The impact of frailty according to Clinical Frailty Scale on clinical outcome in patients with heart failure

Kanenawa, Kenji; Isotani, Akihiro; Yamaji, Kyohei; Nakamura, Miho; Tanaka, Yuichi; Hirose-Inui, Kaoru; Fujioka, Shimpei; Mori, Shintaro; Yano, Mariko; Ito, Shinya; Morinaga, Takashi; Fukunaga, Masato; Hyodo, Makoto; Ando, Kenji

doi:10.1002/ehf2.13254

Cited by 29 publications

(22 citation statements)

References 31 publications

(59 reference statements)

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“…Previous studies have demonstrated that frailty is common in patients with HF and is associated with mortality (29,30). The CFS is a semi-quantitative tool for evaluating patients' frailty and has been widely used because of its simplicity and usefulness (31). Our study demonstrated that the CFS is an independent prognostic factor for HF in elderly patients.…”

Section: Discussionsupporting

confidence: 56%

Differences in Prognostic Factors among Patients Hospitalized for Heart Failure According to the Age Category: From the KUNIUMI Registry Acute Cohort

et al. 2022

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Objective Previous studies have described several prognostic factors for heart failure (HF); however, these results were derived from registries consisting of conventional age groups, which might not represent the increasingly aging society. The present study explored the prognostic factors for all-cause death in hospitalized patients with HF across different age categories using an acute HF registry that included relatively old patients. Methods From a total of 1,971 consecutive patients with HF, 1,136 patients were enrolled. We divided the patients into 4 groups (! 65, 66-75, 76-85, and >85 years old) to evaluate all-cause death and prognostic factors of all-cause death. Results During the mean follow-up period of 1,038 days, 445 patients (39.2%) had all-cause death. A Kaplan-Meier analysis demonstrated significantly higher incidence of all-cause death in the elderly groups than in the younger groups (log-rank p<0.001). A Cox proportional-hazard regression analysis revealed that the presence of atrial fibrillation [hazard ratio (HR): 23.3, 95% confidence interval (CI): 2.36-231.1, p=0.007] was a notable predictive factor for all-cause death in the ! 65 years old group, whereas the Clinical Frailty Scale score (HR: 1.33, 95% CI: 1.16-1.52, p<0.001) and hypoalbuminemia (HR: 0.49, 95% CI: 0.31-0.78, p= 0.003) were predictors in the >85 years old group. Conclusions Atrial fibrillation was a notable predictor of HF in young patients, whereas frailty and lowgrade albuminemia were essential predictive factors of HF in elderly patients. With the increasing number of elderly patients with HF, comprehensive multidisciplinary treatment will be necessary.

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Section: Discussionsupporting

confidence: 56%

Differences in Prognostic Factors among Patients Hospitalized for Heart Failure According to the Age Category: From the KUNIUMI Registry Acute Cohort

et al. 2022

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“…Of interest, markers of cachexia such as low albumin and haemoglobin were also associated with late mortality independent of age and sex. Interestingly, frailty, malnutrition, and cachexia often co‐exist in older individuals; in a recent study examining more than 110 000 older individuals across the UK, frailty was detected in >90% of patients characterized by malnutrition and in 100% of patients characterized by cachexia, 21 while recent studies suggest an inverse relationship between CFS and albumin or BMI 22 . The association of CFS with various tissue loss syndromes (sarcopenia, frailty, cachexia, and malnutrition) as a general marker of baseline patient status is worth exploring in future studies regarding COVID‐19 patients and older individuals in general.…”

Section: Discussionmentioning

confidence: 99%

Clinical frailty, and not features of acute infection, is associated with late mortality in COVID‐19: a retrospective cohort study

