title: The frailty syndrome is associated with adverse health outcomes in very old patients with stable heart failure: A prospective study in six Spanish hospitals.
abstract: BACKGROUND
  Most studies on the association between the frailty syndrome and adverse health outcomes in patients with heart failure (HF) have used non-standard definitions of frailty. This study examined the association of frailty, diagnosed by well-accepted criteria, with mortality, readmission and functional decline in very old ambulatory patients with HF.
  
  
  METHODS
  Prospective study with 497 patients in six Spanish hospitals and followed up during one year. Mean (SD) age was 85.2 (7.3) years, and 79.3% had LVEF >45%. Frailty was diagnosed as having ≥3 of the 5 Fried criteria. Readmission was defined as a new episode of hospitalisation lasting >24h, and functional decline as an incident limitation in any activity of daily living at the 1-year visit. Statistical analyses were performed with Cox and logistic regression, as appropriate, and adjusted for the main prognostic factors at baseline.
  
  
  RESULTS
  At baseline, 57.5% of patients were frail. The adjusted hazard ratio (95% confidence interval) for mortality among frail versus non-frail patients was 1.93 (1.20-3.27). Mortality was higher among patients with low physical activity [1.64 (1.10-2.45)] or exhaustion [1.83 (1.21-2.77)]. Frailty was linked to increased risk of readmission [1.66 (1.17-2.36)] and functional decline [odds ratio 1.67 (1.01-2.79)]. Slow gait speed was related to functional decline [odds ratio 3.59 (1.75-7.34)]. A higher number of frailty criteria was associated with a higher risk of the three study outcomes (P trend<0.01 in each outcome).
  
  
  CONCLUSIONS
  Frailty was associated with increased risk of 1-year mortality, hospital readmission and functional decline among older ambulatory patients with HF.
authors.affiliation: Geriatric Medicine Department, Complejo Hospitalario Universitario de Vigo, Spain; University of Lincoln, Lincoln County Hospital, Lincoln, Lincolnshire, United Kingdom. Electronic address: CRodriguezpascual@lincoln.ac.uk.
authors.forename: Carlos
authors.initials: C
authors.lastname: Rodríguez-Pascual
authors.affiliation: Cardiology Department, Complejo Hospitalario Universitario de Vigo, Spain. Electronic address: eparedesgalan@hotmail.com.
authors.forename: Emilio
authors.initials: E
authors.lastname: Paredes-Galán
authors.affiliation: Geriatric Medicine Department, Complejo Hospitalario Universitario de Vigo, Spain. Electronic address: anaiferrero@yahoo.es.
authors.forename: Ana-Isabel
authors.initials: AI
authors.lastname: Ferrero-Martínez
authors.affiliation: Geriatric Medicine Department, Complejo Hospitalario de Cáceres, Spain. Electronic address: jlgonzalez@movistar.es.
authors.forename: Jose-Luis
authors.initials: JL
authors.lastname: Gonzalez-Guerrero
authors.affiliation: Geriatric Medicine Department, Hospital Universitario de Guadalajara, Departamento de Medicina, Universidad de Alcalá de Henares, Madrid, Spain. Electronic address: mhornillos@sescam.jccm.es.
authors.forename: Mercedes
authors.initials: M
authors.lastname: Hornillos-Calvo
authors.affiliation: Geriatric Medicine Department, Hospital Universitario La Paz, Departamento de Medicina, Facultad de Medicina, Universidad Autónoma de Madrid, Spain. Electronic address: rociocolino@hotmail.com.
authors.forename: Rocio
authors.initials: R
authors.lastname: Menendez-Colino
authors.affiliation: Geriatric Medicine Department, Complejo Hospitalario de Albacete, Spain. Electronic address: igttorres@outlook.es.
authors.forename: Ivett
authors.initials: I
authors.lastname: Torres-Torres
authors.affiliation: Geriatric Medicine Department, Complejo Hospitalario Universitario de Vigo, Spain. Electronic address: avilchesm@yahoo.co.uk.
authors.forename: Arturo
authors.initials: A
authors.lastname: Vilches-Moraga
authors.affiliation: Geriatric Medicine Department, Complejo Hospitalario de Oviedo, Departamento de Medicina, Universidad de Oviedo, Spain. Electronic address: conchitagalan@yahoo.es.
authors.forename: Maria-Concepcion
authors.initials: MC
authors.lastname: Galán
authors.affiliation: Geriatric Medicine Department, Complejo Hospitalario de Oviedo, Departamento de Medicina, Universidad de Oviedo, Spain. Electronic address: fransua1968@me.com.
authors.forename: Francisco
authors.initials: F
authors.lastname: Suarez-Garcia
authors.affiliation: Geriatric Medicine Department, Complejo Hospitalario Universitario de Vigo, Spain; Department of Care of the Elderly,Lincoln County Hospital, Lincoln, United Kingdom. Electronic address: molcchi@gmail.com.
authors.forename: Maria-Teresa
authors.initials: MT
authors.lastname: Olcoz-Chiva
authors.affiliation: Department of Preventive Medicine and Public Health, Universidad Autónoma de Madrid/IdiPaz, CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain. Electronic address: fernando.artalejo@uam.es.
authors.forename: Fernando
authors.initials: F
authors.lastname: Rodríguez-Artalejo
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D016330:Frail Elderly; D000073496:Frailty / Q000175:diagnosis* / Q000401:mortality*; D006333:Heart Failure / Q000175:diagnosis* / Q000401:mortality*; D006760:Hospitalization / Q000639:trends*; D006801:Humans; D008297:Male; D009026:Mortality / Q000639:trends; D011446:Prospective Studies; D013030:Spain / Q000453:epidemiology; D016896:Treatment Outcome
keywords: Elderly; Frailty; Functional decline; Heart failure; Mortality; Readmission