Frailty and outcomes in heart failure patients from high-, middle-, and low-income countries

Leong, D. P. et al. (2023) Frailty and outcomes in heart failure patients from high-, middle-, and low-income countries. European Heart Journal, 44(42), pp. 4435-4444. (doi: 10.1093/eurheartj/ehad595) (PMID:37639487) (PMCID:PMC10635666)

Abstract

Background and Aims: There is little information on the incremental prognostic importance of frailty beyond conventional prognostic variables in heart failure (HF) populations from different country income levels. Methods: A total of 3429 adults with HF (age 61 ± 14 years, 33% women) from 27 high-, middle- and low-income countries were prospectively studied. Baseline frailty was evaluated by the Fried index, incorporating handgrip strength, gait speed, physical activity, unintended weight loss, and self-reported exhaustion. Mean left ventricular ejection fraction was 39 ± 14% and 26% had New York Heart Association Class III/IV symptoms. Participants were followed for a median (25th to 75th percentile) of 3.1 (2.0–4.3) years. Cox proportional hazard models for death and HF hospitalization adjusted for country income level; age; sex; education; HF aetiology; left ventricular ejection fraction; diabetes; tobacco and alcohol use; New York Heart Association functional class; HF medication use; blood pressure; and haemoglobin, sodium, and creatinine concentrations were performed. The incremental discriminatory value of frailty over and above the MAGGIC risk score was evaluated by the area under the receiver-operating characteristic curve. Results: At baseline, 18% of participants were robust, 61% pre-frail, and 21% frail. During follow-up, 565 (16%) participants died and 471 (14%) were hospitalized for HF. Respective adjusted hazard ratios (95% confidence interval) for death among the pre-frail and frail were 1.59 (1.12–2.26) and 2.92 (1.99–4.27). Respective adjusted hazard ratios (95% confidence interval) for HF hospitalization were 1.32 (0.93–1.87) and 1.97 (1.33–2.91). Findings were consistent among different country income levels and by most subgroups. Adding frailty to the MAGGIC risk score improved the discrimination of future death and HF hospitalization. Conclusions: Frailty confers substantial incremental prognostic information to prognostic variables for predicting death and HF hospitalization. The relationship between frailty and these outcomes is consistent across countries at all income levels.

• Item Type: Articles
• Additional Information: This study was funded by Bayer.
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: McMurray, Professor John
• Authors: Leong, D. P., Joseph, P., McMurray, J. J.V., Rouleau, J., Maggioni, A. P., Lanas, F., Sharma, S. K., Núñez, J., Mohan, B., Celik, A., Abdullakutty, J., Ogah, O. S., Mielniczuk, L. M., Balasubramanian, K., McCready, T., Grinvalds, A., and Yusuf, S.
• College/School: College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health
• Journal Name: European Heart Journal
• Publisher: Oxford University Press
• ISSN: 0195-668X
• ISSN (Online): 1522-9645
• Published Online: 28 August 2023
• Copyright Holders: Copyright © 2023 The Authors
• First Published: First published in European Heart Journal 44(42):4435–4444
• Publisher Policy: Reproduced under a Creative Commons License