Physical frailty and long-term mortality in older people with chronic heart failure with preserved and reduced ejection fraction: a retrospective longitudinal study

Shuo-Chun Weng,Chu-Sheng Lin,Shih-Yi Lin,Der-Cherng Tarng

doi:10.1186/s12877-020-01971-4

Abstract

BackgroundFrailty, a syndrome characterized by a decline in function reserve, is common in older patients with heart failure (HF) and is associated with prognosis. This study aimed to evaluate the impact of frailty on outcomes in older patients with preserved and reduced cardiac function.MethodsIn total, 811 adults aged ≥65 years were consecutively enrolled from 2009 to 2018. HF was diagnosed according to the ICD9 code and a 2D echocardiogram was categorized by reduced ejection fraction (HFrEF) and preserved ejection fraction (HFpEF). The index date was registered at the time of HF. All patients received a comprehensive geriatric assessment, and clinical outcomes were examined with adjustment of the other prognostic variables.ResultsMean age was 80.5 ± 7.1 years. The prevalence of HF, HFpEF, HFrEF, Fried, and Rockwood frailty indicators was 28.5, 10.4, 9.7, 52.5, and 74.9%, respectively. At baseline, scores in the Timed Up and Go test was closely associated with the severity of HF, either with HFpEF or HFrEF. After a mean follow-up of 3.2 ± 2.0 years, we found that HF patients with low handgrip strength (HGS) had the poorest survival, followed by non-HF patients with decreased HGS, and HF with fair HGS in comparison with non-HF with fair HGS (p = 0.008) if participants were arbitrarily divided into two HGS groups. In all patients, a high Rockwood frailty index was independently associated with increased mortality (adjusted hazard ratio [aHR] = 1.05; 95% confidence interval [CI]: 1.0004 to 1.10). In addition, the adjusted mortality HR was 3.42 with decreased HGS (95% CI: 1.03 to 11.40), 7.65 with use of mineralocorticoid receptor antagonist (95% CI: 2.22 to 26.32), and 1.26 with associated multi-comorbidities assessed by Charlson comorbidity index (95% CI: 1.05 to 1.51).ConclusionsOur study results indicate that frailty and decreased physical functions were associated with HF. Besides, frailty and HGS predicted prognosis in the patients, and there was a combined effect of HF and low HGS on survival.

Highlights

Frailty, a syndrome characterized by a decline in function reserve, is common in older patients with heart failure (HF) and is associated with prognosis
NT-proBNP and timed up and go test and cardiac ejection fraction We examined the relationships among LV ejection fraction (LVEF), NTproBNP, and different functional status of Timed Up and Go (TUG), handgrip strength (HGS), and 6 6-m walking (MW) in male HF and non-HF patients
Frailty and HGS predicted prognosis in the patients, and there was a combined effect of HF and low HGS on survival

Summary

Introduction

A syndrome characterized by a decline in function reserve, is common in older patients with heart failure (HF) and is associated with prognosis. In aging populations with HF, there is an increase in concomitant non-cardiac conditions, which can complicate management and contribute to adverse outcomes [3]. Among these comorbidities, frailty, a syndrome caused by multisystem dysregulations, impaired homeostasis, and decreased physiologic reserve, frequently occurs in HF patients with a prevalence ranging from 15 to 74%, depending on the studied population and the method of assessment [4,5,6]. Several frailty indicators, including gait speed (GS > 1.0 m/sec) [8], Timed Up and Go (TUG) test scores [7], and handgrip strength (HGS) [8] were each reported to be associated with prognosis in patients with HF

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