Author + information
- Received December 18, 2012
- Revision received January 7, 2013
- Accepted January 14, 2013
- Published online April 1, 2013.
- Sheila M. McNallan, MPH∗,
- Mandeep Singh, MD†,
- Alanna M. Chamberlain, PhD∗,
- Robert L. Kane, MD‡,
- Shannon M. Dunlay, MD, MSc†,
- Margaret M. Redfield, MD†,
- Susan A. Weston, MS∗ and
- Véronique L. Roger, MD, MPH∗,†∗ ()
- ↵∗Reprint requests and correspondence:
Dr. Véronique L. Roger, Mayo Clinic, Division of Cardiovascular Diseases, 200 First Street SW, Rochester, Minnesota 55905.
Objectives The aim of this study was to determine the prevalence of frailty in a community cohort of patients with heart failure (HF) and to determine whether frailty is associated with healthcare utilization.
Background Frailty is associated with death in patients with HF, but its prevalence and impact on healthcare utilization in patients with HF are poorly characterized.
Methods Residents of Olmsted, Dodge, and Fillmore counties in Minnesota with HF between October 2007 and March 2011 were prospectively recruited to undergo frailty assessment. Frailty was defined as 3 or more of the following: unintentional weight loss, exhaustion, weak grip strength, and slowness and low physical activity measured by the SF-12 physical component score. Intermediate frailty was defined as 1 or 2 components. Negative binomial regression was used to examine the association between outpatient visits and frailty; Andersen-Gill models were used to determine if frailty predicted emergency department (ED) visits or hospitalizations.
Results Among 448 patients (mean age 73 ± 13 years, 57% men), 74% had some degree of frailty (19% frail, 55% intermediate frail). Over a mean follow-up period of 2.0 ± 1.1 years, 20,164 outpatient visits, 1,440 ED visits, and 1,057 hospitalizations occurred. After adjustment for potential confounders, frailty was associated with a 92% increased risk for ED visits and a 65% increased risk for hospitalizations. The population-attributable risk associated with any degree of frailty was 35% for ED visits and 19% for hospitalizations.
Conclusions Frailty is common among community patients with HF and is a strong and independent predictor of ED visits and hospitalizations. Because frailty is potentially modifiable, it should be incorporated in the clinical evaluation of patients with HF.
This study was supported by grants from the National Institutes of Health (R01 HL72435) and the Rochester Epidemiology Project from the National Institute on Aging (R01 AG034676). The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received December 18, 2012.
- Revision received January 7, 2013.
- Accepted January 14, 2013.
- American College of Cardiology Foundation