Background Frailty is common in patients with chronic heart failure (CHF) and is associated with poor outcomes. We investigated the relation between frailty and treatments, hospitalisation and death in patients with CHF.
Methods Frailty was assessed using the clinical frailty scale (CFS) in 467 consecutive patients with CHF (67% male, median (IQR) age 76 (69-82) years, median (IQR) NT-proBNP 1156 (469-2463) ng/L) attending a routine follow-up visit. Those with CFS>4 were classified as frail. We studied the primary cause of death and hospitalisations, ascertained from electronic records, autopsy reports and death certificates, within 1 year of enrolment.
Results 206 patients (44%) were frail. Frail patients with heart failure with reduced ejection fraction (HFrEF) were less likely to receive optimal treatment, with many not receiving an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker (frail: 25% vs non-frail: 4%), a beta-blocker (16% vs 8%) or a mineralocorticoid receptor antagonist (50% vs 41%).
After 1 year, there were 56 deaths and 322 hospitalisations, 46 (82%) and 215 (67%) of which, respectively, occurred in frail patients. 43% of deaths in frail patients were due to non-cardiovascular causes (non-frail: 50%), commonly infections (60%). 58% of cardiovascular deaths in frail patients were due to HF progression (non-frail:100%). (Figure 1)
64% of hospitalisations in frail patients were due to non-cardiovascular causes (non-frail: 57%), commonly infections (34%) and falls (30%). 59% of cardiovascular hospitalisations in frail patients were due to decompensated HF (non-frail: 63%). (Figure 2)
Conclusion Frailty in patients with CHF is associated with sub-optimal medical treatment for HFrEF and a high rate of non-cardiovascular events, suggesting that interventions not directed to treating CHF might be appropriate.
Conflict of Interest None
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