Prevalence and prognostic impact of cognitive frailty in elderly patients with heart failure: sub‐analysis of FRAGILE‐HF

Abstract

Aims Although evidence suggests that cognitive decline and physical frailty in elderly patients with heart failure (HF) are associated with prognosis, the impact of concurrent physical frailty and cognitive impairment, that is, cognitive frailty, on prognosis has yet to be fully investigated. The current study sought to investigate the prevalence and prognostic impact of cognitive frailty in elderly patients with HF. Methods and resultsThis study is a sub-analysis of FRAGILE-HF, a prospective multicentre observational study involving patients aged ≥65 years hospitalized for HF. The Fried criteria and Mini-Cog were used to diagnose physical frailty and cognitive impairment, respectively. The association between cognitive frailty and the combined endpoint of mortality and HF rehospitalization within 1 year was then evaluated. Among the 1332 patients identified, 1215 who could be assessed using Mini-Cog and the Fried criteria were included in this study. Among those included, 279 patients (23.0%) had cognitive frailty. During the follow-up 1 year after discharge, 398 combined events were observed. Moreover, cognitive frailty was determined to be associated with a higher incidence of combined events (log-rank: P = 0.0146). This association was retained even after adjusting for other prognostic factors (hazard ratio: 1.55, 95% confidence interval: 1.13-2.13). Furthermore, a sensitivity analysis using grip strength, short physical performance battery, and gait speed to determine physical frailty instead of the Fried criteria showed similar results. Conclusions This cohort study found that 23% of elderly patients with HF had cognitive frailty, which was associated with a 1.55-fold greater risk for combined events within 1 year compared with patients without cognitive frailty.

Handgrip strength and the prognosis of patients with heart failure: A meta‐analysis

“…Accordingly, 31 articles underwent full‐text review, and 16 of them were further excluded for the reasons listed in Figure 1. Finally, 15 studies were included in the meta‐analysis 13–27 …”

“…The characteristics of the included studies are summarized in Table 1. Overall, 15 cohort studies involving 7350 patients with HF were included in the meta‐analysis 13–27 . These studies were published between 2009 and 2022, and performed in Japan, Mexico, the United States, China, India, Brazil, the United Kingdom, and Singapore.…”

“…For all of the included studies, HGS of the patients was measured with a muscle strength dynamometer. The HGS was analyzed as a continuous variable in six studies, 13,14,17,21,24,26 and as a categorized variable in 12 studies 15–20,22–27 . The follow‐up durations varied from 3 to 43 months, and the outcomes of all‐cause mortality and composite outcome of HF rehospitalization and mortality were reported in 13 13–22,24,26,27 and 4 studies 16,23,25,27 .…”

“…Finally, 15 studies were included in the meta-analysis. [13][14][15][16][17][18][19][20][21][22][23][24][25][26][27]…”

“…Accumulating studies suggest that besides causing low physical performance and reduced cardiorespiratory fitness in older HF patients, reduced HGS in HF may also be a prognostic factor for poor survival 11,12 . However, previous studies evaluating the prognostic role of HGS in patients with HF retrieved inconsistent results 13–27 . Therefore, the aim of the study was to evaluate the association between HGS and prognosis of patients with HF by conducting a systematic review and meta‐analysis.…”