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Multicenter Study
. 2024 Jun;26(6):1399-1407.
doi: 10.1002/ejhf.3234. Epub 2024 May 14.

Frailty according to the 2019 HFA-ESC definition in patients at risk for advanced heart failure: Insights from the HELP-HF registry

Alessandro Villaschi #  1   2 , Mauro Chiarito #  1   2 , Matteo Pagnesi  3 , Davide Stolfo  4 , Luca Baldetti  5 , Carlo Mario Lombardi  3 , Marianna Adamo  3 , Ferdinando Loiacono  1 , Antonio Maria Sammartino  3 , Giada Colombo  3 , Daniela Tomasoni  3 , Riccardo Maria Inciardi  3 , Marta Maccallini  1   2 , Gaia Gasparini  1   2 , Marco Montella  1   2 , Stefano Contessi  4 , Daniele Cocianni  4 , Maria Perotto  4 , Giuseppe Barone  5 , Marco Merlo  4 , Cristiana Vitale  6 , Giuseppe Massimo Claudio Rosano  6 , Alberto Maria Cappelletti  7 , Gianfranco Sinagra  4 , Marco Metra #  3 , Daniela Pini #  1
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Free article
Multicenter Study

Frailty according to the 2019 HFA-ESC definition in patients at risk for advanced heart failure: Insights from the HELP-HF registry

Alessandro Villaschi et al. Eur J Heart Fail. 2024 Jun.
Free article

Abstract

Aims: Frailty is highly prevalent in patients with heart failure (HF), but a concordant definition of this condition is lacking. The Heart Failure Association of the European Society of Cardiology (HFA-ESC) proposed in 2019 a new multi-domain definition of frailty, but it has never been validated.

Methods and results: Patients from the HELP-HF registry were stratified according to the number of HFA-ESC frailty domains fulfilled and to the cumulative deficits frailty index (FI) quintiles. Prevalence of frailty and of each domain was reported, as well as the rate of the composite of all-cause death and HF hospitalization, its single components, and cardiovascular death in each group and quintile. Among 854 included patients, 37 (4.3%), 206 (24.1%), 365 (42.8%), 217 (25.4%), and 29 (3.4%) patients fulfilled zero, one, two, three, or four domains, respectively, while 179 patients had a FI < 0.21 and were considered not frail. The 1-year risk of adverse events increased proportionally to the number of domains fulfilled (for each criterion increase, all-cause death or HF hospitalization: hazard ratio [HR] 1.43, 95% confidence interval [CI] 1.27-1.62; all-cause death: HR 1.72, 95% CI 1.46-2.02, HF hospitalizations: subHR 1.21, 95% CI 1.04-1.31; cardiovascular death: HR 1.77, 95% CI 1.45-2.15). Consistent results were found stratifying the cohort for FI quintiles. The FI as a continuous variable demonstrated higher discriminative ability than the number of domains fulfilled (area under the curve = 0.68 vs. 0.64, p = 0.004).

Conclusion: Frailty in patients at risk for advanced HF, assessed via a multi-domain approach and the FI, is highly prevalent and identifies those at increased risk of adverse events. The FI was found to be slightly more effective in identifying patients at increased risk of mortality.

Keywords: Advanced heart failure; Frailty; Frailty index; Heart failure.

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