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Heart failure (HF) is prevalent in advanced ages. Our objective was to assess the impact of frailty on 1-year mortality in older patients with ambulatory HF.Our data come from the FRAGIC study (Spanish acronym for "Study of the impact of frailty and other geriatric syndromes on the clinical management and prognosis of elderly outpatients with heart failure"), a multicenter prospective registry conducted in 16 Spanish hospitals including outpatients ≥ 75 years with HF followed up by cardiology services in Spain.We included 499 patients with a mean age of 81.4±4.3 years, of whom 193 (38%) were women. A total of 268 (54%) had left ventricular ejection fraction40%, and 84.6% was in NYHA II functional class. The FRAIL scale identified 244 (49%) pre-frail and 111 (22%) frail patients. Frail patients were significantly older, were more frequently female (both, P.001), and had higher comorbidity according to the Charlson index (P=.017) and a higher prevalence of geriatric syndromes (P.001). During a median follow-up of 371 [361-387] days, 58 patients (11.6%) died. On multivariate analysis (Cox regression model), frailty detected with the FRAIL scale was marginally associated with mortality (HR=2.35; 95%CI, 0.96-5.71; P=.059), while frailty identified by the visual mobility scale was an independent predictor of mortality (HR=2.26; 95%CI, 1.16-4.38; P=.015); this association was maintained after adjustment for confounding variables (HR=2.13; 95%CI, 1.08-4.20; P=.02).In elderly outpatients with HF, frailty is independently associated with mortality at 1 year of follow-up. It is essential to identify frailty as part of the comprehensive approach to elderly patients with HF.

To assess the value of sirolimus-eluting magnesium bioresorbable scaffolds (MgS) in the treatment of patients with in-stent restenosis (ISR). The better option for the treatment of patients with ISR remains unsettled. Bioresorbable vascular scaffolds represent an interesting strategy in this setting to avoid another permanent metal layer. The novel MgS is an attractive option to treat these challenging patients.We present the results of the first prospective series of consecutive patients with ISR treated with MgS under optical coherence tomography (OCT) guidance.A total of 14 patients (15 lesions) were prospectively included. The mean age was 67 ± 9 years and six patients (40%) presented with an acute coronary syndrome. In 10 patients (67%), underlying neoatherosclerosis was disclosed by OCT. An excellent MgS expansion was obtained in all but two patients who showed persistent suboptimal expansion in heavily calcified vessels. Minor residual malapposition ( n = 5) and angiographically silent minor edge dissections ( n = 8) were readily recognized by OCT. After a median clinical follow-up of 30 (range, 20-54) months, no patient required repeated revascularization, suffered a myocardial infarction or device thrombosis.These preliminary results suggest a potential role for the MgS in selected patients presenting with ISR.

IntroductionFrailty is common among patients with heart failure (HF). Our aim was to address the role of frailty in the management and prognosis of elderly men and women with HF.Methods and resultsProspective multicenter registry that included 499 HF outpatients ≥75 years old. Mean age was 81.4 ± 4.3 years, and 193 (38%) were women. Compared with men, women were older (81.9 ± 4.3 vs. 81.0 ± 4.2 years, p = 0.03) and had higher left ventricular ejection fraction (46 vs. 40%, p < 0.001) and less ischemic heart disease (30 vs. 57%, p < 0.001). Women had a higher prevalence of frailty (22 vs. 10% with Clinical Frailty Scale, 34 vs. 15% with FRAIL, and 67% vs. 46% with the mobility visual scale, all p-values < 0.001) and other geriatric conditions (Barthel index ≤90: 14.9 vs. 6.2%, p = 0.003; malnutrition according to Mini Nutritional Assessment Short Formulary ≤11: 55% vs. 42%, p = 0.007; Pfeiffer cognitive test's errors: 1.6 ± 1.7 vs. 1.0 ± 1.6, p < 0.001; depression according to Yesavage test; p < 0.001) and lower comorbidity (Charlson index ≥4: 14.1% vs. 22.1%, p = 0.038). Women also showed worse self-reported quality of life (6.5 ± 2.1 vs. 6.9 ± 1.9, on a scale from 0 to 10, p = 0.012). In the univariate analysis, frailty was an independent predictor of mortality in men [Hazard ratio (HR) 3.18, 95% confidence interval (CI) 1.29–7.83, p = 0.012; HR 4.53, 95% CI 2.08–9.89, p < 0.001; and HR 2.61, 95% CI 1.23–5.43, p = 0.010, according to FRAIL, Clinical Frailty Scale, and visual mobility scale, respectively], but not in women. In the multivariable analysis, frailty identified by the visual mobility scale was an independent predictor of mortality (HR 1.95, 95% CI 1.04–3.67, p = 0.03) and mortality/readmission (HR 2.06, 95% CI 1.05–4.04, p = 0.03) in men.ConclusionsIn elderly outpatients with HF frailty is more common in women than in men. However, frailty is only associated with mortality in men.

