Association of frailty with in-hospital outcomes in elderly patients with heart failure

doi:10.12998/wjcc.v9.i36.11208

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World Journal of Clinical Cases

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

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World J Clin Cases. Dec 26, 2021; 9(36): 11208-11219
Published online Dec 26, 2021. doi: 10.12998/wjcc.v9.i36.11208

Table 1 Characteristics of the included elderly patients with heart failure and reduced ejection according to the frailty status

	Frail (n = 135)	Pre-frail (n = 93)	P value
Demographic factors
Age (yr)	70.7 ± 7.2	68.8 ± 5.8	0.039
Female, n (%)	44 (32.6)	25 (26.9)	0.022
NYHA Class
III, n (%)	70 (51.9)	57 (61.3)	0.249
IV, n (%)	44 (32.6)	23 (24.7)	0.010
Medical history
Hypertension, n (%)	78 (57.8)	48 (51.6)	0.358
DM, n (%)	57 (42.2)	29 (31.2)	0.091
Dyslipidemia, n (%)	34 (25.2)	17 (18.3)	0.219
AF, n (%)	40 (29.6)	18 (19.4)	0.080
PAD, n (%)	9 (6.7)	8 (8.6)	0.585
CABG, n (%)	15 (11.1)	11 (11.8)	0.867
PCI, n (%)	24 (17.8)	18 (19.4)	0.763
Clinical parameters
SBP (mmHg)	107.71 ± 21.03	114.01 ± 23.39	0.035
DBP (mmHg)	66.90 ± 13.57	72.03 ± 12.06	0.004
HR (bpm)	88.16 ± 20.41	89.39 ± 19.77	0.653
ALT (U/L)¹	39 (23, 79)	35 (20, 71)	0.347
SCr (μmol/L)	109.70 ± 65.63	102.67 ± 54.03	0.395
FPG (mmol/L)	9.01 ± 6.32	8.49 ± 4.18	0.499
TG (mmol/L)¹	1.4 (0.9, 1.8)	1.5 (1.0, 2.1)	0.082
LDL-C (mmol/L)	2.59 ± 0.77	3.44 ± 1.51	0.455
HDL-C (mmol/L)	1.05 ± 0.31	0.99 ± 0.31	0.901
PaO₂ (mmHg)	96.85 ± 33.03	101.12 ± 38.93	0.374
BNP (μmol/L)¹	712 (329, 1422)	542 (307, 925)	0.189
Echocardiography
LVEDD (mm)	56.81 ± 9.01	54.46 ± 7.66	0.036
LVESD (mm)	41.97 ± 11.03	41.89 ± 9.98	0.956
LVEF (%)	33.79 ± 6.06	34.03 ± 5.64	0.753
LV thrombosis, n (%)	27 (20)	9 (9.7)	0.036
Medications
Diuretics, n (%)	101 (74.8)	73 (78.5)	0.521
ARAs, n (%)	90 (66.7)	55 (59.1)	0.246
ACEIs/ARBs, n (%)	75 (55.6)	53 (57.0)	0.830
Beta-blockers, n (%)	114 (84.4)	76(81.7)	0.588
Digitalis, n (%)	51 (37.8)	23 (24.7)	0.039
Anticoagulants, n (%)	65 (48.1)	33 (35.5)	0.058

¹Data are presented as medians and interquartile ranges.

NYHA: New York Heart Association; DM: Diabetes mellitus; AF: Atrial fibrillation; PAD: Peripheral artery disease; CABG: Coronary artery bypass grafting; PCI: Percutaneous coronary intervention; SBP: Systolic blood pressure; DBP: Diastolic blood pressure; HR: Heart rate; ALT: Alanine aminotransferase; SCr: Serum creatinine; FPG: Fasting plasma glucose; TG: Triglyceride; LDL-C: Low-density lipoprotein cholesterol; HDL-C: High-density lipoprotein cholesterol; BNP: Type B natriuretic peptide; LVEDD: Left ventricular end-diastolic dimension; LVESD: Left ventricular end-systolic dimension; LVEF: Left ventricular ejection fraction; LV: Left ventricular; ARAs: Aldosterone Receptor Antagonists; ACEIs: Angiotensin converting enzyme inhibitors; ARBs: Angiotensin II receptor blockers.

