title: Frailty Assessment in Advanced Heart Failure.
abstract: BACKGROUND
  Several studies have recently demonstrated the value of frailty assessment in a general heart failure (HF) population; however, it is unknown whether these findings are also applicable in advanced HF. We investigated the utility of frailty assessment and its prognostic value in elderly patients with advanced HF.
  
  
  METHODS
  Forty consecutive elderly subjects aged ≥65 years, with left ventricular ejection fraction ≤35%, New York Heart Association class III or IV, and a 6-minute walk test <300 m were enrolled from the HF clinic at Montefiore Medical Center between October 2012 and July 2013. Subjects were assessed for frailty with the Fried Frailty Index, consisting of 5 components: hand grip strength, 15-foot walk time, weight loss, physical activity, and exhaustion. All subjects were prospectively followed for death or hospitalization.
  
  
  RESULTS
  At baseline, the mean age of the cohort was 74.9 ± 6.5 years, 58% female, left ventricular ejection fraction 25.6 ± 6.4%, 6-minute walk test 195.8 ± 74.3 m and length of follow-up 454 ± 186 days. Thirty-five percent were prefrail and 65% were frail. Frailty status was associated with the combined primary endpoint of mortality and all-cause hospitalization (hazard ratio [HR] 1.93, 95% confidence interval [CI] 1.15-3.25, P = .013). On individual analysis, frailty was associated with all-cause hospitalizations (HR 1.92, 95% CI 1.12-3.27, P = .017) and non-HF hospitalizations (HR 3.31, 95% CI 1.14- 9.6, P = .028), but was not associated with HF hospitalizations alone (HR 1.31, 95% CI 0.68-2.49, P = .380).
  
  
  CONCLUSIONS
  Frailty assessment in patients with advanced HF is feasible and provides prognostic value. These findings warrant validation in a larger cohort.
authors.affiliation: Division of Cardiology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York.
authors.forename: Shivank A
authors.initials: SA
authors.lastname: Madan
authors.affiliation: Division of Cardiology, Department of Medicine, Houston Methodist Hospital, Houston, Texas.
authors.forename: Nadia
authors.initials: N
authors.lastname: Fida
authors.affiliation: Department of Health Sciences Research, Division of Biomedical Statistics and Informatics Mayo Clinic, Rochester, Minnesota.
authors.forename: Poulami
authors.initials: P
authors.lastname: Barman
authors.affiliation: Division of Cardiology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York.
authors.forename: Daniel
authors.initials: D
authors.lastname: Sims
authors.affiliation: Division of Cardiology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York.
authors.forename: Jooyoung
authors.initials: J
authors.lastname: Shin
authors.affiliation: Division of Geriatrics, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York.
authors.forename: Joe
authors.initials: J
authors.lastname: Verghese
authors.affiliation: Division of Cardiology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York.
authors.forename: Ileana
authors.initials: I
authors.lastname: Piña
authors.affiliation: Division of Cardiology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York.
authors.forename: Ulrich
authors.initials: U
authors.lastname: Jorde
authors.affiliation: Division of Cardiology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York. Electronic address: SNEPATEL@montefiore.org.
authors.forename: Snehal R
authors.initials: SR
authors.lastname: Patel
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D004185:Disability Evaluation; D015444:Exercise / Q000502:physiology; D017079:Exercise Tolerance / Q000502:physiology; D005260:Female; D016330:Frail Elderly; D018737:Hand Strength / Q000502:physiology; D006333:Heart Failure / Q000175:diagnosis* / Q000401:mortality*; D017052:Hospital Mortality; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D010865:Pilot Projects; D011379:Prognosis; D016016:Proportional Hazards Models; D018570:Risk Assessment; D012720:Severity of Illness Index; D013318:Stroke Volume / Q000502:physiology*; D016019:Survival Analysis; D015431:Weight Loss / Q000502:physiology
keywords: Frailty; advanced heart failure; elderly; heart failure; hospitalization; mortality