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Left atrial (LA) and left ventricular (LV) remodeling are associated with atrial fibrillation (AF). The prospective associations of impairment in cardiac mechanical function, as assessed by speckle-tracking echocardiography, with incident AF are less clear. In the Cardiovascular Health Study, a community-based cohort of older adults, participants free of AF with echocardiograms of adequate quality for speckle tracking were included. We evaluated the associations of indices of cardiac mechanics (LA reservoir strain, LV longitudinal strain, and LV early diastolic strain rate) with incident AF. Of 4341 participants with strain imaging, participants with lower LA reservoir strain were older, had more cardiometabolic risk factors, and had lower renal function at baseline. Over a median follow-up of 10 years, 497 (11.4%) participants developed AF. Compared with the highest quartile of LA reservoir strain, the lowest quartile of LA reservoir strain was associated with higher risk of AF after covariate adjustment, including LA volume and LV longitudinal strain (heart rate [HR], 1.80; 95% CI, 1.31-2.45; P < 0.001). The association of LA reservoir strain and AF was stronger in subgroups with higher blood pressure, NT-proBNP, and LA volumes. There were no associations of LV longitudinal strain and LV early diastolic strain rate with incident AF after adjustment for LA reservoir strain. Lower LA reservoir strain was associated with incident AF, independent of LV mechanics, and with stronger associations in high-risk subgroups. These findings suggest that LA mechanical dysfunction precedes the development of AF. Therapies targeting LA mechanical dysfunction may prevent progression to AF. This research was supported by contracts HHSN268201200036C, HHSN268200800007C, HHSN268201800001C, N01HC55222, N01HC85079, N01HC85080, N01HC85081, N01HC85082, N01HC85083, and N01HC85086 and grants KL2TR001424, R01HL107577, U01HL080295, and U01HL130114 from the NIH's National Center for Advancing Translational Sciences, and National Heart, Lung, and Blood Institute (NHLBI), with additional contribution from the National Institute of Neurological Disorders and Stroke (NINDS). Additional support was provided by R01AG023629 from the National Institute on Aging (NIA). A full list of principal CHS investigators and institutions can be found at CHS-NHLBI.org.

Why you should read this article: • To recognise how older age and pre-existing multimorbidity may complicate the self-management of cancer • To learn about research that showed how a reduction in physical function due to cancer affected older people's ability to manage their health, other responsibilities and live their everyday lives • To identify the role of healthcare professionals, including nurse specialists, in enhancing older people's ability to self-manage cancer Background: Many older people who are living with cancer do so with concurrent complex health and social issues. Assessment and treatment planning for cancer often focus primarily on the disease, missing opportunities to identify and address these significant wider concerns. Aim: To gain an understanding of the factors that can increase or reduce older people's capacity to manage the workload associated with the self-management of cancer and other conditions. Method: Secondary analysis of questionnaire data comprising 224 responses to 19 structured items covering health and daily living issues and analysis of free-text responses, focusing on factors affecting an individual's capacity to manage their workload associated with living with cancer. Results: Reduced physical function affected many respondents' capacity to manage their health and other responsibilities and to live their everyday lives. Many respondents were concerned about continuing to care for those dependent on them and identified factors that enhanced their capacity in their social network and from healthcare professionals. Organisational factors such as scheduled appointments, transport and availability of parking further affected respondents' capacity. Conclusion: There is an implicit need to identify and address the main factors that can increase an individual's capacity to manage their health and to support the delivery of person-centred cancer treatment and care plans. [ABSTRACT FROM AUTHOR]

Abstract Background Sarcopenia is defined as the loss of muscle mass and strength with age. Although a number of adult influences are recognised, there remains considerable unexplained variation in muscle mass and strength between older individuals. This has focused attention on influences operating earlier in life. Our objective for this study was to identify life course influences on muscle mass and strength in an established birth cohort and develop methodology for collection of muscle tissue suitable to investigate underlying cellular and molecular mechanisms. Methods One hundred and five men from the Hertfordshire Cohort Study (HCS), born between 1931 and 1939 who have historical records of birth weight and weight at one year took part in the Hertfordshire Sarcopenia Study (HSS). Each participant consented for detailed characterisation of muscle mass, muscle function and aerobic capacity. In addition, a muscle biopsy of the vastus lateralis using a Weil-Blakesley conchotome was performed. Data on muscle mass, function and aerobic capacity was collected on all 105 participants. Muscle biopsy was successfully carried out in 102 participants with high rates of acceptability. No adverse incidents occurred during the study. Discussion The novel approach of combining epidemiological and basic science characterisation of muscle in a well established birth cohort will allow the investigation of cellular and molecular mechanisms underlying life course influences on sarcopenia.