Author + information
- Received September 3, 2019
- Revision received October 7, 2019
- Accepted October 7, 2019
- Published online November 25, 2019.
- Ambarish Pandey, MD, MSCSa,
- Dalane Kitzman, MDb,
- David J. Whellan, MD, MHSc,
- Pamela W. Duncan, PT, PhDd,
- Robert J. Mentz, MDe,
- Amy M. Pastva, PT, PhDf,
- M. Benjamin Nelson, MSb,
- Bharathi Upadhya, MDb,
- Haiying Chen, PhDg and
- Gordon R. Reeves, MD, MPTh,∗ ()
- aDivision of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
- bDepartment of Internal Medicine, Section of Cardiovascular Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
- cDepartment of Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania
- dDepartment of Neurology, Wake Forest School of Medicine, Winston-Salem, North Carolina
- eDepartment of Medicine, Cardiology Division, Duke University School of Medicine, Durham, North Carolina
- fDepartment of Medicine and Orthopedic Surgery, Duke University School of Medicine, Durham, North Carolina
- gDepartment of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, North Carolina
- hHeart and Vascular Institute, Novant Health, Charlotte, North Carolina
- ↵∗Address for correspondence:
Dr. Gordon R. Reeves, Novant Health Heart & Vascular Institute, 1718 East 4th Street, Charlotte, North Carolina 28204.
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.
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.
- Received September 3, 2019.
- Revision received October 7, 2019.
- Accepted October 7, 2019.
- 2019 American College of Cardiology Foundation
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