Targeted Geriatric Assessment In Heart Failure With Preserved Ejection Fraction

• Published in: Journal of cardiac failure 2024-01, Vol.30 (1), p.262-263
• Main Authors: Pieroni, Cole, Humphrey-Stark, Lauren, Konerman, Matthew, Hummel, Scott
• Format: Article
• Language: English
• ISSN: 1071-9164; 1532-8414
• DOI: 10.1016/j.cardfail.2023.10.346

Heart failure with preserved ejection fraction (HFpEF) is common in older adults and associated with poor outcomes. Geriatric syndromes, such as frailty, cognitive impairment, and malnutrition, affect prognosis and quality of life but are challenging to comprehensively evaluate in high-volume clinical settings. The Targeted Geriatric Assessment (TaGA) can quickly assess multiple geriatric domains and provide independent prognostic information in HFpEF. The TaGA is a 10-domain assessment requiring minimal training and designed to be completed in 10 minutes. The instrument assigns 0, 0.5, or 1 point to social support, recent hospital admissions, falls within 12 months, total medication numbers, functionality (Katz Index of Independence in Activities of Daily Living), cognitive status (Education-corrected 10-Point Cognitive Screener), self-rated health, depression (4-item Geriatric Depression Scale), nutritional status, and gait speed. All data points are summed and divided by the total number of evaluated domains to calculate a TaGA score ranging from 0 (no deficits) to 1 (high deficits). The TaGA was used to assess patients with HFpEF (n=19) at Michigan Medicine in March 2023. We compared TaGA scores with two other markers of prognosis in HFpEF, the Meta-Analysis Global Group in Chronic heart failure (MAGGIC) score and B-type natriuretic peptide (BNP) levels. The TaGA score in the cohort was 0.33±0.14 points (Figure 1A), indicating low to moderate geriatric impairment in most patients. Polypharmacy, poor self-rated health, depression, and slow gait speed (a marker of frailty) were common. There was no significant association between TaGA scores and MAGGIC risk scores or BNP levels (Figures 1B & 1C). The TaGA was feasible to administer in patients with HFpEF and identified several geriatric impairments that could be improved with directed intervention. In addition, the lack of relationship with standard prognostic markers suggests that the TaGA could provide independent prognostic information in HFpEF management.