Prognostic effect of systematic geriatric assessment on patients with acute heart failure.

Abstract

Frailty and dependence are frequent in patients admitted for acute heart failure (AHF), but their prognostic significance is unknown, especially in young adults. We aimed to study in adults admitted for AHF, regardless of age, the effect of frailty and dependence on the incidence of mortality and a combined event of mortality, readmissions for AHF, and visits to the emergency room (ER) for AHF at 1 and 6months. We designed a prospective cohort study by including all the patients with AHF admitted in our Cardiology Department from July 2020 through May 2021. A multidimensional geriatric assessment was performed during the admission. We clinically followed up the patients 6months after discharge. We enrolled 202 patients. The mean age was 73±12.32years, and 100 (49.5%) of the patients were elderly (>75years). Just 78 patients (38.6%) were women, and 100 (49.5%) had previous HF. Frailty (FRAIL≥3) was observed in 68 (33.7%) patients (mean FRAIL score: 1.88±1.48). Dependence (Barthel<100) was observed in 65 (32.2%) patients (mean Barthel index: 94.38±11.21). Frailty and dependence showed a significant association with both prognostic events at 1 and 6months. In the multivariable analysis, frailty was associated with higher mortality at 1month [hazard ratio (HR) 12.61, 95% confidence interval (CI) 1.57-101.47, P=0.017] but not at 6months (HR 2.25, 95% CI 0.61-8.26, P=0.224) or with the combined endpoint at neither 1month (HR 1.64, 95% CI 0.54-5.03, P=0.384) nor 6months (HR 1.35, 95% CI 0.75-2.46, P=0.320). Dependence was related to higher mortality at 1month (HR 13.04, 95% CI 1.62-104.75, P=0.016) and 6months (HR 7.18, 95% CI 1.99-25.86, P=0.003) and to higher incidence of the combined event at 1month (HR 5.93, 95% CI 1.63-21.50, P=0.007) and 6months (HR 2.62, 95% CI 1.49-4.61, P=0.001). In AHF patients, frailty and dependence implied a worse prognosis, rising mortality, readmissions, and ER visits for AHF.