title: Effect of fragility on quality of life in patients with heart failure.
abstract: Heart failure (HF) is a chronic disease that frequently causes quality of life (QoL) impairment. We aimed to evaluate whether fragility affects QoL perception in outpatients with HF across age strata. The Minnesota Living with Heart Failure Questionnaire (MLWHFQ) was used to assess QoL, and fragility was defined according to basic standardized geriatric scales. Predefined criteria for such scales were scores of Barthel index <90, Older Americans' Resources and Services scale <10 in women and <6 in men, and Pfeiffer test >3 (±1 depending on educational grade) and ≥1 positive depression response on the abbreviated Geriatric Depression Scale. We evaluated 1,405 consecutive outpatients with HF (27.8% women, median age 69 years [twenty-fifth to seventy-fifth percentiles: 59 to 76 years]). Fragility, defined as at least 1 abnormal evaluation, was detected in 621 patients (44.2%). A positive depression response on the abbreviated Geriatric Depression Scale was the most prevalent (31.2%) component of fragility. We found a strong correlation between MLWHFQ score and the presence of fragility and all fragility components (all p <0.001). These associations prevailed in both younger (<75 years) and older patients (≥75 years; all p values <0.001 except for Pfeiffer test in younger patients [p = 0.007]). In multivariate regression analysis, QoL remained significantly associated with fragility after adjustment for age, gender, etiology of HF, left ventricular ejection fraction, New York Heart Association functional class, co-morbidities, and HF treatment, in both younger and older patients (p <0.001). In conclusion, MLWHFQ, a specific HF QoL questionnaire, is significantly influenced by fragility regardless of age.
authors.affiliation: Heart Failure and Regeneration Research Lab, Germans Trias i Pujol Health Research Institute, Badalona, Spain. Electronic address: pgastelurrutia@gmail.com.
authors.forename: Paloma
authors.initials: P
authors.lastname: Gastelurrutia
authors.forename: Josep
authors.initials: J
authors.lastname: Lupón
authors.forename: Salvador
authors.initials: S
authors.lastname: Altimir
authors.forename: Marta
authors.initials: M
authors.lastname: de Antonio
authors.forename: Beatriz
authors.initials: B
authors.lastname: González
authors.forename: Roser
authors.initials: R
authors.lastname: Cabanes
authors.forename: Lucía
authors.initials: L
authors.lastname: Cano
authors.forename: Agustín
authors.initials: A
authors.lastname: Urrutia
authors.forename: Mar
authors.initials: M
authors.lastname: Domingo
authors.forename: Elisabet
authors.initials: E
authors.lastname: Zamora
authors.forename: Crisanto
authors.initials: C
authors.lastname: Díez
authors.forename: Ramon
authors.initials: R
authors.lastname: Coll
authors.forename: Antoni
authors.initials: A
authors.lastname: Bayes-Genis
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D015331:Cohort Studies; D003863:Depression / Q000523:psychology; D005260:Female; D016330:Frail Elderly; D015577:Geriatric Assessment; D006333:Heart Failure / Q000503:physiopathology* / Q000523:psychology; D006801:Humans; D016014:Linear Models; D008297:Male; D008609:Mental Status Schedule; D008875:Middle Aged; D015999:Multivariate Analysis; D011446:Prospective Studies; D011788:Quality of Life; D011795:Surveys and Questionnaires