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

European Journal of Heart Failure - Tập 22 Số 11 - Trang 2112-2119 - 2020
Yuya Matsue1,2, Kentaro Kamiya3, Hiroshi Saitô2,4, Kazuya Saito5, Yuki Ogasahara6, Emi Maekawa7, Masaaki Konishi8, Takeshi Kitai9, K. Iwata10, Kentaro Jujo11, Hiroshi Wada12, Takatoshi Kasai1,2, Hirofumi Nagamatsu13, Tetsuya Ozawa14, Katsuya Izawa15, Shuhei Yamamoto16, Naoki Aizawa17, Ryusuke Yonezawa18, Kazuhiro Oka19, Shin‐ichi Momomura12, Nobuyuki Kagiyama20,21
1Cardiovascular Respiratory Sleep Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
2Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
3Department of Rehabilitation, School of Allied Health Science, Kitasato University, Tokyo, Japan
4Department of Rehabilitation, Kameda Medical Center, Kamogawa, Japan
5Department of Rehabilitation, The Sakakibara Heart Institute of Okayama, Okayama, Japan
6Department of Nursing, The Sakakibara Heart Institute of Okayama, Okayama, Japan
7Department of Cardiovascular Medicine, Kitasato University School of Medicine, Tokyo, Japan
8Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan
9Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
10Department of Rehabilitation, Kobe City Medical Center General Hospital, Kobe, Japan
11Department of Cardiology, Nishiarai Heart Center Hospital, Tokyo, Japan
12Department of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Shimotsuke, Japan
13Department of Cardiology, Tokai University School of Medicine, Tokyo, Japan
14Department of Rehabilitation, Odawara Municipal Hospital, Odawara, Japan
15Department of Rehabilitation, Kasukabe Chuo General Hospital, Kasukabe, Japan
16Department of Rehabilitation, Shinshu University Hospital, Matsumoto, Japan
17Department of Cardiovascular Medicine, Nephrology and Neurology, University of the Ryukyus, Nishihara, Japan
18Department of Rehabilitation, Kitasato University Medical Center, Kitasato, Japan
19Department of Rehabilitation, Saitama Citizens Medical Center, Saitama, Japan
20Department of Cardiology, The Sakakibara Heart Institute of Okayama, Okayama, Japan
21West Virginia University Heart and Vascular Institute, Morgantown, WV, USA

Tóm tắt

AbstractAimsTo describe the prevalence, overlap, and prognostic implications of physical and social frailties and cognitive dysfunction in hospitalized elderly patients with heart failure.Methods and resultsThe 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.ConclusionsThe 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.

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European Journal of Heart Failure

Tập 22 Số 11

2112-2119

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