA supports multidisciplinary care planning for older adults with heart failure.