Physical Frailty, Self-Care Behaviors, and 6-Month Clinical Outcomes Among Adults With Heart Failure

Background: Many adults with heart failure (HF) are physically frail, and HF self-care behaviors, especially symptom monitoring and management (SMM), may affect physical frailty; however, the association between SMM behaviors and physical frailty has not been studied. Objective: In this study, we aimed to quantify associations between SMM behaviors and physical frailty and to determine their combined influence on 6-month clinical outcomes. Methods: We conducted a prospective observational study of adults with New York Heart Association (NYHA) functional class II–IV HF. Physical frailty was assessed with the Frailty Phenotype Criteria. SMM behaviors were measured with the Self-care of HF Index (v.7.2). Logistic regression was used to quantify the association between SMM behaviors and physical frailty. Cox regression was used to quantify the combined influence of frail versus nonfrail and adequate versus inadequate SMM behaviors on all-cause 6-month clinical events. Results: The sample (n = 126) was 68.3 ± 12.6 years and 48% female. Most were NYHA Class III HF (54%) and had HF with nonischemic etiology (73%). Forty-three (34%) participants were physically frail. Better symptom monitoring ( P = .037) and better symptom management ( P = .023) were associated with physical frailty, after adjusting for mortality risk score. Physical frailty was associated with significantly worse 6-month clinical event risk irrespective of adequacy of symptom monitoring. Combination of physical frailty and symptom management did not predict 6-month clinical events. Conclusions: Physical frailty may drive adults with HF to engage in better SMM. Physical frailty, however, remains an important predictor of clinical event risk regardless of how well adults monitor and manage their HF symptoms.