Effect of frailty on treatment, hospitalisation and death in patients with chronic heart failure

Clin Res Cardiol. 2021 Aug;110(8):1249-1258. doi: 10.1007/s00392-020-01792-w. Epub 2021 Jan 5.

Abstract

Background: Frailty is common in patients with chronic heart failure (CHF) and is associated with poor outcomes. The natural history of frail patients with CHF is unknown.

Methods: Frailty was assessed using the clinical frailty scale (CFS) in 467 consecutive patients with CHF (67% male, median age 76 years, median NT-proBNP 1156 ng/L) attending a routine follow-up visit. Those with CFS > 4 were classified as frail. We investigated the relation between frailty and treatments, hospitalisation and death in patients with CHF.

Results: 206 patients (44%) were frail. Of 291 patients with HF with reduced ejection fraction (HeFREF), those who were frail (N = 117; 40%) were less likely to receive optimal treatment, with many not receiving a renin-angiotensin-aldosterone system inhibitor (frail: 25% vs. non-frail: 4%), a beta-blocker (16% vs. 8%) or a mineralocorticoid receptor antagonist (50% vs 41%). By 1 year, there were 56 deaths and 322 hospitalisations, of which 25 (45%) and 198 (61%), respectively, were due to non-cardiovascular (non-CV) causes. Most deaths (N = 46, 82%) and hospitalisations (N = 215, 67%) occurred in frail patients. Amongst frail patients, 43% of deaths and 64% of hospitalisations were for non-CV causes; 58% of cardiovascular (CV) deaths were due to advancing HF. Among non-frail patients, 50% of deaths and 57% of hospitalisations were for non-CV causes; all CV deaths were due to advancing HF.

Conclusion: Frailty in patients with HeFREF is associated with sub-optimal medical treatment. Frail patients are more likely to die or be admitted to hospital, but whether frail or not, many events are non-CV.

Keywords: Cause of death; Cause of hospitalisation; Frailty; Heart failure.

MeSH terms

  • Aged
  • Biomarkers / blood
  • Cardiovascular Agents / therapeutic use*
  • Chronic Disease
  • Female
  • Frail Elderly
  • Frailty*
  • Heart Failure / drug therapy*
  • Heart Failure / mortality*
  • Hospital Mortality
  • Hospitalization*
  • Humans
  • Male
  • Natriuretic Peptide, Brain / blood
  • Peptide Fragments / blood
  • Risk Factors
  • Stroke Volume

Substances

  • Biomarkers
  • Cardiovascular Agents
  • Peptide Fragments
  • pro-brain natriuretic peptide (1-76)
  • Natriuretic Peptide, Brain