Fried Frailty Phenotype and 6-Month Risk of First All-Cause Rehospitalisation Among Older Outpatients with Heart Failure and LVEF >40%: A Multicentre Prospective Cohort Study
TL;DR
Frailty was common and associated with a higher 6-month risk of first all-cause rehospitalisation among older outpatients with HF and LVEF >40%.
Abstract
Background Heart failure (HF) with left ventricular ejection fraction (LVEF) >40% is common in older adults and carries a substantial risk of post-discharge rehospitalisation. However, the prognostic association of the Fried frailty phenotype with short-term rehospitalisation remains incompletely characterised. Methods We conducted a multicentre prospective cohort study of adults aged ≥60 years with HF and LVEF >40% who were enrolled 1–3 months after HF hospitalisation at two tertiary HF outpatient clinics in Ho Chi Minh City, Vietnam. Frailty was assessed at enrolment using the Fried frailty phenotype and defined as meeting ≥3 criteria. For prognostic analyses, robust and pre-frail participants were combined into a non-frail group and compared with frail participants. Participants were followed for 6 months from enrolment to ascertain first all-cause rehospitalisation. Cox proportional hazards regression assessed the association between frailty and rehospitalisation, and the incremental prognostic contribution of frailty was evaluated using Harrell’s C-statistic and the likelihood-ratio test. Results Among 313 participants, the median age was 72.0 years (interquartile range, 66.0–81.0), 53.4% were male, and 190 (60.7%) were frail. First all-cause rehospitalisation occurred in 118 participants (37.7%): 33 of 123 non-frail participants (26.8%) and 85 of 190 frail participants (44.7%). Frailty was associated with a higher risk of rehospitalisation in univariable analysis (HR, 1.89; 95% CI, 1.27–2.83) and after adjustment for prespecified covariates (adjusted HR, 1.80; 95% CI, 1.09–2.95; p = 0.021). Adding frailty increased Harrell’s C-statistic from 0.717 to 0.723, corresponding to a change of 0.006 (95% CI, −0.004 to 0.027), and improved overall model fit according to the likelihood-ratio test (p = 0.017). Conclusion Frailty was common and associated with a higher 6-month risk of first all-cause rehospitalisation among older outpatients with HF and LVEF >40%. Adding frailty improved overall model fit, whereas the estimated change in discrimination was small and its confidence interval included no improvement. The models were not internally or externally validated; independent validation is warranted.