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Digital archive of theses discussed at the University of Pisa

 

Thesis etd-10272023-175117


Thesis type
Tesi di specializzazione (4 anni)
Author
MORELLI, VIRGINIA
URN
etd-10272023-175117
Thesis title
USEFULNESS OF AN EARLY SARCOPENIA SCREENING IN PREDICTING SHORT-TERM MORTALITY IN VERY OLD PATIENTS DISCHARGED FOR ACUTE HEART FAILURE
Department
MEDICINA CLINICA E SPERIMENTALE
Course of study
GERIATRIA
Supervisors
relatore Prof. Virdis, Agostino
Keywords
  • heart failure; older adults; sarcopenia
Graduation session start date
20/11/2023
Availability
Withheld
Release date
20/11/2026
Summary
Objectives: To determine the short-term prognostic significance of an early sarcopenia screening, in very old, hospitalized patients with acutely decompensated heart failure (ADHF).
Design: Single-center, prospective study.
Setting and Participants: Patients aged 75 years or older hospitalized with ADHF in the Geriatric Unit of a tertiary care hospital.
Measures: A panel of clinicians adjudicated the diagnosis of congestive heart failure based on clinical symptoms, signs, chest x-ray film results, echocardiographic findings and therapy at admission. All patients underwent a focused cardiac ultrasound, performed by an expert clinician. A comprehensive geriatric assessment, including physical performance through SARC-F questionnaire, and Handgrip Strength (HGS) test was performed. A multivariable logistic regression was performed to evaluate the association between SARC-F, HGS test and 30-days-mortality using a priori selected model covariates based on clinical considerations. As a secondary analysis a logistic multivariable regression was performed among SARC-F sub-items resulted statistically significant at the univariate analysis. The thirty-day post-discharge mortality rate was assessed by phone interview.
Results: Out of 184 patients hospitalized with ADHF enrolled in the study (mean [SD], 86.8 [5.9] years, 60.3% female), 47 died within 30 days after discharge. Patients with SARC-F ≥ 4 had a 1.9-fold higher mortality rate compared to those with SARC-F < 4. By multivariate logistic analysis, HGS (β = -0.73 ± 0.03, p = 0.008) and SARC-F [adjusted OR: 1.13 (CI95% 1.03–1.33), p = 0.03] resulted independently associated with mortality. Furthermore, SARC-F two sub-items, namely, limitation in rising from a chair and history of falls [aOR: 3.47 (CI95% 1.28–8.70), p = 0.008; aOR: 3.30 (CI95% 1.28–8.49), p = 0.01; respectively] emerged as determinants of 30-days mortality.
Conclusions and Implications: An early sarcopenia assessment comprising SARC-F and HGS test independently predicts 30-day post-discharge mortality in oldest-old patients hospitalized for acute HF.
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