title: Identifying a Relationship Between Physical Frailty and Heart Failure Symptoms.
abstract: BACKGROUND
  Heart failure (HF) is a complex clinical syndrome associated with significant symptom burden; however, our understanding of the relationship between symptoms and physical frailty in HF is limited.
  
  
  OBJECTIVE
  The aim of this study was to quantify associations between symptoms and physical frailty in adults with HF.
  
  
  METHODS
  A sample of adults with symptomatic HF were enrolled in a cross-sectional study. Physical symptoms were measured with the HF Somatic Perception Scale-Dyspnea subscale, the Epworth Sleepiness Scale, and the Brief Pain Inventory short form. Affective symptoms were measured with the Patient Health Questionnaire-9 and the Brief Symptom Inventory-Anxiety scale. Physical frailty was assessed according to the Frailty Phenotype Criteria: shrinking, weakness, slowness, physical exhaustion, and low physical activity. Comparative statistics and generalized linear modeling were used to quantify associations between symptoms and physical frailty, controlling for Seattle HF Model projected 1-year survival.
  
  
  RESULTS
  The mean age of the sample (n = 49) was 57.4 ± 9.7 years, 67% were male, 92% had New York Heart Association class III/IV HF, and 67% had nonischemic HF. Physically frail participants had more than twice the level of dyspnea (P < .001), 75% worse wake disturbances (P < .001), and 76% worse depressive symptoms (P = .003) compared with those who were not physically frail. There were no differences in pain or anxiety.
  
  
  CONCLUSIONS
  Physically frail adults with HF have considerably worse dyspnea, wake disturbances, and depression. Targeting physical frailty may help identify and improve physical and affective symptoms in HF.
authors.affiliation: Quin E. Denfeld, PhD, RN Post-Doctoral Fellow, Knight Cardiovascular Institute, Oregon Health & Science University, Portland. Kerri Winters-Stone, PhD, FACSM Elnora E. Thompson Distinguished Professor, Research Professor, School of Nursing and Knight Cancer Institute, Oregon Health & Science University, Portland. James O. Mudd, MD Associate Professor, Knight Cardiovascular Institute, Oregon Health & Science University, Portland. Shirin O. Hiatt, MS, MPH, RN Research Associate, School of Nursing, Oregon Health & Science University, Portland. Christopher S. Lee, PhD, RN, FAHA, FAAN, FHFSA Carol A. Lindeman Distinguished Professor, Associate Professor, Knight Cardiovascular Institute and School of Nursing, Oregon Health & Science University, Portland.
authors.forename: Quin E
authors.initials: QE
authors.lastname: Denfeld
authors.forename: Kerri
authors.initials: K
authors.lastname: Winters-Stone
authors.forename: James O
authors.initials: JO
authors.lastname: Mudd
authors.forename: Shirin O
authors.initials: SO
authors.lastname: Hiatt
authors.forename: Christopher S
authors.initials: CS
authors.lastname: Lee
mesh_terms: D000342:Affective Symptoms / Q000209:etiology; D000368:Aged; D001007:Anxiety / Q000209:etiology; D003430:Cross-Sectional Studies; D003863:Depression / Q000209:etiology; D004417:Dyspnea / Q000209:etiology; D015444:Exercise; D005221:Fatigue / Q000209:etiology; D005260:Female; D000073496:Frailty / Q000150:complications* / Q000503:physiopathology / Q000523:psychology*; D006333:Heart Failure / Q000150:complications* / Q000503:physiopathology / Q000523:psychology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D063189:Symptom Assessment