1. Is heart failure associated with disability? European Academy for Medicine of Ageing, Martigny, January 24th 2013 Marius Myrstad

2. Outline of the presentation Short review of epidemiological research Underlying mechanisms for disability Prevention of disability Take-home messages

3. Prevalence of Heart Failure (HF) 80 % of HF patients are 65 years or older 25 % of HF patients are 80 years or older AHA Heart Disease and Stroke statistics 2006 Wong C. Am J Med 2011 ;124 :136-43..

4. Prevalence of disability in HF 54% with ≥ 1 basic ADL disability Mobility disability (42%) most common limitation 57 % with mobility disability 11 % any other ADL limitation Proportion with disability stable over 20 years Wong C. Am J Med 2011 ;124 :136-43.. Gure TR. J Gen Intern Med 2007.:23(1):70-76.

5. HF is associated with disability Table: Crude and adjusted association of ADL and I-ADL limitations, by Heart disease category Gure TR. J Gen Intern Med 2007.:23(1):70-76.

6. Major predictors for disability in HF Impaired gait speed Depressive symptoms Cognitive impairment Chaudry S. J Card Fail 2011;17(9) :764-70..

7. Mechanisms for disability in HF Mobility disability – Muscle weakness Loncar G. Int J Cardiol 2013;162(2) :77-85. – Reduced lung capacity – Reduced peripher oxygen consumption – Anemia – Fatigue

8. Mechanisms for disability in HF Cognitive impairment – Low cardiac output – Hypotension – Impaired cerebral vessel reactivity – Microembolism Dardiotis E. Cardiol Res Pract 2012;2012:595821 (Epub).

9. Other contributing factors Disability Social factorsMalnutritionMedicationCo-morbidity Psychological factors Muscle weaknes FatigueAnemia Reduced lung capacity Cognitive impairment Age-related functional decline

10. Prevention of disability in HF Optimal heart failure treatment Angiotensin-converting enzyme inhibitors Zuccalà G. Eur Heart J 2005;26(3):226-233. Pedone C. J Gerontol A Biol Sci Med 2004;59(7):716-721 Treatment of co-morbid conditions Treatment of depression Vaccarino V. J Am Coll Cardiol 2001;38:199-205.

11. Prevention of disability in HF Regular physical exercise - prevents age-related decline in cardiac function Molmen HE. Scand Cardiovasc Journ 2012 ;46(3):163-71 - increases muscle strength in HF patients Savage P. Med Sci Sports Exerc 2011;43(8):1379-1386. - is safe in patiets with heart disease Rognmo Ø. Circulation 2012;126(12):1436-40.

12. Take-home messages HF is independently associated with disability Disability can be prevented HF patients should practice regular physical exercise

13. Thanks for your attention!