Background
Frailty is a complex, multi-dimensional syndrome commonly observed in patients with
heart failure (HF). The presence of frailty in patients living with HF is strongly
associated with increased vulnerability to adverse events, including falls, hospitalisation,
and increased mortality. Several scoring systems have been developed to assess the
presence of frailty in patients with HF. These scoring systems vary in their complexity
and applicability; however, they provide the physician with a more comprehensive understanding
of the biological, functional, and psycho-social needs of these patients.
Objectives
To assess the clinical applicability of frailty tools in HF patients and their prognostic
value, specifically relating to outcomes such as mortality, readmissions, and clinical
deterioration.
Methods
A literature search using six electronic databases (PubMed, Scopus, Embase, Medline,
Cochrane and Web of Science) was performed in accordance with Preferred Reporting
Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Key search Medical
Subject Headings (MeSH) terms combined “Frailty” AND “Heart failure”. Studies were
included if they assessed frailty using systematically defined criteria in a HF population.
The PRISMA guidelines were used to include all relevant articles based on titles and
abstracts. Full text articles were screened based on abstract relevance. A systematic
narrative review of the literature was conducted on the final list of full text articles.
Results
An initial search yielded 8,066 articles. Following the removal of duplicates, title,
and abstract searches, the remaining 154 articles underwent full text review, with
31 articles accepted for final qualitative synthesis. The two most utilised frailty
scores were the Fried Frailty Phenotype (n=10) and the Barthel Index (n=8). The frailty
scores provide prognostic data on multiple outcomes including mortality, increased
hospitalisation, and functional decline.
Conclusion
At the present time there is no universally applied frailty measure in a HF population.
Choice of frailty score should be guided by physician experience and clinical setting,
as well as tailored to a patient’s functional, biological, and psycho-social circumstances.
A push to adopt a single universal scoring system may help to ensure that frailty
is assessed in all patients who live with HF.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Heart, Lung and CirculationAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Frailty in older adults: evidence for a phenotype.J Gerontol A Biol Sci Med Sci. 2001; 56: 146-156
- Frailty assessment in the cardiovascular care of older adults.J Am Coll Cardiol. 2014; 63: 747-762
- Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement.BMJ. 2009; 6: 339
- Sex and age differences in fragility in a heart failure population.Eur J Heart Fail. 2005; 7: 798-802
- Clinical profile and predictors of in-hospital outcome in patients with heart failure: the FADOI “CONFINE” Study.Int. J. Cardiol. 2011; 152: 88-94
- Frailty and co-morbidity predict first hospitalisation after heart failure diagnosis in primary care: population-based observational study in England.Age Ageing. 2019; 48: 347-354
- The 6-minute walk is associated with frailty and predicts mortality in older adults with heart failure.Congest Heart Fail. 2010; 16: 208-213
- Frailty predicts long-term mortality in elderly subjects with chronic heart failure.Eur J Clin Invest. 2005; 35: 723-730
- In nonagenarians, acute kidney injury predicts in-hospital mortality, while heart failure predicts hospital length of stay.PLoS One. 2013; 8e77929
- Lower extremity performance measures predict long-term prognosis in older patients hospitalized for heart failure.J Card Fail. 2010; 16: 390-395
- Basal functional status predicts one year mortality after a heart failure hospitalization in elderly patients—The RICA prospective study.Int J Cardiol. 2018; 1: 182-188
- Frailty is independently associated with 1-year mortality after hospitalization for acute heart failure.Int J Cardiol Heart Vasc. 2018; 21: 103-106
- Frequency of and significance of physical frailty in patients with heart failure.Am J Cardiol. 2017; 119: 1243-1249
- Frailty significantly impairs the short-term prognosis in elderly patients with heart failure.J Geriatr Cardiol. 2018; 15: 675-681
- Predictors of in-hospital mortality present at admission among patients hospitalised because of decompensated heart failure.Cardiology. 2007; 108: 73-78
- Basal functional status predicts three-month mortality after a heart failure hospitalization in elderly patients—the prospective RICA study.Int J Cardiol. 2014; 172: 127-131
