Prognostic Significance of the “Frailty Syndrome” in Elderly Patients with Diastolic Dysfunction and Heart Failure with Preserved Ejection Fraction

Abstract

Introduction:The last several years have seen increasing interest in understanding cachexia, muscle wasting, and physical frailty across the broad spectrum of old patients with cardiovascular illnesses. This interest originally started in the field of heart failure (HF). Moreover, "frailty syndrome" (FS) contributes to increased mortality and hospitalization and reduced quality of life in HF. Objectives: to determine the degree of association of the FS and its prognostic utility in diastolic dysfunction (DD) and heart failure with preserved ejection fraction in an elderly population. Material and methods: One hundred and thirty-two patients ≥ 65 years of age who had at least one cardiovascular risk factor were prospectively examined at the Specialized Hospital for Geriatric and Palliative Medicine "13th November" -Skopje. The degree of frailty was determined with the Groningen Frailty Index (GFI questionnaire). DD and the degree of HF were determined by transthoracic echocardiography according to the latest recommendations of the European/American Society of Cardiology and Echocardiography. Results: Patients' age had a significant effect on the degree of frailty, with frail patients being significantly older than patients without frailty. Regarding the comorbidities present, patients without frailty, moderately frail, and marked frail did not differ significantly in terms of the frequency of hypertension, dyslipidemia, and myocardial infarction, while they differed significantly in regarding the frequency of stroke, heart failure, and diabetes mellitus. FS was associated with a larger left atrial volume, a lower left ventricular ejection fraction, and a higher degree of DD. During the 12-month period, 15 patients (19.8%) of the study group had a new cardiovascular event and death, all of whom had a high degree of FS, which significantly correlated with the degree of DD and HF. Conclusions: FS and the degree of DD were significantly correlated with each other and with future cardiovascular events and death in an elderly population with heart failure with preserved ejection fraction.