Trends in Frailty and Use of Evidence-Based Pharmacotherapy for Heart Failure in Australian Hospitalised Patients: An Observational Study

Frailty increases morbidity and mortality in heart failure (HF) patients. Current risk-adjustment models do not include frailty-status and the relationship between frailty and pharmacotherapy is unclear. This study explored trends in frailty over time and its relationship with prescription of heart failure specific pharmacotherapy in hospitalised HF patients. We used the Hospital Frailty Risk Score (HFRS) to determine frailty status of patients ≥18 years admitted between 2015–2019 at two tertiary hospitals in Australia. Patients with an HFRS ≥ 5 were classified as frail. In the 3706 patients with a mean (SD) age of 76.1 (14.4) years, 876 (23.6%) were classified as frail. HFRS was weakly correlated with age (r = 0.16) and Charlson-index (r = 0.35) (both p values < 0.001). Whilst frailty was more common in older HF patients (28.9% of patients ≥80 years), 15.1% of patients ≤65 years of age were also found to be frail. The proportion of frail patients increased from 19.4% in 2015 to 29.2% in 2019 despite no significant change in age during this period. The proportion of patients who received heart failure specific pharmacotherapy decreased from 86.7% in 2015 to 82.9% in 2019 (p value = 0.03) and frail patients were significantly less likely to be prescribed HF specific pharmacotherapy than non-frail patients (77.4% vs. 85.9%, p < 0.001).