Editorial
Comprehensive assessment in heart failure
Valoración integral en la insuficiencia cardiaca
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Comorbidity, frailty and geriatric syndromes are common with ageing, have a major effect on worsening symptoms and prognosis of HF and therefore their management is critical to minimise complications and poor outcomes.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">In terms of comorbidity, older HF patients have an average of five chronic diseases.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> There are diseases that can make diagnosis (e.g. chronic obstructive pulmonary disease) and management of HF difficult (e.g. chronic renal failure). On the other hand, comorbidities differ according to left ventricular ejection fraction and have different effects on mortality.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> In fact, specific clusters of comorbidities have been described that increase the risk of short-term mortality in older patients with decompensated HF.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> In addition, control of certain active comorbidities has been shown to improve outcomes and quality of life (e.g. diabetes mellitus, anaemia and iron deficiency, hypertension, dyslipidaemia, coronary heart disease, valvular heart disease, flutter and atrial fibrillation, and sleep disturbance).<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> This is even more important in patients with preserved ejection fraction, who are more likely to die of a non-cardiac cause.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> On the other hand, comorbidity is closely associated with polypharmacy, and polypharmacy with non-adherence, medication errors, interactions and inappropriate prescriptions. Hyperpolypharmacy due to non-cardiovascular rather than cardiovascular drugs has been associated with increased risk of mortality following an episode of HF decompensation.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> Chronic medication should therefore be reviewed and adjusted. The STOPP/START criteria are a tool to help avoid problems related to potentially inappropriate medications, including prescription omissions.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Cognitive, physical, social and nutritional status have been documented as determinants of stratification and are not usually considered in HF risk scores, nor are they considered in routine clinical practice in the decision-making process or in the design of a care plan.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> In addition, deficits in these different domains decrease the ability to adhere to recommendations, determine outcomes, and modify HF treatment goals.</p><p id="par0025" class="elsevierStylePara elsevierViewall">The degree of physical dependency, as measured by the Barthel index, is the most important prognostic factor in older patients with decompensated HF and has therefore been included in risk stratification scores for decompensated HF, such as the MEESSI-AHF score.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> The frequency of falls is higher in older HF patients, especially after hospital discharge.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> Caution should be exercised in those with a history of recurrent falls when combining diuretics with SGLT2 inhibitors, or prescribing a vasodilator if there is persistent postural hypotension.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Physical frailty and sarcopenia are frequently present in older patients with HF and confer a poor prognosis.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> These are potentially reversible conditions that are often under-diagnosed or under-treated in the elderly. The FRAIL and SARC-F questionnaires can be screening scores for physical frailty and sarcopenia, respectively.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> Physical activity and proper nutrition are the cornerstones of the treatment of sarcopenia-associated frailty. Nutrition should include adequate energy intake, high protein intake and vitamin D supplementation in case of deficiency. A multicomponent physical training programme adapted to the functional situation of each patient (e.g. Vivifrail), including aerobic, strength and balance exercises, is the most effective tool to improve mobility and gait, increase muscle mass and strength, decrease falls, improve functional performance in activities of daily living and quality of life.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Malnutrition is a common poor prognostic factor in older patients with HF, and its treatment can reduce all-cause mortality.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> It is therefore important to assess the nutritional status of these patients, and for this purpose it is recommended that the short version of the Mini-Nutritional Assessment (MNN-SF) be used as a screening tool.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Cognitive impairment is present in 25–75% of older patients with HF. Their presence has significant implications for self-care, leading to poorer health outcomes.