Yuya Matsue1,2, Kentaro Kamiya3, Hiroshi Saito1,4, Kazuya Saito5, Yuki Ogasahara6, Emi Maekawa7, Masaaki Konishi8, Takeshi Kitai9, Kentaro Iwata10, Kentaro Jujo11, Hiroshi Wada12, Takatoshi Kasai1,2, Hirofumi Nagamatsu13, Tetsuya Ozawa14, Katsuya Izawa15, Shuhei Yamamoto16, Naoki Aizawa17, Ryusuke Yonezawa18, Kazuhiro Oka19, Shin-Ichi Momomura12, Nobuyuki Kagiyama20,21. 1. Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan. 2. Cardiovascular Respiratory Sleep Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan. 3. Department of Rehabilitation, School of Allied Health Science, Kitasato University, Tokyo, Japan. 4. Department of Rehabilitation, Kameda Medical Center, Kamogawa, Japan. 5. Department of Rehabilitation, The Sakakibara Heart Institute of Okayama, Okayama, Japan. 6. Department of Nursing, The Sakakibara Heart Institute of Okayama, Okayama, Japan. 7. Department of Cardiovascular Medicine, Kitasato University School of Medicine, Tokyo, Japan. 8. Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan. 9. Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan. 10. Department of Rehabilitation, Kobe City Medical Center General Hospital, Kobe, Japan. 11. Department of Cardiology, Nishiarai Heart Center Hospital, Tokyo, Japan. 12. Department of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Shimotsuke, Japan. 13. Department of Cardiology, Tokai University School of Medicine, Tokyo, Japan. 14. Department of Rehabilitation, Odawara Municipal Hospital, Odawara, Japan. 15. Department of Rehabilitation, Kasukabe Chuo General Hospital, Kasukabe, Japan. 16. Department of Rehabilitation, Shinshu University Hospital, Matsumoto, Japan. 17. Department of Cardiovascular Medicine, Nephrology and Neurology, University of the Ryukyus, Nishihara, Japan. 18. Department of Rehabilitation, Kitasato University Medical Center, Kitasato, Japan. 19. Department of Rehabilitation, Saitama Citizens Medical Center, Saitama, Japan. 20. Department of Cardiology, The Sakakibara Heart Institute of Okayama, Okayama, Japan. 21. West Virginia University Heart and Vascular Institute, Morgantown, WV, USA.
Abstract
AIMS: To describe the prevalence, overlap, and prognostic implications of physical and social frailties and cognitive dysfunction in hospitalized elderly patients with heart failure. METHODS AND RESULTS: The FRAGILE-HF study was a prospective multicentre cohort study enrolling consecutive hospitalized patients with heart failure aged ≥65 years. The study objectives were to examine the prevalence, overlap, and prognostic implications of the coexistence of multiple frailty domains. Physical frailty, social frailty, and cognitive dysfunction were evaluated by the Fried phenotype model, Makizako's 5 items, and Mini-Cog, respectively. The primary study outcome was the combined endpoint of heart failure rehospitalization and all-cause death within 1 year. Among 1180 enrolled hospitalized patients (median age, 81 years; 57.4% male), physical frailty, social frailty, and cognitive dysfunction were identified in 56.1%, 66.4%, and 37.1% of the patients, respectively. The number of identified frailty domains was 0, 1, 2, and 3 in 13.5%, 31.4%, 36.9%, and 18.2% of the patients, respectively. During follow-up, the combined endpoint occurred in 383 patients. Adjusted hazard ratios for 1, 2, and 3 domains, with 0 domains as the reference, were 1.38 [95% confidence interval (CI) 0.89-2.13; P = 0.15], 1.60 (95% CI 1.04-2.46; P = 0.034), and 2.04 (95% CI 1.28-3.24; P = 0.003), respectively. Incorporating the number of frailty domains into the pre-existing risk model yielded a 22.0% (95% CI 0.087-0.352; P = 0.001) net reclassification improvement for the primary outcome. CONCLUSIONS: The coexistence of multiple frailty domains is prevalent in hospitalized elderly patients with heart failure. Holistic assessment of multi-domain frailty provides additive value to known prognostic factors.
AIMS: To describe the prevalence, overlap, and prognostic implications of physical and social frailties and cognitive dysfunction in hospitalized elderly patients with heart failure. METHODS AND RESULTS: The FRAGILE-HF study was a prospective multicentre cohort study enrolling consecutive hospitalized patients with heart failure aged ≥65 years. The study objectives were to examine the prevalence, overlap, and prognostic implications of the coexistence of multiple frailty domains. Physical frailty, social frailty, and cognitive dysfunction were evaluated by the Fried phenotype model, Makizako's 5 items, and Mini-Cog, respectively. The primary study outcome was the combined endpoint of heart failure rehospitalization and all-cause death within 1 year. Among 1180 enrolled hospitalized patients (median age, 81 years; 57.4% male), physical frailty, social frailty, and cognitive dysfunction were identified in 56.1%, 66.4%, and 37.1% of the patients, respectively. The number of identified frailty domains was 0, 1, 2, and 3 in 13.5%, 31.4%, 36.9%, and 18.2% of the patients, respectively. During follow-up, the combined endpoint occurred in 383 patients. Adjusted hazard ratios for 1, 2, and 3 domains, with 0 domains as the reference, were 1.38 [95% confidence interval (CI) 0.89-2.13; P = 0.15], 1.60 (95% CI 1.04-2.46; P = 0.034), and 2.04 (95% CI 1.28-3.24; P = 0.003), respectively. Incorporating the number of frailty domains into the pre-existing risk model yielded a 22.0% (95% CI 0.087-0.352; P = 0.001) net reclassification improvement for the primary outcome. CONCLUSIONS: The coexistence of multiple frailty domains is prevalent in hospitalized elderly patients with heart failure. Holistic assessment of multi-domain frailty provides additive value to known prognostic factors.