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Aim: The impact of cognitive dysfunction‐associated activities of daily living (ADL) on mortality and rehospitalization for heart failure has not yet been evaluated. Methods: We retrospectively evaluated DASC‐21, the incidence of all‐cause mortality, and rehospitalization for heart failure after discharge in 329 older patients with heart failure. Results: The mean age was 85.1 ± 7.4 years (62.6% women). There were 110 cases of death from any cause (33.4%) during 25.5 ± 16.1 months of follow‐up and 166 cases of rehospitalization from heart failure (50.5%) during 16.1 ± 15.2 months of follow‐up. The DASC‐21 score was not significantly associated with an increased risk of all‐cause mortality or rehospitalization. For each item of the DASC‐21 questionnaire, defective route‐finding (item 6) (HR = 2.631, P = 0.003), common sense and capacity for judgement (item 9) (HR = 1.717, P = 0.040), instrumental ADL (IADL) for shopping (item 10) (HR = 1.771, P = 0.020), and IADL for meal preparation (item 14) (HR = 1.790, P = 0.019) were significantly associated with an increased risk of all‐cause mortality. Disabilities in route finding (HR = 2.257, P = 0.005), IADL for shopping (HR = 1.632, P = 0.016), and IADL for transportation (HR = 1.537, P = 0.033) were significant risk factors for rehospitalization due to heart failure. Even in the multivariate‐adjusted model, disability in defective route‐finding was significantly associated with an increased risk of all‐cause mortality (hazard ratio [HR] = 2.148, 95% confidence interval [CI] 1.090–4.236; P = 0.027) and of rehospitalization for heart failure (HR = 2.138, 95% CI 1.153–3.963, P = 0.016). Conclusions: In older patients hospitalized for heart failure, route disability was associated with all‐cause mortality and rehospitalization for heart failure after discharge. Geriatr Gerontol Int 2024; 24: 1130–1136. [ABSTRACT FROM AUTHOR]

Aim: We investigated whether the Dementia Assessment Sheet for Community‐based Integrated Care System‐21 Items (DASC‐21), a questionnaire that assesses cognitive function, including activities of daily living (ADL), was predictive of in‐hospital death and prolonged hospital stay in elderly patients hospitalized for heart failure. Methods: We retrospectively assessed the DASC‐21 score at the time of admission, in‐hospital death, length of hospital stay, and change in the Barthel index in 399 patients hospitalized for heart failure between 2016 and 2019. Results: The mean patient age was 85.8 ± 7.7 years (61.3% women). The median DASC‐21 score was 38 (64.7% higher than 31). On multivariate logistic regression analysis, a higher DASC‐21 score was associated with an increased risk of in‐hospital death (odds ratio [OR] = 1.045 per 1 point increase, 95% confidence interval [CI]: 1.010–1.081, P = 0.012), even after adjusting for confounding factors, including atrial fibrillation, ejection fraction, and B‐type natriuretic peptide. Difficulties (3 or 4) with the self‐management of medication in instrumental ADL inside the home (OR = 3.28, 95% CI: 1.05–10.28, P = 0.042), toileting (OR = 3.66, 95% CI: 1.19–11.29, P = 0.024), grooming (OR = 6.47, 95% CI: 2.00–20.96, P = 0.002), eating (OR = 7.96, 95% CI: 2.49–25.45, P < 0.001), and mobility in physical ADL (OR = 5.99, 95% CI: 1.85–19.35, P = 0.003) were identified as risk factors for in‐hospital death. Patients in the highest tertile of the DASC‐21 score had a significantly longer hospital stay (P = 0.006) and a greater reduction in the Barthel index (P < 0.001). Conclusions: In elderly patients hospitalized for heart failure, higher DASC‐21 scores were associated with an increased risk of in‐hospital death, prolonged hospital stay, and impaired ADL. Geriatr Gerontol Int 2024; 24: 546–553. [ABSTRACT FROM AUTHOR]

Myocardial ischemia due to narrowing of the right coronary artery (RCA) may result in sinus arrhythmias, which usually present as transient sinus bradycardia with no hemodynamic instability. We report a rare case of sinus arrest with hemodynamic instability, which lasted for several months, and was caused by the occlusion of the sinus node (SN) artery following the RCA stenting. A 78-year-old woman with diabetes mellitus, hypertension, and dyslipidemia was referred to our hospital because of chest pain during activity. In her coronary angiogram, severe diffuse stenosis of the RCA was observed and intracoronary imaging using intravascular ultrasound revealed diffuse atherosclerotic plaque lesions with partial calcification and vulnerability. RCA was treated by inserting three zotarolimus-eluting stents. Immediately after these interventions, the SN artery originating from the RCA proximal to the lesion was occluded, which resulted in SN dysfunction. Significant bradycardia was observed on electrocardiogram along with low blood pressure, suggesting sinus arrest. Along with hemodynamic instability, sinus arrest lasted for several months, and permanent pacemaker implantation was needed. The plaque burden should be taken into consideration when choosing the appropriate percutaneous coronary intervention strategy because of the potential complication of sinus arrest after RCA stenting. < Learning objective: Clinicians should be aware of the potential for sinus arrest after right coronary artery stent implantation. In cases with large plaque burden, it might be best to protect a side branch using a catheter or a small diameter balloon. Acute sinus node ischemia is a possible cause of sinus dysfunction after percutaneous coronary intervention. As such the strategy for this intervention should be chosen with care.> [ABSTRACT FROM AUTHOR]