TY - JOUR
T1 - Frailty Among Older Decompensated Heart Failure Patients
T2 - Prevalence, Association With Patient-Centered Outcomes, and Efficient Detection Methods
AU - Pandey, Ambarish
AU - Kitzman, Dalane
AU - Whellan, David J.
AU - Duncan, Pamela W.
AU - Mentz, Robert J.
AU - Pastva, Amy M.
AU - Nelson, M. Benjamin
AU - Upadhya, Bharathi
AU - Chen, Haiying
AU - Reeves, Gordon R.
N1 - Funding Information:
Supported by U.S. National Institutes of Health (NIH) grants R01AG045551 and R01AG18915; the Kermit Glenn Phillips II Chair in Cardiovascular Medicine at Wake Forest School of Medicine (to Dr. Kitzman); the Claude D. Pepper Older Americans Independence Center (OAIC) NIH grants P30AG021332 (to Dr. Kitzman) and P30AG028716 (to Dr. Pandey); the OAIC Pepper National Coordinating Center NIH grant U24 AG05964; and the Wake Forest Clinical and Translational Science Award, NIH grant UL1TR001420. Dr. Kitzman is a consultant for Abbvie, AstraZeneca, Merck, Novartis, Corvia Medical, Bayer, CinRx, Boehringer Ingelheim, and St. Luke's Medical Center, Kansas City, Kansas; and has received research support from Novartis, Bayer, AstraZeneca, and St. Luke's Medical Center, Kansas City, Kansas; and owns stock in Gilead Sciences. Dr. Mentz has received research support from Amgen, AstraZeneca, Bayer, GlaxoSmithKline, Gilead, Luitpold, Medtronic, Merck, Novartis, Otsuka, and ResMed; and has received honoraria from Abbott, Bayer, Janssen, Luitpold Pharmaceuticals, Merck, Novartis, and ResMed; and has served on advisory boards for Amgen, Luitpold, Merck, and Boehringer Ingelheim. Dr. Whellan has received research support from National Institutes of Health, Amgen, CVR Global, Merck, Novartis, ResMed; and is a consultant for Akros Pharmaceuticals, BDC Advisors, Cytokinetics, and Fibrogen. Dr. Duncan is a consultant for Molec; and holds equity in Care Directions. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Barry Greenberg, MD, served as Guest Editor for this paper.
Publisher Copyright:
© 2019 American College of Cardiology Foundation
PY - 2019/12
Y1 - 2019/12
N2 - Objectives: This study sought to assess the prevalence of frailty, its associations with physical function, quality of life (QoL), cognition, and depression and to investigate more efficient methods of detection in older patients hospitalized with acute decompensated heart failure (ADHF). Background: In contrast to the outpatient population with chronic HF, much less is known regarding frailty in older, hospitalized patients with ADHF. Methods: Older hospitalized patients (N = 202) with ADHF underwent assessment of frailty (using Fried criteria), short physical performance battery (SPPB), 6-min walk test (6-MWT) distance, quality of life (QoL using the Kansas City Cardiomyopathy Questionnaire), cognition (using the Montreal Cognition Assessment), and depression (using the Geriatric Depression Screen [GDS]). The associations of frailty with these patient-centered outcomes were assessed by using adjusted linear regression models. Novel strategies to identify frailty were examined. Results: A total of 50% of older, hospitalized patients with ADHF were frail, 48% were pre-frail, and 2% were non-frail. Female sex, burden of comorbidity, and prior HF hospitalization were significantly associated with higher likelihood of frailty. Frailty (vs. pre-frail status) was associated with a significantly worse SPPB score (5 ± 2.2 vs. 7 ± 2.4, respectively), 6-MWT distance (143 ± 79 m vs. 221 ± 99 m, respectively), QoL (35 ± 19 vs. 46 ± 21, respectively), and more depression (GDS score: 5.5 ± 3.5 vs. 4.2 ± 3.3, respectively) but similar cognition. These associations were unchanged after adjustment for age, sex, race, total comorbidities, and body mass index. Slow gait speed plus low physical activity signaled frailty status as well (C-statistic = 0.85). Conclusions: Ninety-eight percent of older, hospitalized patients with ADHF are frail or pre-frail. Frailty (vs. pre-frail status) is associated with worse physical function, QoL, comorbidity, and depression. The simple 4-m walk test combined with self-reported physical activity may quickly and efficiently identify frailty in older patients with ADHF.
AB - Objectives: This study sought to assess the prevalence of frailty, its associations with physical function, quality of life (QoL), cognition, and depression and to investigate more efficient methods of detection in older patients hospitalized with acute decompensated heart failure (ADHF). Background: In contrast to the outpatient population with chronic HF, much less is known regarding frailty in older, hospitalized patients with ADHF. Methods: Older hospitalized patients (N = 202) with ADHF underwent assessment of frailty (using Fried criteria), short physical performance battery (SPPB), 6-min walk test (6-MWT) distance, quality of life (QoL using the Kansas City Cardiomyopathy Questionnaire), cognition (using the Montreal Cognition Assessment), and depression (using the Geriatric Depression Screen [GDS]). The associations of frailty with these patient-centered outcomes were assessed by using adjusted linear regression models. Novel strategies to identify frailty were examined. Results: A total of 50% of older, hospitalized patients with ADHF were frail, 48% were pre-frail, and 2% were non-frail. Female sex, burden of comorbidity, and prior HF hospitalization were significantly associated with higher likelihood of frailty. Frailty (vs. pre-frail status) was associated with a significantly worse SPPB score (5 ± 2.2 vs. 7 ± 2.4, respectively), 6-MWT distance (143 ± 79 m vs. 221 ± 99 m, respectively), QoL (35 ± 19 vs. 46 ± 21, respectively), and more depression (GDS score: 5.5 ± 3.5 vs. 4.2 ± 3.3, respectively) but similar cognition. These associations were unchanged after adjustment for age, sex, race, total comorbidities, and body mass index. Slow gait speed plus low physical activity signaled frailty status as well (C-statistic = 0.85). Conclusions: Ninety-eight percent of older, hospitalized patients with ADHF are frail or pre-frail. Frailty (vs. pre-frail status) is associated with worse physical function, QoL, comorbidity, and depression. The simple 4-m walk test combined with self-reported physical activity may quickly and efficiently identify frailty in older patients with ADHF.
KW - acute heart failure
KW - aging
KW - frailty
KW - functional status
KW - quality of life
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U2 - 10.1016/j.jchf.2019.10.003
DO - 10.1016/j.jchf.2019.10.003
M3 - Article
C2 - 31779931
AN - SCOPUS:85075027430
SN - 2213-1779
VL - 7
SP - 1079
EP - 1088
JO - JACC: Heart Failure
JF - JACC: Heart Failure
IS - 12
ER -