Frailty and Cognitive Function in Middle-Aged and Older Adults With Congenital Heart Disease

Daelman B 1 , Van Bulck L 2 , Luyckx K 3 , Kovacs AH 4 , Van De Bruaene A 5 , Ladouceur M 6 Show all authors , Yang HL 7 , Moon JR 8 , Schmidt A 9 , Lykkeberg B 10 , Callus E 11 , de Hosson M 12 , Sandberg C 13 , Johansson B 14 , Hlebowicz J 15 , Areias ME 16 , Amedro P 17 , Coats L 18 , Mandalenakis Z 19 , Kaneva A 20 , Moons P 21 , Goossens E 22 , APPROACH-IS II consortium , International Society for Adult Congenital Heart Disease

Affiliations 

  • 1 KU Leuven Department of Public Health and Primary Care, KU Leuven-University of Leuven, Leuven, Belgium
  • 2 KU Leuven Department of Public Health and Primary Care, KU Leuven-University of Leuven, Leuven, Belgium; Research Foundation Flanders, Brussels, Belgium. Electronic address: https://twitter.com/BulckLiesbet
  • 3 School Psychology and Development in Context, KU Leuven-University of Leuven, Leuven, Belgium; Unit for Professional Training and Service in the Behavioural Sciences, University of the Free State, Bloemfontein, South Africa
  • 4 Equilibria Psychological Health, Toronto, Ontario, Canada. Electronic address: https://twitter.com/AdrienneK_PhD
  • 5 Division of Congenital and Structural Cardiology, University Hospitals Leuven, Leuven, Belgium. Electronic address: https://twitter.com/alexvdbruaene
  • 6 Centre de recherche Cardiovasculaire de Paris, INSERM U970, Adult Congenital Heart Disease Medico-Surgical Unit, European Georges Pompidou Hospital, Paris, France. Electronic address: https://twitter.com/Mag_Ladouceur
  • 7 School of Nursing, College of Medicine, National Taiwan University, Taipei, Taiwan
  • 8 Department of Nursing, Cardiac Center, Heart Vascular Stroke Institute, Samsung Medical Center, Seoul, South Korea
  • 9 Adult Congenital Heart Disease Unit, Hospital das Clínicas, Facultdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, São Paulo, Brazil
  • 10 The Cardiology Clinic, the Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
  • 11 Clinical Psychology Service, Istituto di Ricovero e Cura a Carattere Scientifico, Policlinico San Donato, Milan, Italy; Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
  • 12 Department of Adult Congenital Heart Disease Ghent, Ghent University Hospital, Ghent, Belgium
  • 13 Department of Surgery and Perioperative Sciences, Umeå University, Umeå, Sweden; Department of Community Medicine and Rehabilitation, Umeå University, Umeå, Sweden
  • 14 Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
  • 15 Department of Cardiology, Clinical Sciences, Lund University, Skåne University Hospital, Lund, Sweden. Electronic address: https://twitter.com/JoannaHlebowicz
  • 16 UnIC@RISE, Faculty of Medicine, University of Porto, Porto, Portugal
  • 17 University of Bordeaux, Liryc Institute, Hôpital cardiologique Haut-Leveque, Bordeaux, France; Paediatric and Congenital Cardiology Department, M3C Regional Reference Centre, Montpellier University Hospital, Montpellier, France. Electronic address: https://twitter.com/Pascal_Amedro
  • 18 Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom. Electronic address: https://twitter.com/LouiseCoats7
  • 19 Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
  • 20 Pediatric Cardiology Department, National Cardiology Hospital, Sofia, Bulgaria
  • 21 KU Leuven Department of Public Health and Primary Care, KU Leuven-University of Leuven, Leuven, Belgium; Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden; Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa. Electronic address: [email protected]
  • 22 KU Leuven Department of Public Health and Primary Care, KU Leuven-University of Leuven, Leuven, Belgium; Faculty of Medicine and Health Sciences, Centre for Research and Innovation in Care, Division of Nursing and Midwifery, University of Antwerp, Antwerp, Belgium. Electronic address: https://twitter.com/EvaGoossens_PhD
J Am Coll Cardiol, 2024 Mar 26;83(12):1149-1159.
PMID: 38508848 DOI: 10.1016/j.jacc.2024.01.021

Abstract

BACKGROUND: Life expectancy of patients with congenital heart disease (CHD) has increased rapidly, resulting in a growing and aging population. Recent studies have shown that older people with CHD have higher morbidity, health care use, and mortality. To maintain longevity and quality of life, understanding their evolving medical and psychosocial challenges is essential.

OBJECTIVES: The authors describe the frailty and cognitive profile of middle-aged and older adults with CHD to identify predictor variables and to explore the relationship with hospital admissions and outpatient visits.

METHODS: Using a cross-sectional, multicentric design, we included 814 patients aged ≥40 years from 11 countries. Frailty phenotype was determined using the Fried method. Cognitive function was assessed by the Montreal Cognitive Assessment.

RESULTS: In this sample, 52.3% of patients were assessed as robust, 41.9% as prefrail, and 5.8% as frail; 38.8% had cognitive dysfunction. Multinomial regression showed that frailty was associated with older age, female sex, higher physiologic class, and comorbidities. Counterintuitively, patients with mild heart defects were more likely than those with complex lesions to be prefrail. Patients from middle-income countries displayed more prefrailty than those from higher-income countries. Logistic regression demonstrated that cognitive dysfunction was related to older age, comorbidities, and lower country-level income.

CONCLUSIONS: Approximately one-half of included patients were (pre-)frail, and more than one-third experienced cognitive impairment. Frailty and cognitive dysfunction were identified in patients with mild CHD, indicating that these concerns extend beyond severe CHD. Assessing frailty and cognition routinely could offer valuable insights into this aging population.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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