Article Text

Download PDFPDF

83 Effect of frailty on treatment, cause of death and hospitalisation in patients with chronic heart failure
Free
  1. Shirley Sze1,
  2. Pierpaolo Pellicori2,
  3. Jufen Zhang3,
  4. Joan Weston4,
  5. Iain Squire5,
  6. Andrew Clark6
  1. 1Leicester University Hospitals NHS Trust
  2. 2University of Glasgow
  3. 3Anglia Ruskin University
  4. 4Castle Hill Hospital
  5. 5University of Leicester
  6. 6University of Hull

Abstract

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)

Abstract 83 Figure 1 Cause of death at 1 year in frail vs non-frail patients

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)

Abstract 83 Figure 2 Cause of hospitalisations at 1 year in frail vs non-frail patients

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

  • heart failure
  • frailty
  • cause of death

Statistics from Altmetric.com

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.