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Physical functional performance and prognosis in patients with heart failure: a systematic review and meta-analysis.

ABSTRACT: Background: Patients with Heart Failure (HF) show impaired functional capacities which have been related to their prognosis. Moreover, physical functional performance in functional tests has also been related to the prognosis in patients with HF. Thus, it would be useful to investigate how physical functional performance in functional tests could determine the prognosis in patients with HF, because HF is the leading cause of hospital admissions for people older than 65?years old. This systematic review and meta-analysis aims to summarise and synthesise the evidence published about the relationship between physical functional performance and prognosis in patients with HF, as well as assess the risk of bias of included studies and the level of evidence per outcome.

Methods: Major electronic databases, such as PubMed, AMED, CINAHL, EMBASE, PEDro, Web of Science, were searched from inception to March 2020 for observational longitudinal cohort studies (prospective or retrospective) examining the relationship between physical functional performance and prognosis in patients with HF.

Results: 44 observational longitudinal cohort studies with a total of 22,598 patients with HF were included. 26 included studies reported a low risk of bias, and 17 included studies showed a moderate risk of bias. Patients with poor physical functional performance in the Six Minute Walking Test (6MWT), in the Short Physical Performance Battery (SPPB) and in the Gait Speed Test showed worse prognosis in terms of larger risk of hospitalisation or mortality than patients with good physical functional performance. However, there was a lack of homogeneity regarding which cut-off points should be used to stratify patients with poor physical functional performance from patients with good physical functional performance.

Conclusion: The review includes a large number of studies which show a strong relationship between physical functional performance and prognosis in patients with HF. Most of the included studies reported a low risk of bias, and GRADE criteria showed a low and a moderate level of evidence per outcome.

SUBMITTER: Fuentes-Abolafio IJ

PROVIDER: S-EPMC7724724 | biostudies-literature | 2020 Dec

REPOSITORIES: biostudies-literature

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Physical functional performance and prognosis in patients with heart failure: a systematic review and meta-analysis.

Fuentes-Abolafio Iván José IJ Stubbs Brendon B Pérez-Belmonte Luis Miguel LM Bernal-López María Rosa MR Gómez-Huelgas Ricardo R Cuesta-Vargas Antonio Ignacio AI

BMC cardiovascular disorders 20201209 1

<h4>Background</h4>Patients with Heart Failure (HF) show impaired functional capacities which have been related to their prognosis. Moreover, physical functional performance in functional tests has also been related to the prognosis in patients with HF. Thus, it would be useful to investigate how physical functional performance in functional tests could determine the prognosis in patients with HF, because HF is the leading cause of hospital admissions for people older than 65 years old. This sys ...[more]

PMID: 33297975

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Project description:Background: Heart failure with improved ejection fraction (HFimpEF) is classified as a new type of heart failure, and its prevalence and prognosis are not consistent in previous studies. There is no systematic review and meta-analysis regarding the prevalence and prognosis of the HFimpEF. Method: A systematic search was performed in MEDLINE, EMBASE, and Cochrane Library from inception to May 22, 2021 (PROSPERO registration: CRD42021260422). Studies were included for analysis if the prognosis of mortality or hospitalization were reported in HFimpEF or in patients with heart failure with recovered ejection fraction (HFrecEF). The primary outcome was all-cause mortality. Cardiac hospitalization, all-cause hospitalization, and composite events of mortality and hospitalization were considered as secondary outcomes. Result: Nine studies consisting of 9,491 heart failure patients were eventually included. During an average follow-up of 3.8 years, the pooled prevalence of HFimpEF was 22.64%. HFimpEF had a lower risk of mortality compared with heart failure patients with reduced ejection fraction (HFrEF) (adjusted HR: 0.44, 95% CI: 0.33-0.60). HFimpEF was also associated with a lower risk of cardiac hospitalization (HR: 0.40, 95% CI: 0.20-0.82) and the composite endpoint of mortality and hospitalization (HR: 0.56, 95% CI: 0.44-0.73). Compared with patients with preserved ejection fraction (HFpEF), HFimpEF was associated with a moderately lower risk of mortality (HR: 0.42, 95% CI: 0.32-0.55) and hospitalization (HR: 0.73, 95% CI: 0.58-0.92). Conclusion: Around 22.64% of patients with HFrEF would be treated to become HFimpEF, who would then obtain a 56% decrease in mortality risk. Meanwhile, HFimpEF is associated with lower heart failure hospitalization. Further studies are required to explore how to promote left ventricular ejection fraction improvement and improve the prognosis of persistent HFrEF in patients. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021260422, identifier: CRD42021260422.

