Prognostic Value of Frailty for Older Patients with Heart Failure: A Systematic Review and Meta-Analysis of Prospective Studies

Abstract

Objective Numerous studies have investigated the prognostic role of frailty in elderly patients with heart failure (HF), but the limited size of the reported studies has resulted in continued uncertainty regarding its prognostic impact. The aim of this study was to integrate the findings of all available studies and estimate the impact of frailty on the prognosis of HF by performing a systematic review and meta-analysis. Methods PubMed, Embase, Cochrane, and Web of Science databases were searched from inception to November 8th 2017 to identify eligible prospective studies. The Newcastle-Ottawa Scale (NOS) was used to evaluate study quality. The association between frailty and HF outcomes was reviewed. Overall hazard ratios (HRs) for the effects of frailty on all-cause mortality were pooled using a fixed-effect model and publication bias was evaluated using funnel plots. Results A total of 10 studies involving 3033 elderly patients with HF were included in the systematic review and meta-analysis. All eligible studies indicated that frailty was of prognostic significance for HF patients. The HRs for the effects of frailty on all-cause mortality were 1.70 (95% confidence interval (CI): 1.41–2.04), based on the pooling of six studies that provided related data. However, publication bias was observed among the studies. Conclusions Frailty has a high prevalence among older patients with HF. Elderly HF patients with frailty have a poorer prognosis than those without frailty. Further studies are now required to implement the use of frailty assessment tools and explore effective interventions for frailty in older HF patients.

Frailty and the risk of all‐cause mortality and hospitalization in chronic heart failure: a meta‐analysis

“…Also, previous meta-analyses quantifying the link between frailty and outcomes in HF produced variable results, with overall HRs of 1.44-1.70 and 1.31-1.56 for all-cause mortality and hospitalization, respectively. [19][20][21] These results are somehow different from those documented in our present meta-analysis, despite the substantial overlap in the included source studies. Our findings suggest that this variance might originate from two sources: (i) characteristics of the study patients/setting and (ii) considered frailty measure.…”

“…The HRs for all‐cause mortality in the source studies included in our meta‐analysis ranged between 0.98 33 and 17.41, 35 and those for HF‐related hospitalization varied between 1.17 27 and 3.11, 38 with the overall HRs for all‐cause mortality and hospitalization equal 1.66 (95% CI: 1.45–1.90) and 1.51 (95% CI: 1.34–1.70), respectively. Also, previous meta‐analyses quantifying the link between frailty and outcomes in HF produced variable results, with overall HRs of 1.44–1.70 and 1.31–1.56 for all‐cause mortality and hospitalization, respectively 19–21 . These results are somehow different from those documented in our present meta‐analysis, despite the substantial overlap in the included source studies.…”

“…Heterogeneity across studies of frailty and clinical outcomes is undoubtedly multifactorial but at least in part constitutes a function of different clinical settings and the lack of an operational definition and measure of frailty 36 . The lack of the standardization was also reflected in a few recently published meta‐analyses examining the effects of frailty on all‐cause mortality and hospitalization risk; depending on the authors' approach to source study selection, the results differed, especially in terms of the magnitude of the effect of frailty on outcomes 19–22 . Given significant variation in both setting and the conceptualization and measurement of frailty in HF, and a constant influx of new evidence, the purpose of this meta‐analysis was to quantify the relationship between frailty and clinical outcomes (all‐cause mortality and hospitalization) among adults with HF.…”

<p>Early DNR Order and Long-Term Prognosis Among Patients Hospitalized for Acute Heart Failure: Single-Center Cohort Study in Japan</p>

“…Physicians often consider, in addition to heart failurespecific factors, other common negative prognostic factors, including the advanced stage of other illnesses, such as chronic pulmonary disease, dementia, and malignancy. Frailty is also a risk factor for increased mortality among heart failure patients, 19,20 and ADL-dependency is associated with a bad one-year prognosis in the general population. 21 Because elderly patients can present with multiple comorbidities, both physicians and patients often take into account the patient's functional capacity, cognitive function, and other heart failureunrelated disease-related conditions, when requesting a DNR order.…”

Frailty syndrome. What physicians and cardiologists need to know?

“…В настоящее время проведено несколько клинических исследований по изучению прогностической роли хрупкости у пожилых пациентов с хронической сердечной недостаточностью (ХСН). В одном из систематических обзоров 10 исследований с участием 3033 пожилых пациентов, страдающих ХСН, выявлено, что хрупкость, несомненно, имеет неблагоприятное прогностическое значение в отношении риска смертности от различных причин для данной когорты пациентов (ОР 1,70, 95% ДИ 1,41-2,04) [43]. В исследовании J. Afilalo и соавт., куда вошли только пожилые пациенты с тяжелой ишемической болезнью сердца или сердечной недостаточностью, распространенность хрупкости составила 54% и была достоверно связана с высоким риском смертности от различных причин (OР 1,6-4,0) [44].…”