Lala Anuradha, Shah Palak, Khalatbari Shokoufeh, Yosef Matheos, Mountis Maria M, Robinson Shawn W, Lanfear David E, Estep Jerry D, Jeffries Neal, Taddei-Peters Wendy C, Stevenson Lynne W, Richards Blair, Mann Douglas L, Mancini Donna M, Stewart Garrick C, Aaronson Keith D
Zena and Weil Cardiovascular Institute, Mount Sinai Hospital, Icahn School of Medicine, New York, New York; Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York.
Heart Failure, Mechanical Circulatory Support and Transplant, Inova Heart and Vascular Institute, Falls Church, Virginia.
J Card Fail. 2022 May;28(5):765-774. doi: 10.1016/j.cardfail.2021.10.014. Epub 2021 Dec 25.
The Fried Frailty Phenotype predicts adverse outcomes in geriatric populations, but has not been well-studied in advanced heart failure (HF). The Registry Evaluation of Vital Information for Ventricular Assist Devices (VADs) in Ambulatory Life (REVIVAL) study prospectively collected frailty measures in patients with advanced HF to determine relevant assessments and their impact on clinical outcomes.
HF-Fried Frailty was defined by 5 baseline components (1 point each): (1) weakness: hand grip strength less than 25% of body weight; (2) slowness based on time to walk 15 feet; (3) weight loss of more than 10 lbs in the past year; (4) inactivity; and (5) exhaustion, both assessed by the Kansas City Cardiomyopathy Questionnaire. A score of 0 or 1 was deemed nonfrail, 2 prefrail, and 3 or greater was considered frail. The primary composite outcome was durable mechanical circulatory support implantation, cardiac transplant or death at 1 year. Event-free survival for each group was determined by the Kaplan-Meier method and the hazard of prefrailty and frailty were compared with nonfrailty with proportional hazards modeling. Among 345 patients with all 5 frailty domains assessed, frailty was present in 17%, prefrailty in 40%, and 43% were nonfrail, with 67% (n = 232) meeting the criteria based on inactivity and 54% (n = 186) for exhaustion. Frail patients had an increased risk of the primary composite outcome (unadjusted hazard ratio [HR] 2.82, 95% confidence interval [CI] 1.52-5.24; adjusted HR 3.41, 95% CI 1.79-6.52), as did prefrail patients (unadjusted HR 1.97, 95% CI 1.14-3.41; adjusted HR 2.11, 95% CI 1.21-3.66) compared with nonfrail patients, however, the predictive value of HF-Fried Frailty criteria was modest (Harrel's C-statistic of 0.603, P = .004).
The HF-Fried Frailty criteria had only modest predictive power in identifying ambulatory patients with advanced HF at high risk for durable mechanical circulatory support, transplant, or death within 1 year, driven primarily by assessments of inactivity and exhaustion. Focus on these patient-reported measures may better inform clinical trajectories in this population.
弗里德虚弱表型可预测老年人群的不良结局，但在晚期心力衰竭（HF）中尚未得到充分研究。门诊生活中心室辅助装置（VAD）生命体征信息登记评估（REVIVAL）研究前瞻性收集了晚期HF患者的虚弱指标，以确定相关评估及其对临床结局的影响。
HF-弗里德虚弱由5个基线成分定义（每个成分1分）：（1）虚弱：握力小于体重的25%；（2）基于行走15英尺所需时间的行动迟缓；（3）过去一年体重减轻超过10磅；（4）活动不足；（5）疲惫，均通过堪萨斯城心肌病问卷进行评估。得分为0或1被视为非虚弱，2分为虚弱前期，3分及以上被认为虚弱。主要复合结局为1年内植入持久机械循环支持装置、心脏移植或死亡。每组的无事件生存率通过Kaplan-Meier方法确定，并通过比例风险模型将虚弱前期和虚弱的风险与非虚弱进行比较。在345例所有5个虚弱领域均被评估的患者中，17%存在虚弱，40%为虚弱前期，43%为非虚弱，67%（n = 232）符合基于活动不足的标准，54%（n = 186）符合疲惫标准。与非虚弱患者相比，虚弱患者发生主要复合结局的风险增加（未调整风险比[HR] 2.82，95%置信区间[CI] 1.52 - 5.24；调整后HR 3.41，95% CI 1.79 - 6.52），虚弱前期患者也是如此（未调整HR 1.97，95% CI 1.14 - 3.41；调整后HR 2.11，95% CI 1.21 - 3.66），然而，HF-弗里德虚弱标准的预测价值中等（Harrel's C统计量为0.603，P = .004）。
HF-弗里德虚弱标准在识别1年内有植入持久机械循环支持装置、移植或死亡高风险的晚期HF门诊患者方面，预测能力仅为中等，主要由活动不足和疲惫的评估驱动。关注这些患者报告的指标可能会更好地为该人群的临床病程提供信息。
