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

Abstract

IntroductionFrailty is common among patients with heart failure (HF). Our aim was to address the role of frailty in the management and prognosis of elderly men and women with HF.Methods and resultsProspective multicenter registry that included 499 HF outpatients ≥75 years old. Mean age was 81.4 ± 4.3 years, and 193 (38%) were women. Compared with men, women were older (81.9 ± 4.3 vs. 81.0 ± 4.2 years, p = 0.03) and had higher left ventricular ejection fraction (46 vs. 40%, p < 0.001) and less ischemic heart disease (30 vs. 57%, p < 0.001). Women had a higher prevalence of frailty (22 vs. 10% with Clinical Frailty Scale, 34 vs. 15% with FRAIL, and 67% vs. 46% with the mobility visual scale, all p-values < 0.001) and other geriatric conditions (Barthel index ≤90: 14.9 vs. 6.2%, p = 0.003; malnutrition according to Mini Nutritional Assessment Short Formulary ≤11: 55% vs. 42%, p = 0.007; Pfeiffer cognitive test's errors: 1.6 ± 1.7 vs. 1.0 ± 1.6, p < 0.001; depression according to Yesavage test; p < 0.001) and lower comorbidity (Charlson index ≥4: 14.1% vs. 22.1%, p = 0.038). Women also showed worse self-reported quality of life (6.5 ± 2.1 vs. 6.9 ± 1.9, on a scale from 0 to 10, p = 0.012). In the univariate analysis, frailty was an independent predictor of mortality in men [Hazard ratio (HR) 3.18, 95% confidence interval (CI) 1.29–7.83, p = 0.012; HR 4.53, 95% CI 2.08–9.89, p < 0.001; and HR 2.61, 95% CI 1.23–5.43, p = 0.010, according to FRAIL, Clinical Frailty Scale, and visual mobility scale, respectively], but not in women. In the multivariable analysis, frailty identified by the visual mobility scale was an independent predictor of mortality (HR 1.95, 95% CI 1.04–3.67, p = 0.03) and mortality/readmission (HR 2.06, 95% CI 1.05–4.04, p = 0.03) in men.ConclusionsIn elderly outpatients with HF frailty is more common in women than in men. However, frailty is only associated with mortality in men.

Frailty and the Interactions between Skeletal Muscle, Bone, and Adipose Tissue-Impact on Cardiovascular Disease and Possible Therapeutic Measures

“…It has been recommended to evaluate frailty on an outpatient basis, and not in the setting of an acute HF event. In the results of this study, they comment that although the prevalence of frailty was lower, a greater proinflammatory state could explain, at least in part, why there was a greater prognostic impact in older men with HF [156].…”

Using Machine Learning to Predict the In-Hospital Mortality in Women with ST-Segment Elevation Myocardial Infarction

“…In addition, the symptoms of MI are usually atypical in elderly patients and in patients with diabetes, which makes these patients less willing to seek medical service. Therefore there are many papers and literature works that focus on diabetes and the elderly as distinct groups [ 52 , 53 , 54 , 55 ]. Accordingly, future studies should focus on applying machine learning to improve the prognosis of these patients.…”

Sex Differences in Cardiac and Clinical Phenotypes and Their Relation to Outcomes in Patients with Heart Failure

“…Recently, the impacts of physical frailty on the outcomes of HF patients were reported to be different between men and women. In contrast, due to the higher prevalence of physical frailty and lower QOL among female HF patients, the outcomes of HF were reported be more favorable in frail HF women than frail HF men [57,58]. The cause of this paradox is totally unknown and needs to be explored, since it is important to better understand sex differences in the outcomes of the HF population.…”