Frailty and long-term prognosis in elderly patients with chronic heart failure

Objectives Heart failure (HF) is the main cause of hospitalization in patients over 65 years and has a poor short- and long-term outcome. Frailty, frequently unrecognized, seems to worsen the prognosis in this population. We aimed to analyze the impact of frailty in chronic HF patients ≥75 years. Design Prospective observational multicenter study. Setting and participants Inclusion in 16 Spanish centers, from March to September 2019. Methods Comprehensive prospective geriatric evaluation was performed in all patients. Frailty was assessed according to Visual Mobility Scale (VMS, frail if ≥2). Follow-up was conducted through routinely clinical visits, electronical medical record or telephonic consultations. Survival rates were analyzed by Cox regression model. Results A total of 499 ambulatory patients ≥75 years with chronic HF were included. Mean age was 81.4±4.3 years (38% female). At three years follow-up, 174 patients died (34%). Frail patients had significantly higher mortality (117, 43% vs 57, 25% p < 0.001). In the multivariate analysis (Figure 1), frailty, together with age, anaemia, lymphopenia, higher levels of natriuretic peptides and higher comorbidity, was independently associated with mortality at 3 years follow-up (HR 1.47, 95%, CI 1.04-2.07, p=0.02). Conclusions and Implications Frailty is an independent predictor of mortality at long-term follow-up in elderly patients with chronic HF. Our results reinforce the importance of including frailty in scores assessing long-term prognosis of elderly patients with HF.