Frailty and multiple comorbidities in the elderly patient with heart failure: implications for management

Abstract

Heart failure (HF) in the elderly is a major public health problem, and its prevalence is rising. Outcomes of HF in the elderly have not changed in the past 2 decades despite the introduction of novel HF therapies. This may be due to the combined impact of multiple comorbidities and frailty. The majority of elderly patients with HF are frail with multiple comorbidities. These comorbidities, along with frailty, contribute to the poor outcome of HF in the elderly and pose independent management challenges. More research is needed to better understand the interaction between frailty and multiple comorbidities and the mechanisms by which they impact HF and its management; develop prognostic tools that incorporate frailty and multiple comorbidities and provide more accurate prediction of outcomes; test available treatments in typical elderly patients; and develop and test novel interventions that directly address the adverse impact of multiple comorbidities and frailty.

Figure 1

Cox regression adjusted survival curve of patients with HF stratified by Lachs Frailty score (reproduced with permission from Cacciatore et al [22]).

Figure 2

Venn diagram displaying the extent of overlap of frailty with ADL disability and comorbidity (≥2 diseases) in 2,762 subjects who have at least one of these 3 entities (reproduced with permission from Fried et al [12]).

Figure 3

An illustration of the complex relationships between frailty, comorbidities, and heart failure. Notice how heart failure contributes to the development of frailty, and how both frailty and comorbidities give rise to acute stressors resulting in deterioration of the clinical status of patients with heart failure.