Prevalence and prognostic impact of the coexistence of multiple frailty domains in elderly patients with heart failure: the FRAGILE‐HF cohort study

Abstract

Aims To describe the prevalence, overlap, and prognostic implications of physical and social frailties and cognitive dysfunction in hospitalized elderly patients with heart failure. Methods and results The FRAGILE‐HF study was a prospective multicentre cohort study enrolling consecutive hospitalized patients with heart failure aged ≥65 years. The study objectives were to examine the prevalence, overlap, and prognostic implications of the coexistence of multiple frailty domains. Physical frailty, social frailty, and cognitive dysfunction were evaluated by the Fried phenotype model, Makizako's 5 items, and Mini‐Cog, respectively. The primary study outcome was the combined endpoint of heart failure rehospitalization and all‐cause death within 1 year. Among 1180 enrolled hospitalized patients (median age, 81 years; 57.4% male), physical frailty, social frailty, and cognitive dysfunction were identified in 56.1%, 66.4%, and 37.1% of the patients, respectively. The number of identified frailty domains was 0, 1, 2, and 3 in 13.5%, 31.4%, 36.9%, and 18.2% of the patients, respectively. During follow‐up, the combined endpoint occurred in 383 patients. Adjusted hazard ratios for 1, 2, and 3 domains, with 0 domains as the reference, were 1.38 [95% confidence interval (CI) 0.89–2.13; P = 0.15], 1.60 (95% CI 1.04–2.46; P = 0.034), and 2.04 (95% CI 1.28–3.24; P = 0.003), respectively. Incorporating the number of frailty domains into the pre‐existing risk model yielded a 22.0% (95% CI 0.087–0.352; P = 0.001) net reclassification improvement for the primary outcome. Conclusions The coexistence of multiple frailty domains is prevalent in hospitalized elderly patients with heart failure. Holistic assessment of multi‐domain frailty provides additive value to known prognostic factors.

Prevalence and prognostic value of the coexistence of anaemia and frailty in older patients with heart failure

“…The questionnaires used to check and diagnose frailty were published in detail previously. 11 The Short Physical Performance Battery (SPPB), which consists of three components (standing balance, usual gait speed, repeated chair stands), was applied according to established methods, 15 with SPPB scores ranging from 0 to 12, that is 0-4 points for each component (0 = worst; 12 = best). The 6 min walking distance was determined according to the guidelines of the American Thoracic Society.…”

November 2020 at a glance: focus on comorbidities and medical treatment

“…The FRAGILE‐HF study was a prospective multicentre study investigating the prevalence, overlap, and prognostic implications of physical and social frailties and cognitive dysfunction in patients hospitalized with HF. Patients with a greater number of frailty domains had higher mortality and HF rehospitalization 12 . The prevalence of frailty is increased in HF with preserved ejection fraction (HFpEF) patients and is associated with worse outcome 13 .…”

Frailty and the failing heart do not travel alone

“…This highly relevant study by Matsue et al 7 . emphasizes the need for the healthcare team to develop a comprehensive strategy that addresses frailty from a whole‐system perspective as a key to better managed HF, which aligns with the Heart Failure Association of the European Society of Cardiology 11 and illustrated in Figure .…”

“…Importantly, Matsue and colleagues 7 emphasize the importance of managing HF. If frailty is to be viewed as a failure of multiple systems, it will be crucial to institute multidimensional strategies ( Figure ).…”

“…In this issue of the Journal, Matsue and colleagues 7 study the impact of a holistic definition of frailty that encompasses the interaction of physical, social and cognitive domains, as described by others, 8 in older patients with HF (with reduced or preserved ejection fraction) in the multicentre FRAGILE‐HF study ( n = 1180). Eligible patients were recruited at 15 participating (university and non‐university teaching) hospitals in Japan, they were hospitalized for HF, were at least 65 years of age (median age 81; 57% male) and could walk independently prior to their index hospital admission.…”