Use of medical therapy and risk of clinical events according to frailty in heart failure patients – A real-life cohort study

Deewa Zahir Anjum*, Jarl E. Strange, Emil Fosbøl, Caroline Hartwell Garred, Mariam Elmegaard, Charlotte Andersson, Pardeep S. Jhund, John J. V. McMurray, Mark C. Petrie, Lars Kober, Morten Schou

*Corresponding author for this work

Research output: Contribution to journalJournal articleResearchpeer-review

Abstract

Aims: Although recent randomized clinical trials have demonstrated the advantages of heart failure (HF) therapy in both frail and not frail patients, there is insufficient information on the use of HF therapy based on frailty status in a real-world setting. The aim was to examine how frailty status in HF patients associates with use of HF therapy and with clinical outcomes. Methods and results: Patients with new-onset HF between 2014 and 2021 were identified using the nationwide Danish registers. Patients across the entire range of ejection fraction were included. The associations between frailty status (using the Hospital Frailty Risk Score) and use of HF therapy and clinical outcomes (all-cause mortality, HF hospitalization, and non-HF hospitalization) were evaluated using multivariable-adjusted Cox models adjusting for age, sex, diagnostic setting, calendar year, comorbidities, pharmacotherapy, and socioeconomic status. Of 35 999 participants (mean age 69.1 years), 68% were not frail, 26% were moderately frail, and 6% were severely frail. The use of HF therapy was significantly lower in frailer patients. The hazard ratio (HR) for angiotensin-converting enzyme inhibitor/angiotensin receptor blocker initiation was 0.74 (95% confidence interval 0.70–0.77) and 0.48 (0.43–0.53) for moderate frailty and severe frailty, respectively. For beta-blockers, the corresponding HRs were 0.74 (0.71–0.78) and 0.51 (0.46–0.56), respectively, and for mineralocorticoid receptor antagonists, 0.83 (0.80–0.87) and 0.58 (0.53–0.64), respectively. The prevalence of death and non-HF hospitalization increased with frailty status. The HR for death was 1.55 (1.47–1.63) and 2.32 (2.16–2.49) for moderate and severe frailty, respectively, and the HR for non-HF hospitalization was 1.37 (1.32–1.41) and 1.82 (1.72–1.92), respectively. The association between frailty status and HF hospitalization was not significant (HR 1.08 [1.02–1.14] and 1.08 [0.97–1.20], respectively). Conclusion: In real-world HF patients, frailty was associated with lower HF therapy use and with a higher incidence of clinical outcomes including mortality and non-HF hospitalization.

Original languageEnglish
JournalEuropean Journal of Heart Failure
Volume26
Issue number8
Pages (from-to)1717-1726
Number of pages10
ISSN1388-9842
DOIs
Publication statusPublished - 2024

Bibliographical note

Publisher Copyright:
© 2024 European Society of Cardiology.

Keywords

  • Epidemiology
  • Frailty status
  • Heart failure
  • Heart failure medical therapy

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