Characterizing Sex Differences in Physical Frailty Phenotypes in Heart Failure

Abstract

Background: Although women with heart failure (HF) are potentially more likely to be physically frail compared with men with HF, the underlying contributors to this sex difference are poorly understood. The purpose of this study was to characterize sex differences in physical frailty phenotypes in HF. Methods: We prospectively enrolled adults with class I–IV HF. Physical frailty was measured with the frailty phenotype criteria. Symptoms of dyspnea, sleep-related impairment, pain interference, depression, and anxiety were assessed. Body composition was measured using dual-energy x-ray absorptiometry. Simple comparative statistics and stepwise regression modeling were used. Results: The average age of the sample (n=115) was 63.6±15.7 years, 49% were women, and 73% had nonischemic cause. Forty-three percent of the sample was physically frail. Women had a 4.6 times greater odds of being physically frail compared with men, adjusting for covariates (odds ratio=4.63 [95% CI, 1.81–11.84], P =0.001). Both physically frail men and women were characterized by more type 2 diabetes, higher comorbidity burden, and worse dyspnea symptoms. Physically frail women had significantly worse symptoms compared with non–physically frail women but no difference in body composition characteristics. Physically frail men had significantly lower appendicular muscle mass, higher percent fat, lower hemoglobin, and more depressive symptoms compared with non–physically frail men. Conclusions: Women are significantly more likely to be physically frail compared with men in HF. Physical frailty in both women and men is characterized by comorbidities and worse symptoms; physical frailty in men is characterized by worse physiological characteristics.

Response by Denfeld et al to Letter Regarding Article, “Characterizing Sex Differences in Physical Frailty Phenotypes in Heart Failure”

“…We thank Martin et al for their interest in our recent publication on characterizing sex differences in physical frailty in heart failure (HF). 1 We appreciate their insight and suggestions, and we are glad to respond to the key points raised in their letter and continue the dialogue on this important topic.…”

Sex differences in the impact of frailty in elderly outpatients with heart failure

“…Authors found that women with HF were significantly more likely to be physically frail than men. Frailty was related with higher overall comorbidity burden in both men and women although frail women had a worse symptom profile ( 24 ). However, such population was significantly younger than that in our study (mean age 63.6 vs. 81.4 years) and had different baseline characteristics: 71% had reduced LVEF and almost 50% had NYHA III-IV functional status (which may, in part, explain the discrepant findings).…”

Special Considerations in the Care of Women With Advanced Heart Failure

“…Frailty and cachexia, common features of AHF ( 4 , 24 ), are more frequently seen in women ( 24 ). Physical frailty is characterized by worse symptom characteristics in women, and worse body composition characteristics in men ( 25 ). However, current frailty assessment tools are not sex-specific, and future research is needed to identify the ideal index for frailty assessment in women, and sex differences in reversibility of frailty with HF therapies ( 25 ).…”

“…Physical frailty is characterized by worse symptom characteristics in women, and worse body composition characteristics in men ( 25 ). However, current frailty assessment tools are not sex-specific, and future research is needed to identify the ideal index for frailty assessment in women, and sex differences in reversibility of frailty with HF therapies ( 25 ). Women are also admitted less frequently than men for acute decompensated HF ( 1 ) which may lead to delayed recognition of advanced disease.…”