Frequency of adverse outcomes in hypertensive patients aged 80 years and older depending on heart failure and frailty syndrome

Aim. To assess the frequency of adverse outcomes during 12-month follow-up in hypertensive (HTN) patients depending on heart failure (HF) and frailty syndrome (FS).
Material and methods. The study included 320 patients with HTN, who were divided by HF and FS into following groups: group 1A — patients with HTN, FS and HF (n=84), group 1B — patients with HTN, FS without HF (n=77), group 2A — patients with HTN, HF without FS (n=84), group 2B — patients with HTN and without HF and FS (n=75). The FS was identified using the "Age is not a hindrance" questionnaire, and the incidence of adverse outcomes (composite endpoint and all-cause mortality) was analyzed after 12 months. The composite endpoint was cardiovascular mortality and HF-related hospitalization rate.
Results. In HF, the risk of composite endpoint was 2,9 times higher in FS patients with hypertension (p=0,028), while there was no significant effect on all-cause mortality (p=0,526). In non-FS patients with HTN, HF was accompanied by a 6,6-fold increase in the risk of composite endpoint (p=0,015) and a tendency to an increase in all-cause mortality (p=0,079). FS contributed to an increase in the risk of composite endpoint and all-cause mortality in non-HF patients with HTN by 4 and 3 times, respectively (when comparing groups 1B and 2B), and in patients with HTN and HF — by 76,4% and 49,4%, respectively (when comparing groups 1A and 2A). With a combination of FS and HF, patients with HTN had the highest incidence of composite endpoint (11,7 times) and all-cause mortality (3,1 times) compared with patients with HTN without HF and FS.
Conclusion. HF contributes to a significant increase in the risk of cardiovascular mortality and hospitalization due to HF in hypertensive patients with and without FS. A tendency towards an increase in all-cause mortality was demonstrated in FS patients with HTN and HF. FS increases the incidence of composite endpoint and all-cause mortality in patients with HTN regardless of HF. The combination of FS and HF in patients with HTN increases the risk of composite endpoint and all-cause death to the greatest extent.

1. Groenewegen A, Rutten FH, Mosterd A, et al. Epidemiology of heart failure. European journal of heart failure. 2020;22(8):1342-56. doi: 10.1002/ejhf.1858.

2. Turusheva AV, Frolova EV, Bogdanova TA. The prevalence of senile asthenia syndrome and its effect on functional status, depending on the diagnostic model used: the results of the "Hrustal" study. Rossijskij semejnyj vrach. 2021;25(1):35-43. (In Russ.) doi: 10.17816/RFD61632.

3. Vermeiren S, Vella-Azzopardi R, Beckwée D, et al. Frailty and the Prediction of Negative Health Outcomes: A Meta-Analysis. J Am Med Dir Assoc. 2016;17(12):1163.e1-1163.e17. doi: 10.1016/j.jamda.2016.09.010.

4. Tkacheva ON, Kotovskaya YuV, Runikhina NK, et al. Clinical guidelines on frailty. Russian Journal of Geriatric Medicine. 2020;(1):11-46. (In Russ.) doi:10.37586/2686-8636-1-2020-11-46.

5. Orlova YA, Tkacheva ON, Arutyunov GP, et al. Features of diagnosis and treatment of chronic heart failure in elderly and senile patients. Expert opinion from the Society of Heart Failure Specialists, the Russian Association of Gerontologists and Geriatricians and the Eurasian Association of Therapists. Kardiologiia. 2018;58(12S):42-72. (In Russ.) doi: 10.18087/cardio.2560.

6. Wang X, Zhou C, Li Y, et al. Prognostic Value of Frailty for Older Patients with Heart Failure: A Systematic Review and Meta-Analysis of Prospective Studies. Biomed Res Int. 2018;2018:8739058. doi: 10.1155/2018/8739058.

7. Safronenko VA, Chesnikova AI, Sementsova NA. Features of vascular rigidity in patients with arterial hypertension in combination with chronic heart failure and senile asthenia syndrome. Arterial Hypertension. 2022;28(6):659-68. (In Russ.) doi: 10.18705/1607-419X-2022-28-6-659-668.

8. Galyavich AS, Tereshchenko SN, Uskach TM, et al. Clinical practice guidelines for Chronic heart failure. Russian Journal of Cardiology. 2024;29(11):6162. (In Russ.) doi: 10.15829/1560-4071-2024-6162. EDN WKIDLJ.

9. Safronenko VA, Chesnikova AI. Treatment of comorbid patients over 80 years old: Focus at arterial hypertension (analysis of real clinical practice). Therapy. 2023;9(8):38-46. (In Russ.) doi: 10.18565/therapy.2023.8.38-46.

10. Krivoshapova KE, Vegner EA, Barbarash OL. Frailty syndrome as an independent predictor of adverse prognosis in patients with chronic heart failure. Kardiologiia. 2022; 62(3):89-96. (In Russ.) doi: 10.18087/cardio.2022.3.n1206.

11. Polyakov DS, Fomin IV, Belenkov YuN, et al. Chronic heart failure in the Russian Federation: what has changed over 20 years of follow-up? Results of the EPOCH-CHF study. Kardiologiia. 2021;61(4):4-14. (In Russ.) doi: 10.18087/cardio.2021.4.n1628.

12. Bottle A, Dani K, Benedict H, et al. Frailty and co-morbidity predict first hospitalisation after heart failure diagnosis in primary care: population-based observational study in England. Age Ageing. 2019;48(3):347-54. doi: 10.1093/ageing/afy194.

13. Virani S, Alonso A, Benjamin E, et al. Heart Disease and Stroke Statistics-2020 Update: A Report From the American Heart Association. Circulation. 2020;141(9):e139-e596. doi: 10.1161/CIR.0000000000000757.

14. Vinogradova NG, Polyakov DS, Fomin IV. The risks of re-hospitalization of patients with heart failure with prolonged follow-up in a specialized center for the treatment of heart failure and in real clinical practice. Kardiologiia. 2020;60(3):59-69. (In Russ.) doi: 10.18087/cardio.2020.3.n1002.

15. Jones N, Roalfe A, Adoki I, et al. Survival of patients with chronic heart failure in the community: a systematic review and meta-analysis. Eur J Heart Fail. 2019;21(11):1306-25. doi: 10.1002/ejhf.1594.

16. Podobed IV, Proshchaev KI, Akhmedov TA, et al. Geriatric aspects of the course of chronic heart failure. Modern Problems of Health Care and Medical Statistics. 2021;(1):303-25. (In Russ.) doi: 10.24411/2312-2935-2021-00022.