title: Prognostic value of simple frailty and malnutrition screening tools in patients with acute heart failure due to left ventricular systolic dysfunction.
abstract: BACKGROUND
  Frailty and malnutrition are common in patients with heart failure (HF), and are associated with adverse outcomes. We studied the prognostic value of three malnutrition and three frailty indices in patients admitted acutely to hospital with HF.
  
  
  METHODS
  265 consecutive patients [62% males, median age 80 (interquartile range (IQR): 72-86) years, median NTproBNP 3633 (IQR: 2025-6407) ng/l] admitted with HF between 2013 and 2014 were enrolled. Patients were screened for frailty using the Derby frailty index (DFI), acute frailty network (AFN) frailty criteria, and clinical frailty scale (CFS) and for malnutrition using the geriatric nutritional risk index (GNRI), controlling nutritional status (CONUT) score and prognostic nutritional index (PNI).
  
  
  RESULTS
  According to the CFS (> 4), DFI, and AFN, 53, 50, and 53% were frail, respectively. According to the GNRI (≤ 98), CONUT score (> 4), and PNI (≤ 38), 46, 46, and 42% patients were malnourished, respectively. During a median follow-up of 598 days (IQR 319-807 days), 113 patients died. One year mortality was 1% for those who were neither frail nor malnourished; 15% for those who were either malnourished or frail; and 65% for those who were both malnourished and frail. Amongst the malnutrition scores, PNI, and amongst the frailty scores, CFS increased model performance most compared with base model. A final model, including CFS and PNI, increased c-statistic for mortality prediction from 0.68 to 0.84.
  
  
  CONCLUSIONS
  Worsening frailty and malnutrition indices are strongly related to worse outcome in patients hospitalised with HF.
authors.affiliation: Department of Cardiology, Hull and East Yorkshire Medical Research and Teaching Centre, Castle Hill Hospital, Hull York Medical School (at University of Hull), Cottingham, Kingston upon Hull, HU16 5JQ, UK. Shirley.sze@nhs.net.|Department of Cardiology, Diana, Princess of Wales Hospital, Grimsby, Northeast Lincolnshire, DN33 2BA, UK. Shirley.sze@nhs.net.
authors.forename: S
authors.initials: S
authors.lastname: Sze
authors.affiliation: Department of Cardiology, Hull and East Yorkshire Medical Research and Teaching Centre, Castle Hill Hospital, Hull York Medical School (at University of Hull), Cottingham, Kingston upon Hull, HU16 5JQ, UK.
authors.forename: J
authors.initials: J
authors.lastname: Zhang
authors.affiliation: Department of Cardiology, Hull and East Yorkshire Medical Research and Teaching Centre, Castle Hill Hospital, Hull York Medical School (at University of Hull), Cottingham, Kingston upon Hull, HU16 5JQ, UK.
authors.forename: P
authors.initials: P
authors.lastname: Pellicori
authors.affiliation: Department of Cardiology, Diana, Princess of Wales Hospital, Grimsby, Northeast Lincolnshire, DN33 2BA, UK.
authors.forename: D
authors.initials: D
authors.lastname: Morgan
authors.affiliation: Department of Cardiology, Hull and East Yorkshire Medical Research and Teaching Centre, Castle Hill Hospital, Hull York Medical School (at University of Hull), Cottingham, Kingston upon Hull, HU16 5JQ, UK.
authors.forename: A
authors.initials: A
authors.lastname: Hoye
authors.affiliation: Department of Cardiology, Hull and East Yorkshire Medical Research and Teaching Centre, Castle Hill Hospital, Hull York Medical School (at University of Hull), Cottingham, Kingston upon Hull, HU16 5JQ, UK.
authors.forename: A L
authors.initials: AL
authors.lastname: Clark
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D000073496:Frailty / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D015577:Geriatric Assessment / Q000379:methods*; D054143:Heart Failure, Systolic / Q000150:complications* / Q000453:epidemiology / Q000503:physiopathology; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000503:physiopathology; D006801:Humans; D015994:Incidence; D008297:Male; D044342:Malnutrition / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D009752:Nutritional Status; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D015996:Survival Rate / Q000639:trends; D006113:United Kingdom / Q000453:epidemiology; D018487:Ventricular Dysfunction, Left / Q000150:complications* / Q000453:epidemiology / Q000503:physiopathology; D016277:Ventricular Function, Left / Q000502:physiology*
keywords: Frailty; Heart failure; Malnutrition; Mortality; Score