Abstract
Objective Numerous studies have investigated the prognostic role of frailty in elderly patients with heart failure (HF), but the limited size of the reported studies has resulted in continued uncertainty regarding its prognostic impact. The aim of this study was to integrate the findings of all available studies and estimate the impact of frailty on the prognosis of HF by performing a systematic review and meta-analysis. Methods PubMed, Embase, Cochrane, and Web of Science databases were searched from inception to November 8th 2017 to identify eligible prospective studies. The Newcastle-Ottawa Scale (NOS) was used to evaluate study quality. The association between frailty and HF outcomes was reviewed. Overall hazard ratios (HRs) for the effects of frailty on all-cause mortality were pooled using a fixed-effect model and publication bias was evaluated using funnel plots. Results A total of 10 studies involving 3033 elderly patients with HF were included in the systematic review and meta-analysis. All eligible studies indicated that frailty was of prognostic significance for HF patients. The HRs for the effects of frailty on all-cause mortality were 1.70 (95% confidence interval (CI): 1.41–2.04), based on the pooling of six studies that provided related data. However, publication bias was observed among the studies. Conclusions Frailty has a high prevalence among older patients with HF. Elderly HF patients with frailty have a poorer prognosis than those without frailty. Further studies are now required to implement the use of frailty assessment tools and explore effective interventions for frailty in older HF patients.
Highlights
Due to the increased age of the general population, heart failure (HF) patients are predominantly elderly [1, 2]
Four studies were conducted in Italy [20, 22, 26, 28], three in the United States of America (USA) [19, 25, 27], and three in Spain [21, 23, 24]
hazard ratio (HR) 2.5; 95% confidence intervals (CI) = 1.0–6.0; P= 0.047 previous diagnostic of heart failure; Barthel index; baseline New York Heart Association (NYHA) class; tachycardia; hypoxemia; anemia; congestive heart failure (CHF) risk model; NT-proBNP
Summary
Due to the increased age of the general population, HF patients are predominantly elderly [1, 2]. The assessment of care for HF patients was primarily based on biological age and subjective symptoms. The health trajectory of the elderly is complex and cannot be interpreted by physical age criteria or a single disease-specific risk factor [6]. These indicators do not reflect the actual physical health status of older patients, and so current assessments do not fully explain the risk of HF in the elderly [7, 8]
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