Key result
Combined physical and psychological frailty is linked to ~116% higher HF rehospitalization or death.
Why the study?
Physical frailty is a robust risk factor in patients with heart failure and coexistence of physical and psychological frailty is likely prognostic but not well characterized.
Does the combined presence of physical and psychological frailty increase the risk of adverse outcomes in patients with heart failure?
Cohort (n=2,502)
Yes
Does the combined presence of physical and psychological frailty increase the risk of adverse outcomes in patients with heart failure?
Hazard Ratio: 2.16 (95% CI 1.59–2.94)
The coexistence of physical and psychological frailty significantly increases the risk of mortality and heart failure rehospitalization, highlighting the need for comprehensive frailty assessment in HF patients.
Supports combined frailty assessment for refined HF risk stratification; extends observational data but leaves practice change open pending trials.
OBJECTIVES: Physical frailty becomes a robust risk factor in patients with heart failure (HF) and coexistence of physical and psychological frailty is likely to be a prognostic indicator. This study aimed to analyze the prognosis of coexistence of these two factors in patients with HF. METHODS: This study was a secondary analysis of a multicenter prospective cohort study (FLAGSHIP). We analyzed data from 2502 patients with HF from the FLAGSHIP study in Japan. We divided the patients into four physical frailty categories using a frailty score ranging from 0 to 14 (<4: I, 4-8: II, 9-12: III, and 14: IV, the score 13 does not exist in calculation). The higher category indicates more severe physical frailty. Psychological frailty was defined as the presence of cognitive decline and/or depressive symptoms. The study outcome was a 2-year composite outcome of rehospitalization for HF or all-cause mortality after hospital discharge. RESULTS: During the 3734.7 person-year follow-up, 774 patients experienced the composite outcome. After adjusting for confounders, physical and psychological frailty were independently associated with adverse outcomes. Using physical frailty category I, without psychological frailty as the reference, adjusted hazard ratios for adverse outcomes were 1.29 [95% confidence interval (CI) 0.86-1.92] for category I with psychological frailty, 0.99 (95% CI 0.71-1.37) for category II without psychological frailty, 1.61 (95% CI 1.16-2.23) for category II with psychological frailty, 1.56 (95% CI 1.14-2.15) for category III without psychological frailty, 1.62 (95% CI 1.20-2.20) for category III with psychological frailty, 1.50 (95% CI 1.05-2.14) for category IV without psychological frailty, and 2.16 (95% CI 1.59-2.94) for category IV with psychological frailty, respectively. CONCLUSIONS: Combined assessment of physical and psychological frailty leads to more detailed risk stratification of patients with HF.
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Iwatsu et al. (2022) conducted a cohort in Heart failure (n=2,502). Combined physical and psychological frailty vs. Physical frailty category I without psychological frailty was evaluated on 2-year composite outcome of rehospitalization for HF or all-cause mortality after hospital discharge (HR 2.16, 95% CI 1.59-2.94). Combined severe physical and psychological frailty was associated with an increased risk of heart failure rehospitalization or all-cause mortality compared to no frailty (HR 2.16; 95% CI 1.59-2.94).
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