Prevalence and prognosis of frailty in older patients with stage B heart failure with preserved ejection fraction.

Abstract

Frailty in older patients with stage B heart failure with preserved ejection fraction (HFpEF) has not been fully explored. We evaluated the prevalence and prognostic significance of frailty in older patients diagnosed with stage B HFpEF. Our prospective cohort study included inpatients aged ≥65years who were followed up for 3years. Stage B HFpEF was defined as cardiac structural or functional abnormalities with a left ventricular ejection fraction (LVEF)≥50% without signs or symptoms. Frailty was assessed using the Fried phenotype. The primary outcome was 3-year all-cause mortality or readmission. Overall, 520 older inpatients diagnosed with stage B HFpEF [mean±standard deviation age: 75.5±6.25years, male: 222 (42.7%)] were included in the study. Of these, 145 (27.9%) were frail. Frail patients were older (78.5±6.23 vs. 74.3±6.22years, P<0.001), with a lower body mass index (24.6±3.60 vs. 25.7±3.27kg/m2 , P=0.001), higher level of N-terminal pro-B-type natriuretic peptide [279 (interquartile range: 112.4, 596) vs. 140 (67.1, 266) pg/mL, P<0.001], longer timed up-and-go test result (19.9±9.71 vs. 13.3±5.08s, P<0.001), and poorer performance in the short physical performance battery (4.1±3.26 vs. 8.2±2.62, P<0.001), basic activities of daily living (BADL, 4.7±1.71 vs. 5.7±0.57, P<0.001), and instrumental activities of daily living (IADL, 4.4±2.73 vs. 7.4±1.33, P<0.001). Frail patients were more likely to have a Mini-Mental State Examination (MMSE) score <24 (55.9% vs. 28.8%, P<0.001) and take more than five medications (64.1% vs. 47.2%, P=0.001). Frail patients had a higher incidence of all-cause mortality or readmission (62.8% vs. 47.7%, P=0.002), all-cause readmission (56.6% vs. 45.9%, P=0.029), and readmission for non-heart failure (55.2% vs. 41.3%, P=0.004) during the 3-year follow-up, with a 1.53-fold (95%CI 1.11-2.11, P=0.009) higher risk of all-cause mortality or readmission, a 1.52-fold (95%CI 1.09-2.11, P=0.014) higher risk of all-cause readmission, and a 1.70-fold (95%CI 1.21-2.38, P=0.002) higher risk of readmission for non-clinical heart failure, adjusted for sex, age, polypharmacy, Athens Insomnia Scale, MMSE, LVEF, BADL, and IADL. Frailty is common in elderly patients with stage B HFpEF. Physical frailty, particularly low physical activity, can independently predict the long-term prognosis in these patients.