Table 2 Physical performance of the included patients evaluated by short physical performance battery according to the frailty status (mean ± SD)

	Frail (n = 135)	Pre-frail (n = 93)	P value
Handgrip strength (kg)
Men	23.8 ± 4.1	25.1 ± 4.2	0.056
Women	17.9 ± 3.4	21.2 ± 4.5	0.003
Balance test	3.08 ± 0.68	3.42 ± 0.61	< 0.001
Four-meter gait test	2.19 ± 0.82	2.70 ± 0.76	< 0.001
Chair stand test	1.96 ± 0.77	2.83 ± 0.70	< 0.001
Overall SPPB score	7.24 ± 1.72	8.95 ± 1.44	< 0.001

SPPB: Short physical performance battery; SDs: Standard deviations.

Table 3 Incidence of in-hospital mortality and the major causes of mortality during hospitalization according to the frailty status of the patients

	Frail (n = 135)	Pre-frail (n = 93)	P value
In-hospital death	16 (11.9)	4 (4.3)	0.048
Cardiac shock	3 (2.2)	2 (2.4)	0.971
Malignant arrhythmia	3 (2.2)	1 (1.1)	0.517
MOF	10 (7.4)	1 (1.1)	0.028

MOF: Multiple organ failure.

Table 4 Patient characteristics and the composite outcome of in-hospital adverse events: Results of univariate analysis

	With AEs (n = 86)	Without AEs (n = 142)	P value
Female, n (%)	30 (34.9)	39 (27.5)	0.279
NYHA Class III/IV, n (%)	79 (91.9)	115 (80.9)	0.010
Frailty, n (%)	62 (72.1)	73 (51.4)	0.002
Hypertension, n (%)	54 (62.8)	72 (50.7)	0.075
DM, n (%)	33 (38.4)	53 (37.3)	0.874
Dyslipidemia, n (%)	18 (20.9)	33 (23.2)	0.685
AF, n (%)	28 (32.6)	30 (21.1)	0.055
Age (yr)	72.05 ± 7.46	68.65 ± 5.90	< 0.001
Handgrip strength (kg)	22.26 ± 5.34	23.04 ± 4.44	0.030
Overall SPPB score	7.50 ± 2.04	8.18 ± 1.61	0.006
SBP (mmHg)	110.87 ± 23.24	109.92 ± 21.62	0.759
DBP (mmHg)	69.34±15.13	68.78 ± 11.92	0.772
PaO₂ (mmHg)	99.23 ± 47.56	98.20 ± 25.87	0.853
LVEF (%)	33.74 ± 6.45	33.97 ± 5.53	0.786

AEs: Adverse events; NYHA: New York Heart Association; DM: Diabetes mellitus; AF: Atrial fibrillation; SPPB: Short physical performance battery; SBP: Systolic blood pressure; DBP: Diastolic blood pressure; LVEF: Left ventricular ejection fraction; LV: Left ventricular.

Table 5 Potential predictive efficacy of frailty on the composite outcome of in-hospital adverse events: results of multivariate logistic regression analysis

	SE	OR	95%CI	P value
Female	0.410	0.422	0.189-0.943	0.035
Age	0.029	1.090	1.029-1.154	0.003
NYHA Class III/IV	0.253	2.167	1.320-3.559	0.002
Frailty	0.351	2.379	1.196-4.733	0.014
Overall SPPB Score	0.100	0.945	0.776-1.150	0.570
Handgrip strength	0.047	1.106	1.010-1.212	0.030
SBP	0.007	1.003	0.989-1.017	0.656
LVEF	0.027	0.990	0.939-1.042	0.694

SE: Standard error; OR: Odds ratio; CI: Confidence interval; AEs: Adverse events; SPPB: Short physical performance battery; SBP: Systolic blood pressure; LVEF: Left ventricular ejection fraction.

Citation: Kang YP, Chen LY, Zhu JJ, Liu WX, Ma CS. Association of frailty with in-hospital outcomes in elderly patients with heart failure. World J Clin Cases 2021; 9(36): 11208-11219
URL: https://www.wjgnet.com/2307-8960/full/v9/i36/11208.htm
DOI: https://dx.doi.org/10.12998/wjcc.v9.i36.11208