Frailty has traditionally been studied in the elderly population but scarcely in younger individuals. The objective of the present study is to analyze differences according to age in the diagnostic performance of cardiac biomarkers to predict frailty in patients admitted to the hospital for acute heart failure (AHF). A frailty assessment was performed with the SPPB and FRAIL scales (score > 3). We included 201 patients who were divided according to age: those older and younger than 75 years. In the younger group, no biomarker was related to the presence of frailty. This was mainly determined by age and comorbidities. In the elderly group, NT-proBNP was significantly related to the presence of frailty, but none of the baseline characteristics were. The best cut-off point in the elderly group for NT-proBNP was 4000 pg/mL. The area under the curve (AUC) for proBNP for frailty detection was 0.62 in the elderly. Another similar frailty scale, the SPPB, also showed a similar AUC in this group; however, adding the NT-proBNP (one point if NT-proBNP < 4000 pg/mL), it showed a slightly higher yield (AUC 0.65). The addition of biomarkers could improve frailty detection in members of the elderly population who are admitted to the hospital for AHF.

Background There is a lack of evidence regarding the benefits of β-blocker treatment after invasively managed acute myocardial infarction (MI) without reduced left ventricular ejection fraction (LVEF). Methods and results TREatment with Beta-blockers after myOcardial infarction withOut reduced ejection fraction (REBOOT) trial is a pragmatic, controlled, prospective, randomized, open-label blinded endpoint (PROBE design) clinical trial testing the benefits of β-blocker maintenance therapy in patients discharged after MI with or without ST-segment elevation. Patients eligible for participation are those managed invasively during index hospitalization (coronary angiography), with LVEF &gt;40%, and no history of heart failure (HF). At discharge, patients will be randomized 1:1 to β-blocker therapy (agent and dose according to treating physician) or no β-blocker therapy. The primary endpoint is a composite of all-cause death, nonfatal reinfarction, or HF hospitalization over a median follow-up period of 2.75 years (minimum 2 years, maximum 3 years). Key secondary endpoints include the incidence of the individual components of the primary composite endpoint, the incidence of cardiac death, and incidence of malignant ventricular arrhythmias or resuscitated cardiac arrest. The primary endpoint will be analyzed according to the intention-to-treat principle. Conclusion The REBOOT trial will provide robust evidence to guide the prescription of β-blockers to patients discharged after MI without reduced LVEF.

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Funding Acknowledgements Type of funding sources: None. Introduction following cardiac resincronization therapy (CRT), QRS duration is the most important prognostic factor in the 12-lead electrocardiogram (ECG). However, there is little evidence regarding if the electrocardiographic pattern following CRT has impact on morbidity and mortality. Purpose In this historical cohort study we analysed if a certain pattern in three leads of the ECG (Rs in V1, Qr in aVL or rS in I) is associated with lower incidence of adverse outcomes in a population of CRT patients within 1 year of implant. Other variables previously associated with success or failure of CRT were analysed. Methods patients with CRT devices with left ventricle lead in the coronary sinus were included from January 2012 to April 2019. The primary endpoint was a composite of death of any cause and heart failure hospitalization at 1 year. Survival analysis was performed using Kaplan-Meier test, comparing survival graphics through Log-Rank test. For multivariate analysis, Cox regression was performed. Results 111 patients were included. Sample was divided into 2 groups according to the presence of the pattern in any of the three ECG leads. Baseline characteristics are reported in Table 1. Presence of any of the three patterns was independently associated with a lower incidence of the primary endpoint (2.3% vs. 17.6%, hazard ratio 0.1, 95% confidence interval 0.013-0.774, p = 0.016). Previous atrial fibrillation was also independently associated with a higher incidence of the primary endpoint. QRS duration postimplantation did not showed prognostic value. Conclusion the presence of the patterns Rs in V1, Qr in aVL or rS in I is an independent predictor of good prognosis in patients with CRT. Baseline characteristicsPattern Rs-V1/Qr-aVL/rS-INo patternp-valueAge (years)69 ± 1767 ± 210.257Women8 (18.6)17 (25)0.432Atrial fibrillation18 (41.9)22 (32.4)0.309- Ischemic cardiomyopathy- Non ischemic cardiomyopathy18 (41.9)25 (58.1)26 (38.8)41 (61.2)0.75Indication- HFrEF + NYHA II-IV + wide QRS- rEF + indication of cardiac stimulation- LV dysfunction secondary to stimulation 35 (81.4)7 (16.3)1 (2.3) 58 (85.3)9 (13.2)1 (1.5) 0.5870.6560.741Preimplantation LVEF (%)28 ± 1328 ± 150.882Up-titrated treatment17 (39.5)26 (38.2)0.891- LBBB- RBBB36 (83.7)5 (11.6)61 (89.7)6 (8.8)0.3550.63QRS duration postimplantation (ms)144 ± 35142 ± 500.657HFrEFheart failure with reduced ejection fraction; NYHA: New York Heart Association; rEF: reduced ejection fraction; LV: left ventricle; LVEF: left ventricle ejection fraction; LBBB: left bundle branch block; RBBB: right bundle branch block.Abstract Figure. Kaplan Meier survival curves

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