Comparison of Frequency of Frailty and Severely Impaired Physical Function in Patients ≥60 Years Hospitalized With Acute Decompensated Heart Failure Versus Chronic Stable Heart Failure With Reduced and Preserved Left Ventricular Ejection Fraction

Abstract

Older patients with acute decompensated heart failure (ADHF) have persistently poor outcomes including frequent rehospitalization despite guidelines-based therapy. We hypothesized that such patients have multiple, severe impairments in physical function, cognition, and mood that are not addressed by current care pathways. We prospectively examined frailty, physical function, cognition, mood, and quality of life in 27 consecutive older patients with ADHF at 3 medical centers and compared these with 197 participants in 3 age-matched cohorts: stable heart failure (HF) with preserved ejection fraction (n = 80), stable HF with reduced ejection fraction (n = 56), and healthy older adults (n = 61). Based on Fried criteria, frailty was present in 56% of patients with ADHF versus 0 for the age-matched chronic HF and health cohorts. Patients with ADHF had markedly reduced Short Physical Performance Battery score (5.3 ± 2.8) and 6-minute walk distance (178 ± 102 m) (p <0.001 vs other cohorts), with severe deficits in all domains of physical function: balance, mobility, strength, and endurance. In the patients with ADHF, cognitive impairment (78%) and depression (30%) were common, and quality of life was poor. In conclusion, older patients with ADHF are frequently frail with severe and widespread impairments in physical function, cognition, mood, and quality of life that may contribute to their persistently poor outcomes, are frequently unrecognized, are not addressed in current ADHF care paradigms, and are potentially modifiable with targeted interventions.

Figure 1

Comparison of 6MWD among study cohorts. 6MWD (mean ± SE) was significantly less in ADHF (178 ± 20 meters) compared to each of the age-matched cohorts (HFpEF (417 ± 9 meters), HFrEF (432 ± 16 meters), and Healthy (563 ± 9 meters)) (p-value <0.001 for all comparisons with ADHF). Stable HFpEF and stable HFrEF were similar (p=1.0). Comparisons made adjusting for age and ejection fraction and using Bonferroni correction for multiple comparisons. Abbreviations: 6MWD = 6-minute walk distance; ADHF = acute decompensated heart failure; HFpEF = heart failure with preserved ejection fraction; HFrEF = heart failure with reduced ejection fraction.

Figure 2

Comparison of SPPB among study cohorts. Total SPPB score and each component score (chair rise, gait speed, balance) (mean ± SE) was significantly less in ADHF (5.3 ± 0.5 units) than either Stable HFpEF (9.6 ± 0.2 units) or Healthy (11.3 ± 0.1 units) (p-value <0.001 for all comparisons with ADHF). Comparisons made adjusting for age and ejection fraction and using Bonferroni correction for multiple comparisons. Abbreviations: ADHF = acute decompensated heart failure; HFpEF = heart failure with preserved ejection fraction; HFrEF = heart failure with reduced ejection; SPPB = Short Physical Performance Battery.