PERFIL CLÍNICO, CARDIOVASCULAR E FISICOFUNCIONAL DE ACORDO COM A FRAGILIDADE DE PACIENTES IDOSOS COM INSUFICIÊNCIA CARDÍACA EM ATENDIMENTO AMBULATORIAL

Abstract

Traditionally, frailty is diagnosed and staged based on physical function. In situations where the decline in these functions is imminent, as occurs in heart failure (HF), it is necessary to find tests that have a greater ability to predict frailty while also being part of routine clinical assessments of HF, without further burdening healthcare services. Therefore, this research aimed to analyze the clinical, cardiovascular and physical-functional profile according to the frailty of older adults with heart failure in outpatient care. This study used a non-probabilistic, convenience sample. The statistical power of the sample was calculated a posteriori (statistical power of 80% and an α value of 5%). Recruitment was conducted through active searches of medical records and during medical appointments. Patients diagnosed with chronic HF (left ventricular ejection fraction (LVEF) ≤ 50% on echocardiogram within the last year) registered at the outpatient clinic, of both sexes, aged ≥ 60 years, were included. Patients with LVEF > 50% and aged < 60 years were not considered for inclusion. The initial evaluation included questionnaires regarding a) Clinical and psychosocial assessment; b) physical activity level; c) fatigue; d) depression; e) dietary recall; and f) quality of life. Blood samples were collected for N-terminal pro-B-type natriuretic peptide (NT-proBNP) assay. Physical and functional assessment was performed through anthropometry, bioimpedance, hemodynamic assessment, upper limb dynamometry, 4-meter gait speed test, and 6-minute walk test. Patients who did not complete all scheduled assessments were excluded from the analyses. To compare the frail (FG), pre-frail (PF), and robust (RB) groups, one-way ANOVA tests were used for parametric data and Kruskal-Wallis tests for nonparametric data to identify differences between groups. A significance level (α) of 0.05 and a statistical power of 0.80 were adopted. The results are divided into three chapters with original articles: the first on heart rate variability (HRV), the second on the physical, functional, and psychosocial profile, and the third on body composition and metabolic risk, all according to the levels of frailty in patients with HF. Results: 1) Heart rate variability (HRV) proved to be an important tool for assessing the autonomic nervous system (ANS), presenting better clinical values of autonomic control for the RB group compared to the other groups, with no difference for NT-proBNP; 2) Most patients are PF, with low weekly caloric expenditure, physical fatigue, and low cardiorespiratory fitness, with worse clinical values for the FG group. 3) Overall, they do not present significant weight loss and have preserved muscle strength. They are at a metabolic age appropriate for their chronological age and at low risk for developing sarcopenia. However, they have excess body and visceral fat and cardiovascular risk factors. Final considerations: The incidence of frail individuals or those on the verge of becoming frail is noteworthy, highlighting that outpatient monitoring should be combined with non-pharmacological measures, prioritizing frail individuals who have shown worse health outcomes. Thus, older adults with HF may present different phenotypes, with worse results in relation to cardiovascular and physical-functional variables for the FG group, even though they have the same clinical profile at different levels of frailty.