title: Prevalence and prognostic impact of frailty and its components in non-dependent elderly patients with heart failure.
abstract: The aim of this study was to evaluate the prevalence, clinical features, and the independent impact of frailty-a geriatric syndrome characterized by the decline of physiological systems-and its components, on prognosis after heart failure (HF) hospitalization.
  
  
  
  FRAIL-HF is a prospective cohort study including 450 non-dependent patients ≥70 years old hospitalized for HF. Frailty was screened according to the biological phenotype criteria (low physical activity, weight loss, slow walking speed, weak grip strength, and exhaustion). The independent influence of frailty on mortality, functional decline, and readmission risks was calculated adjusted for HF characteristics and co-morbidities. Mean age was 80 ± 6 years; 76% fulfilled frailty criteria. Frail patients were older, more often female, but showed no differences in chronic co-morbidities, LVEF, and NT-proBNP levels. Slow walking speed was the most discriminative component between frail (89.2%) and non-frail patients (26%). Overall, 1-year survival was 89% in the non-frail group and 75% in frail subjects (P = 0.003). After adjusting for age, gender, chronic and acute co-morbidities, NYHA, and NT-proBNP, frail patients showed higher risks for 30-day functional decline [odds ratio (OR) 2.20, 95% confidence interval (CI) 1.19-4.08], 1-year all-cause mortality [hazard ratio (HR) 2.13, 95% CI 1.07-4.23], and 1-year readmission (OR 1.96, 95% CI 1.14-3.34). The association of individual components with 1-year adjusted mortality risk was HR 2.14, 95% CI 1.05-4.39 for low physical activity and HR 1.77, 95% CI 0.95-3.29 for slow walking speed.
  
  
  
  Frailty is highly prevalent even among non-dependent elderly HF patients, and is an independent predictor of early disability, long-term mortality, and readmission. Individual frailty components may be useful for risk prediction.
authors.affiliation: Department of Geriatric Medicine, Hospital General Universitario Gregorio Marañón, Madrid, Spain.|Universidad Complutense de Madrid, Madrid, Spain.|Instituto de Investigación IiSGM, Madrid, Spain.
authors.forename: María T
authors.initials: MT
authors.lastname: Vidán
authors.affiliation: Department of Preventive Medicine and Quality Management, Hospital General Universitario Gregorio Marañón Madrid, Spain.|Agencia de Evaluación de Tecnologías Sanitarias, Instituto de Salud Carlos III, Madrid, Spain.
authors.forename: Vendula
authors.initials: V
authors.lastname: Blaya-Novakova
authors.affiliation: Department of Geriatric Medicine, Hospital Universitario Ramón y Cajal, Madrid, Spain.
authors.forename: Elísabet
authors.initials: E
authors.lastname: Sánchez
authors.affiliation: Department of Geriatric Medicine, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Ortiz
authors.affiliation: Department of Geriatric Medicine, Hospital General Universitario Gregorio Marañón, Madrid, Spain.|Universidad Complutense de Madrid, Madrid, Spain.|Instituto de Investigación IiSGM, Madrid, Spain.
authors.forename: José A
authors.initials: JA
authors.lastname: Serra-Rexach
authors.affiliation: Universidad Complutense de Madrid, Madrid, Spain.|Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain.|Instituto de investigación i + 12, and Cardiology Department, Hospital Universitario 12 de Octubre, Madrid, Spain.
authors.forename: Héctor
authors.initials: H
authors.lastname: Bueno
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D015897:Comorbidity; D005260:Female; D016330:Frail Elderly; D006333:Heart Failure / Q000097:blood / Q000401:mortality* / Q000503:physiopathology; D006760:Hospitalization; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D009026:Mortality; D020097:Natriuretic Peptide, Brain / Q000097:blood; D016017:Odds Ratio; D010446:Peptide Fragments / Q000097:blood; D015995:Prevalence; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012720:Severity of Illness Index; D013318:Stroke Volume; D013577:Syndrome; D000072797:Walking Speed
chemical_list: D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain
keywords: Frailty; Functional decline; Heart failure; Mortality; Readmission