- Fragility is a key determinant of survival in heart failure patients.Int J Cardiol. 2014; 175: 62-66
- Cognitive impairment improves the predictive validity of physical frailty for mortality in patients with advanced heart failure referred for heart transplantation.J Heart Lung Transplant. 2016; 35: 1092-1100
- Impact of gait speed and instrumental activities of daily living on all-cause mortality in adults ≥65 years with heart failure.Am J Cardiol. 2015; 115: 797-801
- Prognostic implication of frailty and depressive symptoms in an out- patient population with heart failure.Rev Esp Cardiol. 2008; 61: 835-842
- Frailty assessment in advanced heart failure.J Card Fail. 2016; 22: 840-844
- Barthel index enhanced feedback for effective cardiac treatment (BI-EFFECT) study: contribution of the Barthel index to the heart failure risk scoring system model in elderly adults with acute heart failure in the emergency department.J Am Geriatr Soc. 2012; 60: 493-498
- Impact of frailty and disability on 30-day mortality in older patients with acute heart failure.Am J Cardiol. 2017; 120: 1151-1157
- Frailty and healthcare utilization among patients with heart failure in the community.JACC Heart Fail. 2013; 1: 135-141
- Short-term prognostic factors in elderly patients seen in emergency departments for acute heart failure.Rev Esp Cardiol. 2009; 62: 757-764
- Incremental value of gait speed in predicting prognosis of older adults with heart failure: insights from the IMAGE-HF study.JACC Heart Fail. 2016; 4: 289-298
- The frailty syndrome is associated with adverse health outcomes in very old patients with stable heart failure: A prospective study in six Spanish hospitals.Int J Cardiol. 2017; 236: 296-303
- Effect of Barthel index on the risk of thirty-day mortality in patients with acute heart failure attending the emergency department: a cohort study of nine thousand ninety-eight patients from the epidemiology of acute heart failure in emergency departments registry.Ann of Emerg Med. 2019; 73: 589-598
- Prevalence of geriatric syndromes and impact on clinical and functional outcomes in older patients with acute cardiac diseases.Heart. 2011; 97: 1602-1606
- Prognostic value of simple frailty and malnutrition screening tools in patients with acute heart failure due to left ventricular systolic dysfunction.Clin Res Cardiol. 2017; 106: 533-541
- Identification of frailty in chronic heart failure.J Am Coll Cardiol HF. 2019; 4: 291-302
- Incremental value of objective frailty assessment to predict mortality in elderly patients hospitalized for heart failure.J Card Fail. 2018; 24: 723-732
- Frailty syndrome and rehospitalizations in elderly heart failure patients.Aging Clin Exp Res. 2018; 30: 617-623
- Prevalence and prognostic impact of frailty and its components in non-dependent elderly patients with heart failure.Eur J Heart Fail. 2016; 18: 869-875
- Frailty assessment instruments in heart failure: a systematic review.Eur J Cardiovasc Nurs. 2018 Jan; 17: 23-35
- Prognostic value of frailty for older patients with heart failure: a systematic review and meta-analysis of prospective studies.Biomed Res Int. 2018; 4: 1-9
- Frailty in older adults: evidence for a phenotype.Journals Gerontol Ser A Biol Sci Med Sci. 2001; 56: M146-M157
- Cognitive frailty: rational and definition from an (IANA/IAGG) International Consensus Group.J Nutr Heal Aging. 2013; 17: 726-734
- Aging, fragility and palliative care: challenges of an emerging context.Hosp Palliat Med Int. 2018; 2: 66-69
- A classification tree to assist with routine scoring of the Clinical Frailty Scale.Age Ageing. 2021; 50: 1406-1411
- Screening, detection and management of depression in elderly primary care attenders. I: The acceptability and performance of the 15 item Geriatric Depression Scale (GDS15) and the development of short versions.Fam Pract. 1994; 11: 260-266
- Grip strength, body composition, and mortality.Int J Epidemiol. 2007; 36: 228-235
- Walking speed and stride length predicts 36 months dependency, mortality, and institutionalization in Chinese aged 70 and older.J Am Geriatr Soc. 1999; 47: 1257-1260
- Usefulness of frailty profile for targeting older heart failure patients in disease management programs: a cost-effectiveness, pilot study.J Cardiovasc Med. 2010; 11: 739-774
Article info
Publication history
Published online: February 18, 2023
Accepted:
January 25,
2023
Received in revised form:
January 16,
2023
Received:
July 27,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2023 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.
