Fragility is a key determinant of survival in heart failure patients

- Fragility is often present in heart failure (HF) patients, even in young patients.
- Influence of fragility beyond age remained unexplored on long-term HF prognosis.
- We analyzed fragility and prognosis in a large cohort of outpatients with HF.
- Fragility carried worse prognosis across different age strata.
- We report a long follow-up (4.9 years) covering many hard events (626 deaths).

BackgroundHeart failure (HF) is a chronic condition with poor prognosis, and has a high prevalence among older adults. Due to older age, fragility is often present among HF patients. However, even young HF patients show a high degree of fragility. The effect of fragility on long-term prognosis in HF patients, irrespective of age, remains unexplored. The aim of this study was to assess the influence of fragility on long-term prognosis in outpatients with HF.Methods and resultsAt least one abnormal evaluation among four standardized geriatric scales was used to identify fragility. Predefined criteria for such scales were: Barthel Index, < 90; OARS scale, < 10 in women and < 6 in men; Pfeiffer Test, > 3 (± 1, depending on educational grade); and ≥ 1 positive response for depression on the abbreviated Geriatric Depression Scale (GDS). We assessed 1314 consecutive HF outpatients (27.8% women, mean age years 66.7 ± 12.4 years with different etiologies. Fragility was detected in 581 (44.2%) patients. 626 deaths occurred during follow-up; the median follow-up was 3.6 years [P25-P75: 1.8-6.7] for the total cohort, and 4.9 years [P25-P75: 2.5-8.4] for living patients. Fragility and its components were significantly associated with decreased survival by univariate analysis. In a comprehensive multivariable Cox regression analysis, fragility remained independently associated with survival in the entire cohort, and in age and left ventricular ejection fraction subgroups.ConclusionFragility is a key determinant of survival in ambulatory patients with HF across all age strata.