Frailty in advanced heart failure patients was associated with an increased risk of adverse events compared to non-frail patients (25% vs 9%; OR 2.8; 95% CI 1.1-6.8; p=0.02).
Observational (n=170)
No
Does frailty, assessed by the ESC-HFA multidimensional tool, predict adverse clinical events and worse quality of life in patients with advanced heart failure?
Multidimensional frailty assessment using the ESC-HFA criteria identifies advanced heart failure patients who are at significantly higher risk for adverse clinical events and poor quality of life.
Effect estimate: OR 2.8 (95% CI 1.1-6.8)
Absolute Event Rate: 25% vs 9%
p-value: p=0.02
Abstract Introduction Frailty is frequently observed in heart failure (HF) and its assessment is recommended for patients referred for heart transplantation (HT). Purpose This study aimed to develop a frailty screening protocol for an advanced HF outpatient service. Methods From May 2024 to February 2025, we assessed frailty, functional capacity, and quality of life (QoL) in all patients referred to our HF center or listed for HT. The patients underwent a 6-minute walking test (6MWT), handgrip strength test (HST), short physical performance battery (SPPB), mini-COG test, instrumental activities of daily living (IADL) evaluation, Patient Health Questionnaire 9 (PHQ-9), and Kansas City Cardiomyopathy Questionnaire (KCCQ). Frailty was defined using the ESC-HFA tool across four domains: clinical (weight loss or more than three non-cardiac comorbidities), psycho-cognitive (pathological PHQ-9 and mini-COG tests), functional (impaired IADL or SPPB 10) and social (lack of a caregiver or institutionalization). Frailty was correlated with the clinical aspects of functional capacity, quality of life (QoL, assessed with KCCQ), and a composite endpoint of hospitalization for HF, outpatient intravenous diuretic administration and death. Results A total of 170 patients were included in the study (mean age 56±1 years). The majority of patients had HFrEF (77%), with a mean LVEF of 33±13%. 67% were NYHA class II and 21% were class III. Half of the patients presented with ≥ 3 non-cardiac comorbidities. The mean 6MWT distance was 413±90 mts and HST was reduced in 18%. 33% showed poor SPPB performance. Mini-COG detected subclinical cognitive impairment in 19 patients, while PHQ-9 revealed depression in 30% of subjects. The fulfillment of the clinical, psycho-cognitive, functional and social domains was 68%, 37%, 39%, and 3% respectively. 37% met the criteria for a single domain, whereas 45% for ≥2 domains and were considered frail. They were older (58±9 vs. 53±9 years, p=0.001), more frequently in NYHA class III-IV (32 vs. 9%, p=0.001), with HF duration 5 years (72 vs. 57%, p=0.03), and showed trend towards increased HF hospitalization (p=0.09). Frail patients had lower LVEF (30 vs. 35%, p=0.009) and worse functional capacity at 6MWT (377±94 vs. 442±76, p0.0001). They reported worse QoL (mean KCCQ score: 47±18 vs 71±16, p0.001), with a larger proportion experiencing poor or very poor QoL (56% vs 9%, p0.0001). After a median follow-up period of 170 days (0-248), 23 events but no deaths were recorded. Frail patients showed increase risk of adverse events (25 vs 9%, OR 2,8 1,1-6,8, p=0.02) Conclusion Multidimensional assessment according to the HFA criteria revealed that frailty is common HF patients. Frailty is associated with worse symptoms, functional capacity and HF severity. Moreover, it negatively impacts QoL and is associated with worse prognosis. Additional research is needed to confirm its prognostic significance and address reversible factors.
Gallingani et al. (Sat,) conducted a observational in Advanced heart failure (n=170). Frailty assessment (ESC-HFA tool) vs. Non-frail patients was evaluated on Composite of hospitalization for HF, outpatient intravenous diuretic administration, and death (OR 2.8, 95% CI 1.1-6.8, p=0.02). Frailty in advanced heart failure patients was associated with an increased risk of adverse events compared to non-frail patients (25% vs 9%; OR 2.8; 95% CI 1.1-6.8; p=0.02).