Retrospective Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Dec 26, 2021; 9(36): 11208-11219
Published online Dec 26, 2021. doi: 10.12998/wjcc.v9.i36.11208
Association of frailty with in-hospital outcomes in elderly patients with heart failure
Yun-Peng Kang, Li-Ying Chen, Jia-Jia Zhu, Wen-Xian Liu, Chang-Sheng Ma
Yun-Peng Kang, Li-Ying Chen, Jia-Jia Zhu, Wen-Xian Liu, Chang-Sheng Ma, Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing 100029, China
Author contributions: Kang YP contributed to the investigation, methodology, data curation, writing - review and editing; Chen LY contributed to conceptualization, data curation, formal analysis, investigation, methodology, project administration, resources, software, supervision, validation, visualization, writing - original draft; Zhu JJ contributed to investigation, methodology, resources, software, supervision; Liu WX and Ma CS contributed to conceptualization, data curation, formal analysis, investigation, methodology, project administration, resources, software, supervision, validation, visualization, writing - original draft, writing - review and editing.
Supported by Beijing Municipal Administration of Hospitals Incubating Program, No. PX2018026.
Institutional review board statement: The protocol for the study was approved by the Ethic Committee of Beijing Anzhen Hospital before the initiation of the study. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent statement: Due to the retrospective nature of this study, the requirement for informed consent was waived.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest.
Data sharing statement: The datasets generated and analyzed during the current study are available from the corresponding author on reasonable request.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Chang-Sheng Ma, MD, Chief Physician, Professor, Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, No. 2 Anzhen Road, Chaoyang District, Beijing 100029, China. chshma@vip.sina.com
Received: May 16, 2021
Peer-review started: May 16, 2021
First decision: June 15, 2021
Revised: June 28, 2021
Accepted: August 17, 2021
Article in press: August 17, 2021
Published online: December 26, 2021
Processing time: 220 Days and 23.5 Hours
Abstract
BACKGROUND

Frailty is prevalent in elderly patients with cardiovascular diseases. However, the association between frailty and in-hospital outcomes for elderly patients with heart failure and reduced ejection (HFrEF) remains unknown.

AIM

To evaluate the predictive efficacy of frailty, compared with pre-frailty, for adverse events in these patients.

METHODS

Elderly patients (≥ 60 years) with HFrEF were assessed. Frailty was evaluated with the Fried phenotype criteria, and physical performance was evaluated based on handgrip strength and the short physical performance battery (SPPB). The composite incidence of adverse events, including all-cause death, multiple organ failure, cardiac shock, and malignant arrhythmia, during hospitalization was recorded.

RESULTS

Overall, 252 elderly individuals with HFrEF [mean age: 69.4 ± 6.7 years, male: 169 (67.0%)] were included. One hundred and thirty-five (53.6%) patients were frail and 93 (36.9%) were pre-frail. Frail patients were older, more likely to be female, to have a lower blood pressure, and to present with left ventricular thrombosis (P all < 0.05). Frail patients with HFrEF had a higher incidence of in-hospital mortality (11.9% vs 4.3%, P = 0.048). Multivariate analyses showed that female gender (OR = 0.422), aging (OR = 1.090), poor cardiac functional class (OR = 2.167), frailty (OR = 2.379), and lower handgrip strength (OR = 1.106) were independent predictors of in-hospital adverse events (P all < 0.05).

CONCLUSION

Frailty may be associated with poor in-hospital outcomes for elderly patients with HFrEF. The influence of frailty on long-term prognosis in these patients deserves further investigation.

Keywords: Heart failure with reduced ejection fraction; Frailty; Elderly; Adverse events

Core Tip: This retrospective study included 252 elderly individuals with heart failure and reduced ejection who showed a high prevalence of frailty (53.6%) and pre-frailty (36.9%). Female gender, aging, poor cardiac functional class, frailty, and lower handgrip strength were found to be independent predictors of in-hospital adverse events in these patients. Taken together, frailty is prevalent in elderly individuals with heart failure and reduced ejection, and frailty may be associated with poor in-hospital outcomes for these patients.