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> Depression is described in 20–30% of HF patients and is associated with increased morbidity and mortality and poorer quality of life, especially in the elderly.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> In the decompensated phase of HF, the prevalence of delirium in elderly patients is 20% at admission, and the incidence is 15–55% during hospitalisation, being higher in intensive care and palliative care units. Delirium is an independent risk factor for mortality and readmission in the short to medium term. Precipitating factors for delirium have been documented, such as the use of urinary catheters, the prescription of three or more new drugs or drugs with a high anticholinergic load (furosemide, nitrates, digoxin and acenocoumarol).<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">There are numerous socio-economic and environmental factors that have a major impact on the development and prognosis of HF.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> Ensuring adequate social support is critical to the course of the disease, especially at hospital discharge, as most older patients lose the necessary skills required for self-care, which has prognostic consequences.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">In summary, we are faced with increasingly older HF patients with a high probability of associated comorbidity, frailty/sarcopenia and geriatric syndromes, with a generally preserved left ventricular ejection fraction, with greater complexity in diagnosis and treatment, with under-representation in clinical trials, with a higher risk of adverse drug reactions, with therapeutic goals that often do not take into account the functional status, quality of life and expectations of patients, with greater difficulties in self-care education, with a very heterogeneous prognosis, and whose care occurs in care models that are generally not adapted to the elderly.</p><p id="par0055" class="elsevierStylePara elsevierViewall">From our point of view, one of the main strategies to face this healthcare challenge is a multidimensional, patient-centred approach with multidisciplinary teams and actions to ensure continuity of care.</p><p id="par0060" class="elsevierStylePara elsevierViewall">For risk stratification and the design of an individualised care plan, multidimensional assessment is recommended. The comprehensive geriatric assessment (CGA) is the recommended tool for the assessment and care of frail older patients in clinical practice. CGA is a multidisciplinary diagnostic and therapeutic process carried out to identify the medical, functional, cognitive, social and nutritional status of frail individuals in order to design a coordinated and integrated care and follow-up plan.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> CGA has been shown to predict in-hospital and long-term adverse outcomes in elderly patients admitted for HF. Elderly patients who underwent CGA on admission to hospital were more likely to be alive and at home during follow-up.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> There are significant limitations to widespread implementation of CGA, as it requires professionals from a variety of disciplines and sufficient time for assessment. As an alternative, it is proposed to use tools derived from the CGA (Edmonton Frailty Scale, Multidimensional Prognostic Index and Comprehensive Geriatric Assessment Score) or a short geriatric assessment (combination of screening scores addressing the different domains) to facilitate their application in different clinical settings.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> There are different published experiences, both in hospital and community settings, including the emergency department as a paradigm of an unfavourable scenario for carrying out a comprehensive assessment, which show the relevance and feasibility of multidimensional assessment in different healthcare settings.</p><p id="par0065" class="elsevierStylePara elsevierViewall">This comprehensive assessment would assist in risk stratification, optimisation of pharmacological treatment, risk-benefit assessment of invasive diagnostic and therapeutic procedures, appropriate referral and activation of resources based on affected domains and life expectancy. A clinical trial (DEED FRAIL-AHF) is currently active with the primary objective of demonstrating the efficacy of a comprehensive care transition intervention to reduce adverse outcomes at 30 days in frail older patients with decompensated HF discharged from emergency departments.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a> This Multilevel Guided Discharge Plan recommends designing a multidimensional plan, with the help of a checklist, which takes into account the clinical situation (clinical HF type, degree of congestion, aetiology and precipitating factor, comorbidity and polypharmacy), physical (frailty/sarcopenia, disability), cognitive (delirium, depression), social (living alone without a support network), nutritional (risk of malnutrition) and geriatric syndromes (falls, incontinence, insomnia, etc.) and ensuring continuity of care with close follow-up in the first 7−10 days of discharge by the doctor responsible for the care process.