Project description:BackgroundThe purpose of this study was to explore the impact of transitional care interventions on the prognosis of patients with heart failure.MethodsLiterature on transitional care interventions in patients with heart failure were retrieved from PubMed, Medline, Embase, and CENTRAL databases. The literature retrieval date was October 12, 2021. The inclusion criteria were based on PICOS principles. A researcher independently extracted information from the literature included in the meta-analysis, including author, title, publication date, patient baseline information, intervention measures, and observation indicators. Two other researchers checked the extracted data. Cochrane bias risk assessment was used to evaluate the quality of the included study. The chi-square test was used for heterogeneity test. Egger test was used for publication bias test. Data were statistically analyzed using Cochrane software RevMan 5.3. The Chi-square test was used to assess heterogeneity. The odds ratio (OR) and 95% confidence interval (CI) were used to describe the count data statistically.ResultsA total of 567 related articles were retrieved, and 18 studies were further screened for meta-analysis, 13 with low risk of overall bias, and 5 with high risk of overall bias. A total of 4,123 patients with heart failure were included, comprising 1,914 patients receiving transitional care interventions (46.42%) and 2,209 patients receiving routine care interventions (53.58%). The readmission rate of heart failure in patients receiving transitional care interventions was lower than that of patients receiving routine care interventions. There was heterogeneity among the literatures, and the source analysis of heterogeneity showed that the results were stable, and the random effect model was adopted without publication bias. The emergency visit rate of patients with heart failure receiving transitional care interventions was lower than that of patients receiving usual care interventions. There was no significant difference in mortality between patients receiving transitional care interventions and patients receiving usual care interventions.DiscussionTransitional care interventions can reduce the rate of patient readmission and emergency visits but have no significant impact on the mortality of patients. This study suggests the establishment of a transitional care intervention system for patients with heart failure.

Project description:AimsSarcopenia has been found to be frequently associated with co-morbidity among patients with heart failure (HF). However, there remain insufficient data to accurately estimate the global prevalence of sarcopenia in HF. Therefore, the purpose of this research was to conduct a systematic review and meta-analysis to estimate the current overall prevalence of sarcopenia in patients with HF.Methods and resultsWe searched relevant databases for studies published up to 13 July 2020, assessing sarcopenia in vpatients with HF. After careful screening, data of included articles were extracted with a predesigned Excel form. Then the pooled prevalence of sarcopenia in patients with HF was calculated using the random-effects model. The Q test was used to assess the heterogeneity, and I2 statistic was calculated to quantify and evaluate the heterogeneity. Subgroup analyses were conducted to determine potential sources of heterogeneity. A total of 2852 articles were initially identified, and after removing duplicate publications and applying the selection criteria, we reviewed 79 full-text articles. Finally, 11 articles (n = 1742 patients with HF) were included in this systematic review and meta-analysis. The pooled prevalence of sarcopenia in patients with HF was 34% [95% confidence interval (CI): 22-47%, I2 = 96.59%] and ranged from 10% to 69%. However, substantial heterogeneity between studies (I2 = 96.59%, P < 0.001) was observed. There was no significant heterogeneity between subgroups by sex (P = 0.803) or the method used to define sarcopenia (P = 0.307). While the heterogeneity between subgroups by population setting was statistically significant (P < 0.001), the pooled prevalence of sarcopenia was 55% (95% CI: 43-66%) for hospitalized patients with HF and 26% (95% CI: 16-37%) for ambulatory patients.ConclusionsSarcopenia was a common condition in patients with HF, and the prevalence of hospitalized patients was higher than for ambulatory patients. Early detection of sarcopenia was therefore important in patients with HF, and it was important to implement interventions so that physical therapists or managerial dieticians can easily be introduced into clinical practice.

Dataset Information

Physical functional performance and prognosis in patients with heart failure: a systematic review and meta-analysis.

Publications

Physical functional performance and prognosis in patients with heart failure: a systematic review and meta-analysis.

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