Carlos Rodríguez-Pascual1, Emilio Paredes-Galán2, Ana-Isabel Ferrero-Martínez3, Jose-Luis Gonzalez-Guerrero4, Mercedes Hornillos-Calvo5, Rocio Menendez-Colino6, Ivett Torres-Torres7, Arturo Vilches-Moraga8, Maria-Concepcion Galán9, Francisco Suarez-Garcia10, Maria-Teresa Olcoz-Chiva11, Fernando Rodríguez-Artalejo12. 1. Geriatric Medicine Department, Complejo Hospitalario Universitario de Vigo, Spain; University of Lincoln, Lincoln County Hospital, Lincoln, Lincolnshire, United Kingdom. Electronic address: CRodriguezpascual@lincoln.ac.uk. 2. Cardiology Department, Complejo Hospitalario Universitario de Vigo, Spain. Electronic address: eparedesgalan@hotmail.com. 3. Geriatric Medicine Department, Complejo Hospitalario Universitario de Vigo, Spain. Electronic address: anaiferrero@yahoo.es. 4. Geriatric Medicine Department, Complejo Hospitalario de Cáceres, Spain. Electronic address: jlgonzalez@movistar.es. 5. Geriatric Medicine Department, Hospital Universitario de Guadalajara, Departamento de Medicina, Universidad de Alcalá de Henares, Madrid, Spain. Electronic address: mhornillos@sescam.jccm.es. 6. Geriatric Medicine Department, Hospital Universitario La Paz, Departamento de Medicina, Facultad de Medicina, Universidad Autónoma de Madrid, Spain. Electronic address: rociocolino@hotmail.com. 7. Geriatric Medicine Department, Complejo Hospitalario de Albacete, Spain. Electronic address: igttorres@outlook.es. 8. Geriatric Medicine Department, Complejo Hospitalario Universitario de Vigo, Spain. Electronic address: avilchesm@yahoo.co.uk. 9. Geriatric Medicine Department, Complejo Hospitalario de Oviedo, Departamento de Medicina, Universidad de Oviedo, Spain. Electronic address: conchitagalan@yahoo.es. 10. Geriatric Medicine Department, Complejo Hospitalario de Oviedo, Departamento de Medicina, Universidad de Oviedo, Spain. Electronic address: fransua1968@me.com. 11. Geriatric Medicine Department, Complejo Hospitalario Universitario de Vigo, Spain; Department of Care of the Elderly,Lincoln County Hospital, Lincoln, United Kingdom. Electronic address: molcchi@gmail.com. 12. Department of Preventive Medicine and Public Health, Universidad Autónoma de Madrid/IdiPaz, CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain. Electronic address: fernando.artalejo@uam.es.
Abstract
BACKGROUND: Most studies on the association between the frailty syndrome and adverse health outcomes in patients with heart failure (HF) have used non-standard definitions of frailty. This study examined the association of frailty, diagnosed by well-accepted criteria, with mortality, readmission and functional decline in very old ambulatory patients with HF. METHODS: Prospective study with 497 patients in six Spanish hospitals and followed up during one year. Mean (SD) age was 85.2 (7.3) years, and 79.3% had LVEF >45%. Frailty was diagnosed as having ≥3 of the 5 Fried criteria. Readmission was defined as a new episode of hospitalisation lasting >24h, and functional decline as an incident limitation in any activity of daily living at the 1-year visit. Statistical analyses were performed with Cox and logistic regression, as appropriate, and adjusted for the main prognostic factors at baseline. RESULTS: At baseline, 57.5% of patients were frail. The adjusted hazard ratio (95% confidence interval) for mortality among frail versus non-frail patients was 1.93 (1.20-3.27). Mortality was higher among patients with low physical activity [1.64 (1.10-2.45)] or exhaustion [1.83 (1.21-2.77)]. Frailty was linked to increased risk of readmission [1.66 (1.17-2.36)] and functional decline [odds ratio 1.67 (1.01-2.79)]. Slow gait speed was related to functional decline [odds ratio 3.59 (1.75-7.34)]. A higher number of frailty criteria was associated with a higher risk of the three study outcomes (P trend<0.01 in each outcome). CONCLUSIONS: Frailty was associated with increased risk of 1-year mortality, hospital readmission and functional decline among older ambulatory patients with HF.
BACKGROUND: Most studies on the association between the frailty syndrome and adverse health outcomes in patients with heart failure (HF) have used non-standard definitions of frailty. This study examined the association of frailty, diagnosed by well-accepted criteria, with mortality, readmission and functional decline in very old ambulatory patients with HF. METHODS: Prospective study with 497 patients in six Spanish hospitals and followed up during one year. Mean (SD) age was 85.2 (7.3) years, and 79.3% had LVEF >45%. Frailty was diagnosed as having ≥3 of the 5 Fried criteria. Readmission was defined as a new episode of hospitalisation lasting >24h, and functional decline as an incident limitation in any activity of daily living at the 1-year visit. Statistical analyses were performed with Cox and logistic regression, as appropriate, and adjusted for the main prognostic factors at baseline. RESULTS: At baseline, 57.5% of patients were frail. The adjusted hazard ratio (95% confidence interval) for mortality among frail versus non-frail patients was 1.93 (1.20-3.27). Mortality was higher among patients with low physical activity [1.64 (1.10-2.45)] or exhaustion [1.83 (1.21-2.77)]. Frailty was linked to increased risk of readmission [1.66 (1.17-2.36)] and functional decline [odds ratio 1.67 (1.01-2.79)]. Slow gait speed was related to functional decline [odds ratio 3.59 (1.75-7.34)]. A higher number of frailty criteria was associated with a higher risk of the three study outcomes (P trend<0.01 in each outcome). CONCLUSIONS: Frailty was associated with increased risk of 1-year mortality, hospital readmission and functional decline among older ambulatory patients with HF.
Authors: Eiran Z Gorodeski; Parag Goyal; Scott L Hummel; Ashok Krishnaswami; Sarah J Goodlin; Linda L Hart; Daniel E Forman; Nanette K Wenger; James N Kirkpatrick; Karen P Alexander Journal: J Am Coll Cardiol Date: 2018-05-01 Impact factor: 24.094
Authors: Mary Roberts Davis; Christopher S Lee; Amy Corcoran; Nandita Gupta; Izabella Uchmanowicz; Quin E Denfeld Journal: Int J Cardiol Date: 2021-02-28 Impact factor: 4.039