Course and prognosis of heart failure in patients with frailty syndrome

Aim. To study the prevalence of frailty syndrome and major geriatric syndromes in hospitalized patients with heart failure (HF), as well as the prognosis depending on frailty severity.

Material and methods. We prospectively included 250 patients over 75 years old, hospitalized for decompensated HF (median age, 83,0 [77,0-86,0] years; men, 41,6% (n=104)). In addition to traditional paraclinical investigations, including N-terminal pro-brain natriuretic peptide and echocardiography, all patients were assessed for frailty using the "Age Is Not a Barrier" questionnaire on the 5th day of hospitalization. Score of 2 or less was recognized as absence of frailty, while score of 3-4 — as probable prefrailty, and score of 5-7 — probable frailty. Patients with intermediate score of 3-4 were given a brief physical functioning tests to clarify the frailty. To assess the prevalence of other geriatric syndromes, all patients underwent cognitive function assessment using the Montreal Cognitive Assessment and functional independence using the Barthel scale. The primary endpoint was all-cause inhospital mortality.

Results. The prevalence of SSA was 64,0% (n=160) in hospitalized patients with HF. The frequency of preserved left ventricular ejection fraction in patients with HF and frailty was 51,1%. Patients with frailty and HF were characterized by worse exercise tolerance (NYHA class III-IV, 90,6% vs. 65,6%, p<0,05), higher N-terminal probrain natriuretic peptide (2912,5 [1709,0-6455,0] vs. 1903,1 [1577,3-3031,8] pg/ml, p<0,05) compared to patients with HF and without frailty. The duration of intravenous diuretic therapy and hospitalization in patients with frailty and HF were higher than in patients without frailty (7,1±3,4 vs. 5,5±3,4 days (p<0,05); 8,1±3,5 vs. 7,1±2,7 days (p<0,05), respectively). The primary endpoint was achieved in 16,1% (n=22) with concomitant frailty compared to 7,1% (n=8) in patients with HF and without frailty (p<0,05). Frailty increased the probability of inhospital mortality by almost 3 times in elderly patients with HF (OR 2,8; 95% CI 1,2-6,4, p<0,05).

Conclusion. The relevance of a comprehensive geriatric assessment in an elderly patient with HF is due to the high prevalence of frailty in this cohort of patients and its significant impact on the prognosis. Identification of frailty can help in making important clinical decisions, identifying a high-risk group for complications, and possibly optimizing treatment. Given that frailty can be potentially reversible, this particularly emphasizes the importance of optimizing HF therapy, on the one hand, and conducting a comprehensive frailty assessment in elderly patients with HF, on the other, to improve the prognosis of both diseases.

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