Introducción y objetivos La insuficiencia cardiaca (IC) es prevalente en edades avanzadas. Nuestro objetivo es conocer el impacto de la fragilidad en la mortalidad a 1 año en pacientes mayores con IC ambulatorios. Métodos El estudio «Impacto de la fragilidad y otros síndromes geriátricos en el manejo clínico y pronóstico del paciente anciano ambulatorio con insuficiencia cardiaca» (FRAGIC) es un registro prospectivo multicéntrico, realizado en 16 centros españoles, que incluyó pacientes con IC ambulatorios de edad ≥ 75 años seguidos por cardiología en España. Resultados Se incluyó a 499 pacientes (media de edad, 81,4±4,3 años; 193 [38%] mujeres); 268 (54%) tenían una fracción de eyección del ventrículo izquierdo

Antecedentes y objetivos La insuficiencia cardiaca (IC) es una enfermedad crónica frecuentemente asociada al envejecimiento. Disponemos de modelos predictivos basados en variables que asocian mal pronóstico y que sin embargo no incluyen condiciones habituales en el paciente mayor, como la fragilidad o la comorbilidad. Nuestro objetivo es conocer las características clínicas y epidemiológicas de una cohorte de pacientes mayores con IC ambulatoria seguidos por cardiología, la prevalencia de la fragilidad y otros síndromes geriátricos, así como su impacto pronóstico, y conocer si su consideración mejora la capacidad predictiva de los modelos de riesgo utilizados. Material y métodos Estudio observacional, prospectivo y multicéntrico que incluirá 400 pacientes ≥ 75 años con IC crónica seguidos en hospital de día y consultas de IC de cardiología de hospitales terciarios españoles, a los que se realizará una valoración geriátrica integral y una predicción de eventos basada en los scores MAGGIC y BCN-Bio HF calculator. La variable de resultado principal es la mortalidad por cualquier causa y de origen cardiovascular a 1 y 3 años. Resultados Este estudio permitirá conocer las características y el pronóstico de pacientes ancianos con IC seguidos por cardiología en nuestro medio y la utilidad en población anciana de scores utilizados en la población general con IC crónica. Conclusión Nuestro trabajo es el primer estudio prospectivo que valorará la fragilidad y otros síndromes geriátricos de forma sistemática en el paciente anciano ambulatorio con IC en España seguido por cardiología, contribuyendo a mejorar el conocimiento de su prevalencia e impacto en nuestros pacientes. Background and objectives Heart failure (HF) is a chronic disease that is often associated with ageing. There are predictive models based on variables that associate it with a poor prognosis, although those do not include common conditions in the elderly, such as frailty or comorbidity. The aim of this study is to determine the clinical and epidemiological characteristics of a cohort of elderly outpatients with HF followed-up by cardiologists. This will include a study of the prevalence of frailty and other geriatric syndromes, as well as their impact on the prognosis, and to evaluate whether these may improve predictive ability of such predictive models. Material and methods Observational, prospective, and multicentre study that will include 400 patients ≥ 75 years old with chronic HF followed-up in Spanish tertiary hospitals by cardiology specialists in HF. Patients will undergo a comprehensive geriatric assessment, and prediction of events will be performed based on MAGGIC (Meta-Analysis Global Group in Chronic Heart Failure) and Barcelona-Bio HF calculator scores. The primary endpoint is cardiovascular and overall mortality at 1 and 3 years follow-up. Results This study will assess both the characteristics and prognosis of elderly patients with HF followed-up by cardiologists in Spain and the applicability in the elderly population of scores used in the general population with chronic HF. Conclusion This is the first prospective study that will systematically assess frailty and other geriatric syndromes in the elderly outpatient with HF in Spain and followed-up by cardiologists, thus contributing to improve knowledge about both its prevalence and impact on our patients. Sin financiación No data JCR 2020 0.206 SJR (2020) Q4, 31/35 Aging No data IDR 2020 UEM