Frailty is associated with poorer health-related quality of life among adult heart transplant recipients: a cross-sectional study

Frailty has recognized prognostic value in cardiovascular disease, but its relationship with health-related quality of life (HRQoL) after heart transplantation remains poorly characterized in middle-income settings. This study evaluated frailty and HRQoL among adult heart transplant survivors. We conducted a cross-sectional analysis of adult heart transplant recipients at a national referral center in Colombia. HRQoL was assessed using the EuroQol 5-Dimension 3-Level instrument, and frailty was evaluated using a self-reported FRAIL scale administered by telephone. Participants were classified as non-frail, prefrail, or frail. EQ-5D index scores were compared using Bonferroni-corrected pairwise tests. Multivariable linear regression with robust standard errors was used as an exploratory analysis. Seventy-three recipients were included: 39 non-frail, 29 prefrail, and 5 frail. EQ-5D index scores decreased across frailty categories. Non-frail participants had higher scores than prefrail and frail participants, and prefrail participants had higher scores than frail participants. In exploratory multivariable analysis, frail participants showed lower HRQoL scores than non-frail participants (β = −0.19; 95% CI, − 0.32 to − 0.06; p = 0.005), whereas prefrail participants showed no clear difference (β = −0.01; 95% CI, − 0.08 to 0.06; p = 0.797). Hypertension also showed an exploratory inverse relationship with EQ-5D index scores (β = −0.11; 95% CI, − 0.19 to − 0.02; p = 0.013). Among long-term survivors, frail participants showed lower HRQoL scores, whereas prefrail participants showed no clear differences. Given the design, small frail subgroup, and survivorship bias, these findings should be interpreted as exploratory and hypothesis-generating.