title: Fragility is a key determinant of survival in heart failure patients.
abstract: BACKGROUND
  Heart 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.
  
  
  RESULTS
  At 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.
  
  
  CONCLUSIONS
  Fragility is a key determinant of survival in ambulatory patients with HF across all age strata.
authors.affiliation: Germans Trias i Pujol Health Research Institute, Badalona, Spain.
authors.forename: Paloma
authors.initials: P
authors.lastname: Gastelurrutia
authors.affiliation: Heart Failure Unit, Germans Trias i Pujol Hospital, Badalona, Spain; Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.
authors.forename: Josep
authors.initials: J
authors.lastname: Lupón
authors.affiliation: Heart Failure Unit, Germans Trias i Pujol Hospital, Badalona, Spain; Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.
authors.forename: Salvador
authors.initials: S
authors.lastname: Altimir
authors.affiliation: Heart Failure Unit, Germans Trias i Pujol Hospital, Badalona, Spain.
authors.forename: Marta
authors.initials: M
authors.lastname: de Antonio
authors.affiliation: Heart Failure Unit, Germans Trias i Pujol Hospital, Badalona, Spain.
authors.forename: Beatriz
authors.initials: B
authors.lastname: González
authors.affiliation: Heart Failure Unit, Germans Trias i Pujol Hospital, Badalona, Spain.
authors.forename: Roser
authors.initials: R
authors.lastname: Cabanes
authors.affiliation: Heart Failure Unit, Germans Trias i Pujol Hospital, Badalona, Spain.
authors.forename: Margarita
authors.initials: M
authors.lastname: Rodríguez
authors.affiliation: Heart Failure Unit, Germans Trias i Pujol Hospital, Badalona, Spain; Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.
authors.forename: Agustín
authors.initials: A
authors.lastname: Urrutia
authors.affiliation: Heart Failure Unit, Germans Trias i Pujol Hospital, Badalona, Spain.
authors.forename: Mar
authors.initials: M
authors.lastname: Domingo
authors.affiliation: Heart Failure Unit, Germans Trias i Pujol Hospital, Badalona, Spain; Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.
authors.forename: Elisabet
authors.initials: E
authors.lastname: Zamora
authors.affiliation: Heart Failure Unit, Germans Trias i Pujol Hospital, Badalona, Spain; Department of Psychiatry, Universitat Autònoma de Barcelona, Barcelona, Spain.
authors.forename: Crisanto
authors.initials: C
authors.lastname: Díez
authors.affiliation: Heart Failure Unit, Germans Trias i Pujol Hospital, Badalona, Spain; Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.
authors.forename: Ramon
authors.initials: R
authors.lastname: Coll
authors.affiliation: Heart Failure Unit, Germans Trias i Pujol Hospital, Badalona, Spain; Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain. Electronic address: abayesgenis@gmail.com.
authors.forename: Antoni
authors.initials: A
authors.lastname: Bayes-Genis
mesh_terms: D000368:Aged; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D016330:Frail Elderly; D006333:Heart Failure / Q000175:diagnosis* / Q000401:mortality*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D015996:Survival Rate / Q000639:trends
keywords: Fragility; Frailty; Heart failure; Prognosis; Survival