Abstract
Frailty increases morbidity and mortality in heart failure (HF) patients. Current risk-adjustment models do not include frailty-status and the relationship between frailty and pharmacotherapy is unclear. This study explored trends in frailty over time and its relationship with prescription of heart failure specific pharmacotherapy in hospitalised HF patients. We used the Hospital Frailty Risk Score (HFRS) to determine frailty status of patients ≥18 years admitted between 2015–2019 at two tertiary hospitals in Australia. Patients with an HFRS ≥ 5 were classified as frail. In the 3706 patients with a mean (SD) age of 76.1 (14.4) years, 876 (23.6%) were classified as frail. HFRS was weakly correlated with age (r = 0.16) and Charlson-index (r = 0.35) (both p values < 0.001). Whilst frailty was more common in older HF patients (28.9% of patients ≥80 years), 15.1% of patients ≤65 years of age were also found to be frail. The proportion of frail patients increased from 19.4% in 2015 to 29.2% in 2019 despite no significant change in age during this period. The proportion of patients who received heart failure specific pharmacotherapy decreased from 86.7% in 2015 to 82.9% in 2019 (p value = 0.03) and frail patients were significantly less likely to be prescribed HF specific pharmacotherapy than non-frail patients (77.4% vs. 85.9%, p < 0.001).
Highlights
Frailty is an important prognostic factor among patients with heart failure because it increases both morbidity and mortality [1]
It is often assumed that the reason for non-prescription or non-achievement of the targeted dose of heart failure specific medications in these patients is due to an increasing age or the higher risk of frailty in these patients [13]
This study proved that, over a wide age range, a significant proportion of patients who were admitted with heart failure were identified as frail according to the Hospital Frailty Assessment Tool (HFRS) and the who were admitted with heart failure were identified as frail according to the HFRS and proportion of inpatients with heart failure who were frail has increased in the last five years the proportion of inpatients with heart failure who were frail has increased in the last five despite no significant aging of this population
Summary
Frailty is an important prognostic factor among patients with heart failure because it increases both morbidity and mortality [1]. The current risk adjustment models determining prognosis in heart failure, does not incorporate frailty [2,3]. The Hospital Frailty Assessment Tool (HFRS) has recently been developed in the UK, and can be generated based on routinely available hospital administrative data [6] This tool was originally developed for individuals aged 75 years or older, it has been validated and is generalisable in different age groups and health care settings [7,8]. It is often assumed that the reason for non-prescription or non-achievement of the targeted dose of heart failure specific medications in these patients is due to an increasing age or the higher risk of frailty in these patients [13]. Only one study [3] has investigated the trends in frequency of frailty among hospitalised heart failure patients
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