Vlachogiannis

Baker

Georgiopoulos

et al. 2022

J cachexia sarcopenia muscle

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Background Coronavirus disease 2019 (COVID‐19) is associated with excess mortality after hospital discharge. Identification of patients at increased risk of death following hospital discharge is needed to guide clinical monitoring and early intervention. Herein, we aimed to identify predictors of early vs. late mortality in COVID‐19 patients. Methods A total of 471 patients with polymerase chain reaction‐confirmed COVID‐19 were followed up for 9 months [median (inter‐quartile range) of follow‐up time: 271 (14) days] after hospital admission. COVID‐19‐related signs and symptoms, laboratory features, co‐morbidities, Coronavirus Clinical Characterisation Consortium (4C) mortality and Clinical Frailty Scale (CFS) scores were analysed by logistic regression for association with early (28 day) vs. late mortality. Receiver operating characteristic (ROC) analysis was used to determine the discriminative value of 4C and CFS scores for early vs. late mortality. Results A total of 120 patients died within 28 days from hospital admission. Of the remaining 351 patients, 41 died within the next 8 months. Respiratory failure, systemic inflammation, and renal impairment were associated with early mortality, while active cancer and dementia were associated with late mortality, after adjustment for age and sex. 4C mortality score and CFS were associated with both early [odds ratio (OR) (95% confidence interval—CI): 4C : 1.34 (1.25–1.45); CFS : 1.49 (1.33–1.66)] and late [OR (95% CI): 4C : 1.23 (1.12–1.36); CFS : 2.04 (1.62–2.56)] mortality. After adjustment for CFS, the association between 4C and late mortality was lost. By ROC analysis, 4C mortality score was superior to CFS for 28 day mortality [area under the curve (AUC) (95% CI): 0.779 (0.732–0.825) vs. 0.723 (0.673–0.773), respectively; P = 0.039]. In contrast, CFS had higher predictive value for late mortality compared with 4C mortality score [AUC (95% CI): 0.830 (0.776–0.883) vs. 0.724 (0.650–0.798), respectively; P = 0.007]. Conclusions In our cohort, late mortality in COVID‐19 patients is more strongly associated with premorbid clinical frailty than with severity of the acute infection phase.

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“…Low albumin concentration is a factor of bad prognosis in HF is connected with malnourishment and FS [45,46]. This parameter could be considered as an alternate one for CholT in our model; however, in the analysis, CholT had a better predicting value compared to albumin.…”

Section: Discussionmentioning

confidence: 89%

A Simple Risk Score Based on Routine Clinical Parameters Can Predict Frailty in Hospitalized Heart Failure Patients

Kałużna‐Oleksy

Kukfisz

Migaj

et al. 2021

JCM

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Frailty syndrome (FS) has recently attracted attention as one of the major predictors of heart failure (HF) course severity. We aimed to develop a simple tool for predicting frailty in hospitalized HF patients using routine clinical parameters. A total of 153 hospitalized patients diagnosed with heart failure with reduced ejection fraction (HFrEF) were included in the study. Presence of FS was assessed with the SHARE-FI questionnaire. Clinical and biochemical parameters were collected. Using ROC curves and logistic regression analysis, a model predicting FS presence was developed and tested. Proposed model includes five variables with following cut-off values (1 point for each variable): age > 50 years, systolic pressure on admission < 110 mmHg, total cholesterol < 4.85 mmol/L, bilirubin ≥ 15.5 mmol/L, and alanine aminotransferase ≤ 34 U/L. Receiving 5 points was considered a high risk of FS with positive and negative predictive values (NPV), 83% and 72%, respectively, and specificity of 97%. Awarding 2 points or less ruled out FS in the studied group with negative predictive value 94%. The presented novel, simple score predicts FS in HFrEF patients with routine clinical parameters and has good positive and negative predictive values.

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The impact of frailty according to Clinical Frailty Scale on clinical outcome in patients with heart failure

Cited by 29 publications

References 31 publications

Differences in Prognostic Factors among Patients Hospitalized for Heart Failure According to the Age Category: From the KUNIUMI Registry Acute Cohort

Differences in Prognostic Factors among Patients Hospitalized for Heart Failure According to the Age Category: From the KUNIUMI Registry Acute Cohort

Clinical frailty, and not features of acute infection, is associated with late mortality in COVID‐19: a retrospective cohort study

A Simple Risk Score Based on Routine Clinical Parameters Can Predict Frailty in Hospitalized Heart Failure Patients

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