The prevalence of frailty in heart failure: A systematic review and meta-analysis

Abstract

Background There is a growing interest in the intersection of heart failure (HF) and frailty; however, estimates of the prevalence of frailty in HF vary widely. The purpose of this paper was to quantitatively synthesize published literature on the prevalence of frailty in HF and to examine the relationship between study characteristics (i.e. age and functional class) and the prevalence of frailty in HF. Methods The prevalence of frailty in HF, divided into Physical Frailty and Multidimensional Frailty measures, was synthesized across published studies using a random-effects meta-analysis of proportions approach. Meta-regression was performed to examine the influence of age and functional class (at the level of the study) on the prevalence of frailty. Results A total of 26 studies involving 6896 patients with HF were included in this meta-analysis. Despite considerable differences across studies, the overall estimated prevalence of frailty in HF was 44.5% (95% Confidence Interval, 36.2%–52.8%; z = 10.54; p < 0.001). The prevalence was slightly lower among studies using Physical Frailty measures (42.9%, z = 9.05; p < 0.001) and slightly higher among studies using Multidimensional Frailty measures (47.4%, z = 5.66; p < 0.001). There were no significant relationships between study age or functional class and prevalence of frailty. Conclusions Frailty affects almost half of patients with HF and is not necessarily a function of age or functional classification. Future work should focus on standardizing the measurement of frailty and on broadening the view of frailty beyond a strictly geriatric syndrome in HF.

The hospital frailty risk score in patients with heart failure is strongly associated with outcomes but less so with pharmacotherapy

“…Thirdly, we do not have details on the clinical presentation, ejection fraction or natriuretic peptide levels in these patients so cannot comment on severity of HF or differences in admission thresholds for frail versus nonfrail patients. Interestingly, a systematic review of 26 studies (6896 patients) reported no association between HF class and prevalence of frailty . Fourthly, we cannot conclusively state the underlying reasons for the observed associations and the possibility of unrecognized residual confounding exists in any observational study.…”

Heart Failure Association of the European Society of Cardiology position paper on frailty in patients with heart failure

“…The relation between the New York Heart Association functional class and the prevalence of frailty is not clear as some studies found a poor association while others a linear correlation . This can be probably related to the methods used for the assessment of frailty.…”

“…Frailty is more prevalent in HF than the general population. The estimated overall prevalence of frailty in HF is around 45%, with a lower prevalence in studies using the physical frailty assessment tool compared to those using the cumulative deficit approach (42.9% vs. 47.4%) . Patients with HF are up to six times more likely to be frail, and frail people have a significantly increased risk of developing HF …”

The frailty syndrome and outcomes in the TOPCAT trial

“…Frailty has been measured using a number of different instruments in clinical trials and observational studies . The approach used to conceptualize frailty generally falls into two groups: frailty defined by phenotype (sometimes termed physical frailty) and frailty defined by a deficit accumulation approach (sometimes termed multi‐dimensional frailty) .…”