Abassi Noor K, Nouhravesh Nina, Elmegaard Mariam, Austreim Marte, Zahir Deewa, Garred Caroline Hartwell, Butt Jawad H, Andersen Camilla Fuchs, Strange Jarl E, Sindet-Pedersen Caroline, Christensen Daniel M, Fosbøl Emil, Andersson Charlotte, Køber Lars, Schou Morten
Department of Cardiology Herlev-Gentofte University Hospital Copenhagen Denmark.
Department of Cardiology Roskilde Hospital Roskilde Denmark.
J Am Heart Assoc. 2025 Feb 4;14(3):e037973. doi: 10.1161/JAHA.124.037973. Epub 2025 Feb 3.
Heart failure (HF) and frailty often coexist. However, it is unknown how the interplay between HF and frailty at HF onset impacts prognosis of frail patients with HF and how this has evolved over time.
We identified 131 235 patients with new-onset HF (median age 74 years, 39.7% women) from Danish nationwide registers in 1999 to 2017. Stratification according to the Hospital Frailty Risk Score resulted in (1) 102 635 (78%) nonfrail, (2) 26 054 (20%) moderately frail, and (3) 2609 (2%) severely frail patients. The proportion of moderately frail patients increased from 13.2% to 24.9%. Five-year absolute risks of all-cause mortality, HF hospitalization, and non-HF hospitalization were calculated using the Kaplan-Meier and Aalen-Johansen estimators. From 1999 to 2002 to 2003 to 2017, all-cause mortality risk (95% CI) declined from 56.4% (55.8%-57.0%) to 33.3% (32.6%-34.1%), 79.8% (78.5%-81.0%) to 58.6% (57.2%-60.1%), and 90.8% (85.6%-96.0%) to 79.8% (76.4%-83.2%) in nonfrail, moderately frail, and severely frail patients, respectively. HF hospitalization risk remained almost constant over the study period. Non-HF hospitalization risk declined from 74.0% (73.5%-74.5%) to 65.8% (65.0%-66.5%) in nonfrail patients and remained stable overall in moderately frail and severely frail patients over the study period.
We observed an increase in frail patients. Mortality decreased for all frailty groups but remained high for severely frail patients. These findings indicate the need for further evidence on the optimization of care for frail patients with HF, and future research should address the development of comprehensive management strategies, integrating frailty assessment into standard clinical care and focused care for older patients with HF.
心力衰竭（HF）与衰弱常并存。然而，HF起病时HF与衰弱之间的相互作用如何影响HF衰弱患者的预后，以及这一情况随时间如何演变尚不清楚。
我们从1999年至2017年丹麦全国登记处确定了131235例新发HF患者（中位年龄74岁，39.7%为女性）。根据医院衰弱风险评分分层得到：（1）102635例（78%）非衰弱患者，（2）26054例（20%）中度衰弱患者，以及（3）2609例（2%）重度衰弱患者。中度衰弱患者的比例从13.2%增至24.9%。使用Kaplan-Meier法和Aalen-Johansen法估计器计算全因死亡率、HF住院率和非HF住院率的5年绝对风险。从1999年至2002年到2003年至2017年，非衰弱、中度衰弱和重度衰弱患者的全因死亡风险（95%CI）分别从56.4%（55.8%-57.0%）降至33.3%（32.6%-34.1%）、从79.8%（78.5%-81.0%）降至58.6%（57.2%-60.1%）、从90.8%（85.6%-96.0%）降至79.8%（76.4%-83.2%）。在研究期间，HF住院风险几乎保持不变。非衰弱患者的非HF住院风险从74.0%（73.5%-74.5%）降至65.8%（65.0%-66.5%），而在研究期间，中度衰弱和重度衰弱患者的非HF住院风险总体保持稳定。
我们观察到衰弱患者数量增加。所有衰弱组的死亡率均下降，但重度衰弱患者的死亡率仍然很高。这些发现表明需要进一步提供关于优化HF衰弱患者护理的证据，未来的研究应致力于制定综合管理策略，将衰弱评估纳入标准临床护理，并针对老年HF患者进行重点护理。
