Pooja Dewan1, Alice Jackson1, Pardeep S Jhund1, Li Shen1, João Pedro Ferreira2, Mark C Petrie1, William T Abraham3, Akshay S Desai4, Kenneth Dickstein5, Lars Køber6, Milton Packer7, Jean L Rouleau8, Scott D Solomon4, Karl Swedberg9, Michael R Zile10, John J V McMurray1. 1. BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, UK. 2. National Institute of Health and Medical Research (INSERM), Center for Clinical Multidisciplinary Research 1433, INSERM U1116, University of Lorraine, Regional University Hospital of Nancy, French Clinical Research Infrastructure Network (F-CRIN) Investigation Network Initiative-Cardiovascular and Renal Clinical Trialists (INI-CRCT), Nancy, France. 3. Division of Cardiovascular Medicine, Davis Heart and Lung Research Institute, Ohio State University, Columbus, OH, USA. 4. Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, USA. 5. University of Bergen, Stavanger University Hospital, Stavanger, Norway. 6. Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark. 7. Baylor Heart and Vascular Institute, Baylor University Medical Center, Dallas, TX, USA. 8. Institut de Cardiologie de Montréal, Université de Montréal, Montréal, Canada. 9. Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden and National Heart. 10. Medical University of South Carolina and Ralph H. Johnson Veterans Administration Medical Center, Charleston, SC, USA.
Abstract
AIMS: Frailty, characterized by loss of homeostatic reserves and increased vulnerability to physiological decompensation, results from an aggregation of insults across multiple organ systems. Frailty can be quantified by counting the number of 'health deficits' across a range of domains. We assessed the frequency of, and outcomes related to, frailty in patients with heart failure and reduced ejection fraction (HFrEF). METHODS AND RESULTS: Using a cumulative deficits approach, we constructed a 42-item frailty index (FI) and applied it to identify frail patients enrolled in two HFrEF trials (PARADIGM-HF and ATMOSPHERE). In keeping with previous studies, patients with FI ≤0.210 were classified as non-frail and those with higher scores were divided into two categories using score increments of 0.100. Clinical outcomes were examined, adjusting for prognostic variables. Among 13 625 participants, mean (± standard deviation) FI was 0.250 (0.10) and 8383 patients (63%) were frail (FI >0.210). The frailest patients were older and had more symptoms and signs of heart failure. Women were frailer than men. All outcomes were worse in the frailest, with high rates of all-cause death or all-cause hospitalization: 40.7 (39.1-42.4) vs. 22.1 (21.2-23.0) per 100 person-years in the non-frail; adjusted hazard ratio 1.63 (1.53-1.75) (P < 0.001). The rate of all-cause hospitalizations, taking account of recurrences, was 61.5 (59.8-63.1) vs. 31.2 (30.3-32.2) per 100 person-years (incidence rate ratio 1.76; 1.62-1.90; P < 0.001). CONCLUSION: Frailty is highly prevalent in HFrEF and associated with greater deterioration in quality of life and higher risk of hospitalization and death. Strategies to prevent and treat frailty are needed in HFrEF.
AIMS: Frailty, characterized by loss of homeostatic reserves and increased vulnerability to physiological decompensation, results from an aggregation of insults across multiple organ systems. Frailty can be quantified by counting the number of 'health deficits' across a range of domains. We assessed the frequency of, and outcomes related to, frailty in patients with heart failure and reduced ejection fraction (HFrEF). METHODS AND RESULTS: Using a cumulative deficits approach, we constructed a 42-item frailty index (FI) and applied it to identify frail patients enrolled in two HFrEF trials (PARADIGM-HF and ATMOSPHERE). In keeping with previous studies, patients with FI ≤0.210 were classified as non-frail and those with higher scores were divided into two categories using score increments of 0.100. Clinical outcomes were examined, adjusting for prognostic variables. Among 13 625 participants, mean (± standard deviation) FI was 0.250 (0.10) and 8383 patients (63%) were frail (FI >0.210). The frailest patients were older and had more symptoms and signs of heart failure. Women were frailer than men. All outcomes were worse in the frailest, with high rates of all-cause death or all-cause hospitalization: 40.7 (39.1-42.4) vs. 22.1 (21.2-23.0) per 100 person-years in the non-frail; adjusted hazard ratio 1.63 (1.53-1.75) (P < 0.001). The rate of all-cause hospitalizations, taking account of recurrences, was 61.5 (59.8-63.1) vs. 31.2 (30.3-32.2) per 100 person-years (incidence rate ratio 1.76; 1.62-1.90; P < 0.001). CONCLUSION: Frailty is highly prevalent in HFrEF and associated with greater deterioration in quality of life and higher risk of hospitalization and death. Strategies to prevent and treat frailty are needed in HFrEF.
Authors: Aude Angelini; Jesus Ortiz-Urbina; JoAnn Trial; Anilkumar K Reddy; Anna Malovannaya; Antrix Jain; Mark L Entman; George E Taffet; Katarzyna A Cieslik Journal: Am J Physiol Heart Circ Physiol Date: 2022-06-17 Impact factor: 5.125