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a> The main outcomes will be measured by the composite variable (ED revisit or admission for heart failure and cardiovascular mortality) and live days out of hospital 30 days after discharge from the ED. This trial is expected to shed light on the efficacy and feasibility of CGA in the transition of care of frail elderly HF patients discharged from the ED.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">Finally, more proactive and integrated models should be developed to enable health management from a care process perspective, promoting multidisciplinary teams to coordinate the comprehensive approach to HF, actions to facilitate communication and coordination between levels of care, and advance planning of palliative care taking into account patient preferences. In addition, more elaborate, person-centred indicators should be established, including functional status (e.g., activities of daily living), quality of life (e.g., Kansas City Cardiomyopathy Questionnaire), and patient experience and outcome measures (e.g., Patient Reported Experience, PREMS and Patient Reported Outcomes, PROMS).</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Ethical considerations</span><p id="par0075" class="elsevierStylePara elsevierViewall">No patient data are included in this paper.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Funding</span><p id="par0080" class="elsevierStylePara elsevierViewall">The authors have not received any support, funding, grants, donations or honoraria for this paper.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflict of interest</span><p id="par0085" class="elsevierStylePara elsevierViewall">FJMS has received grants from the Instituto de Salud Carlos III from funds of the Ministry of Health, Social Services and Equality (MSSSI) and the European Regional Development Fund (ERDF) (PI15/00773, and PI18/00456).</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Ethical considerations" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Funding" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Conflict of interest" ] 3 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:20 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Management of acute heart failure in Spanish emergency departments based on age" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "F.J. Martín-Sánchez" 1 => "R. Marino-Genicio" 2 => "E. Rodríguez-Adrada" 3 => "J. Jacob" 4 => "P. Herrero" 5 => "O. Miró" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.rec.2013.04.019" "Revista" => array:6 [ "tituloSerie" => "Rev Esp Cardiol (Engl Ed)" "fecha" => "2013" "volumen" => "66" "paginaInicial" => "715" "paginaFinal" => "720" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24773677" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Impact of geriatric assessment variables on 30-day mortality among older patients with acute heart failure" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "F.J. Martín-Sánchez" 1 => "E. Rodríguez-Adrada" 2 => "M.T. Vidán" 3 => "P. Díez Villanueva" 4 => "G. Llopis García" 5 => "J. González Del Castillo" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Emergencias" "fecha" => "2018" "volumen" => "30" "paginaInicial" => "149" "paginaFinal" => "155" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29687668" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The influence of comorbidities on the prognosis after an acute heart failure decompensation and differences according to ejection fraction: Results from the EAHFE and RICA registries." "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "Ò. Miró" 1 => "A. Conde-Martel" 2 => "P. Llorens" 3 => "P. Salamanca-Bautista" 4 => "V. Gil" 5 => "Á. González-Franco" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ejim.2023.02.026" "Revista" => array:6 [ "tituloSerie" => "Eur J Intern Med" "fecha" => "2023" "volumen" => "111" "paginaInicial" => "97" "paginaFinal" => "104" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/36914535" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Clusters of comorbidities in the short-term prognosis of acute heart failure among elderly patients: A retrospective cohort study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "L. Falsetti" 1 => "G. Viticchi" 2 => "V. Zaccone" 3 => "E. Guerrieri" 4 => "I. Diblasi" 5 => "L. Giuliani" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3390/medicina58101394" "Revista" => array:4 [ "tituloSerie" => "Medicina (Kaunas)" "fecha" => "2022" "volumen" => "58" "paginaInicial" => "1394" ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "2021 update to the 2017 ACC expert consensus decision pathway for optimization of heart failure treatment: Answers to 10 pivotal issues about heart failure with reduced ejection fraction: A report of the American College of Cardiology Solution Set Oversight Committee" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "Writing Committee" 1 => "T.M. Maddox" 2 => "J.L. Januzzi Jr." 3 => "L.A. Allen" 4 => "K. Breathett" 5 => "J. Butler" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jacc.2020.11.022" "Revista" => array:6 [ "tituloSerie" => "J Am Coll Cardiol" "fecha" => "2021" "volumen" => "77" "paginaInicial" => "772" "paginaFinal" => "810" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/33446410" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prognostic impact of hyperpolypharmacy due to noncardiovascular medications in patients after acute decompensated heart failure — insights from the Clue of Risk Stratification in the Elderly Patients With Heart Failure (CURE-HF) Registry" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Kanai" 1 => "M. Minamisawa" 2 => "H. Motoki" 3 => "Y. Seko" 4 => "K. Kimura" 5 => "T. Okano" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1253/circj.CJ-22-0712" "Revista" => array:5 [ "tituloSerie" => "Circ J" "fecha" => "2023" "volumen" => "88" "paginaInicial" => "33" "paginaFinal" => "42" ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0035" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "STOPP/START criteria for potentially inappropriate prescribing in older people: version 3" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "D. O’Mahony" 1 => "A. Cherubini" 2 => "A.R. Guiteras" 3 => "M. Denkinger" 4 => "J.B. Beuscart" 5 => "G. Onder" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s41999-023-00777-y" "Revista" => array:6 [ "tituloSerie" => "Eur Geriatr Med" "fecha" => "2023" "volumen" => "14" "paginaInicial" => "625" "paginaFinal" => "632" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/37256475" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0040" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Effect of Barthel index on the risk of thirty-day mortality in patients with acute heart failure attending the emergency department: A cohort study of nine thousand ninety-eight patients from the epidemiology of acute heart failure in emergency departments registry" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "X. -Rossello" 1 => "Ò. Miró" 2 => "P. Llorens" 3 => "J. Jacob" 4 => "P. Herrero-Puente" 5 => "V. Gil" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.annemergmed.2018.12.009" "Revista" => array:6 [ "tituloSerie" => "Ann Emerg Med" "fecha" => "2019" "volumen" => "73" "paginaInicial" => "589" "paginaFinal" => "598" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30685211" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0045" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Falls in patients with heart failure: A systematic review" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "K. Lee" 1 => "S.J. Pressler" 2 => "M. Titler" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/JCN.0000000000000292" "Revista" => array:6 [ "tituloSerie" => "J Cardiovasc Nurs" "fecha" => "2016" "volumen" => "31" "paginaInicial" => "555" "paginaFinal" => "561" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26422636" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0050" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Sex differences in the prevalence and prognostic impact of physical frailty and sarcopenia among older patients with heart failure" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "D. Maeda" 1 => "Y. Matsue" 2 => "N. Kagiyama" 3 => "K. Jujo" 4 => "K. Saito" 5 => "K. Kamiya" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.numecd.2021.10.012" "Revista" => array:6 [ "tituloSerie" => "Nutr Metab Cardiovasc Dis" "fecha" => "2022" "volumen" => "32" "paginaInicial" => "365" "paginaFinal" => "372" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/34893406" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0055" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Preserving mobility in older adults with physical frailty and sarcopenia: Opportunities, challenges, and recommendations for physical activity interventions" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Billot" 1 => "R. Calvani" 2 => "A. Urtamo" 3 => "J.L. Sánchez-Sánchez" 4 => "C. Ciccolari-Micaldi" 5 => "M. Chang" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.2147/CIA.S253535" "Revista" => array:6 [ "tituloSerie" => "Clin Interv Aging" "fecha" => "2020" "volumen" => "15" "paginaInicial" => "1675" "paginaFinal" => "1690" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32982201" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0060" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Effect of risk of malnutrition on 30-day mortality among older patients with acute heart failure in emergency departments" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "F.J. Martín-Sánchez" 1 => "F. Cuesta Triana" 2 => "X. Rossello" 3 => "R. Pardo García" 4 => "G. Llopis García" 5 => "F. Caimari" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ejim.2019.04.014" "Revista" => array:6 [ "tituloSerie" => "Eur J Intern Med" "fecha" => "2019" "volumen" => "65" "paginaInicial" => "69" "paginaFinal" => "77" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31076345" "web" => "Medline" ] ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0065" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Self-management of heart failure in dementia and cognitive impairment: a systematic review" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "J. Lovell" 1 => "T. Pham" 2 => "S.Q. Noaman" 3 => "M.C. Davis" 4 => "M. Johnson" 5 => "J.E. Ibrahim" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/s12872-019-1077-4" "Revista" => array:5 [ "tituloSerie" => "BMC Cardiovasc Disord" "fecha" => "2019" "volumen" => "19" "paginaInicial" => "99" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31035921" "web" => "Medline" ] ] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0070" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Depression and heart failure: the lonely comorbidity" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "M. Sbolli" 1 => "M. Fiuzat" 2 => "D. Cani" 3 => "C.M. O’Connor" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/ejhf.1865" "Revista" => array:6 [ "tituloSerie" => "Eur J Heart Fail" "fecha" => "2020" "volumen" => "22" "paginaInicial" => "2007" "paginaFinal" => "2017" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32468714" "web" => "Medline" ] ] ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0075" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Delirium in heart failure" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Correale" 1 => "M. Altamura" 2 => "R. Carnevale" 3 => "L. Tricarico" 4 => "S. Malerba" 5 => "A.M. Gallotta" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s10741-019-09842-w" "Revista" => array:6 [ "tituloSerie" => "Heart Fail Rev" "fecha" => "2020" "volumen" => "25" "paginaInicial" => "713" "paginaFinal" => "723" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31377979" "web" => "Medline" ] ] ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0080" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Social and environmental risks as contributors to the clinical course of heart failure" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "K. Narita" 1 => "E. Amiya" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s10741-021-10116-7" "Revista" => array:6 [ "tituloSerie" => "Heart Fail Rev" "fecha" => "2022" "volumen" => "27" "paginaInicial" => "1001" "paginaFinal" => "1016" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/33945055" "web" => "Medline" ] ] ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib0085" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Most elderly patients hospitalized for heart failure lack the abilities needed to perform the tasks required for self-care: Impact on outcomes" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M.T. Vidán" 1 => "F.J. Martín Sánchez" 2 => "E. Sánchez" 3 => "F.J. Ortiz" 4 => "J.A. Serra-Rexach" 5 => "M. Martínez-Sellés" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/ejhf.1559" "Revista" => array:6 [ "tituloSerie" => "Eur J Heart Fail" "fecha" => "2019" "volumen" => "21" "paginaInicial" => "1434" "paginaFinal" => "1442" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31373161" "web" => "Medline" ] ] ] ] ] ] ] ] 17 => array:3 [ "identificador" => "bib0090" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Comprehensive geriatric assessment for older adults admitted to hospital" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "G. Ellis" 1 => "M. Gardner" 2 => "A. Tsiachristas" 3 => "P. Langhorne" 4 => "O. Burke" 5 => "R.H. Harwood" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/14651858.CD006211.pub3" "Revista" => array:5 [ "tituloSerie" => "Cochrane Database Syst Rev" "fecha" => "2017" "volumen" => "9" "paginaInicial" => "CD006211" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28898390" "web" => "Medline" ] ] ] ] ] ] ] ] 18 => array:3 [ "identificador" => "bib0095" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Practical approach on frail older patients attended for acute heart failure" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "F.J. Martín-Sánchez" 1 => "M. Christ" 2 => "Ò. Miró" 3 => "W.F. Peacock" 4 => "J.J. McMurray" 5 => "H. Bueno" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ijcard.2016.07.151" "Revista" => array:6 [ "tituloSerie" => "Int J Cardiol" "fecha" => "2016" "volumen" => "222" "paginaInicial" => "62" "paginaFinal" => "71" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27458825" "web" => "Medline" ] ] ] ] ] ] ] ] 19 => array:3 [ "identificador" => "bib0100" "etiqueta" => "20" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Planning to reduce 30-day adverse events after discharge of frail elderly patients with acute heart failure: design and rationale for the DEED FRAIL-AHF trial" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "F.J. Martín-Sánchez" 1 => "G. Llopis García" 2 => "P. Llorens" 3 => "J. Jacob" 4 => "P. Herrero" 5 => "V. Gil" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Emergencias" "fecha" => "2019" "volumen" => "31" "paginaInicial" => "27" "paginaFinal" => "35" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30656870" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/23870206/0000016200000005/v1_202403010948/S238702062400055X/v1_202403010948/en/main.assets" "Apartado" => array:4 [ "identificador" => "46797" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Editorial article" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/23870206/0000016200000005/v1_202403010948/S238702062400055X/v1_202403010948/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S238702062400055X?idApp=UINPBA00004N" ]
