Frailty and the risk of all-cause mortality and hospitalization in chronic heart failure: a meta-analysis

Izabella Uchmanowicz, Christopher S. Lee, Cristiana Vitale, Stanisław Manulik, Quin E. Denfeld, Bartosz Uchmanowicz, Joanna Rosińczuk, Marcin Drozd, Joanna Jaroch, Ewa A. Jankowska

Research output: Contribution to journalReview articlepeer-review

2 Scopus citations

Abstract

To estimate the risk of all-cause mortality and hospitalization in frail patients with chronic heart failure (HF), a systematic search and meta-analysis was carried out to identify all prospective cohort studies conducted among adults with HF where frailty was quantified and related to the primary endpoints of all-cause mortality and/or hospitalization. Twenty-nine studies reporting the link between frailty and all-cause mortality in 18 757 patients were available for the meta-analysis, along with 11 studies, with 13 525 patients, reporting the association between frailty and hospitalization. Frailty was a predictor of all-cause mortality and hospitalization with summary hazard ratios (HRs) of 1.48 [95% confidence interval (CI): 1.31–1.65, P < 0.001] and 1.40 (95% CI: 1.27–1.54, P < 0.001), respectively. Summary HRs for all-cause mortality among frail inpatients undergoing ventricular assist device implantation, inpatients hospitalized for HF, and outpatients were 1.46 (95% CI: 1.18–1.73, P < 0.001), 1.58 (95% CI: 0.94–2.22, P = not significant), and 1.53 (95% CI: 1.28–1.78, P < 0.001), respectively. Summary HRs for all-cause mortality and frailty based on Fried's phenotype were 1.48 (95% CI: 1.03–1.93, P < 0.001) and 1.42 (95% CI: 1.05–1.79, P < 0.001) for inpatients and outpatients, respectively, and based on other frailty measures were 1.42 (95% CI: 1.12–1.72, P < 0.001) and 1.60 (95% CI: 1.43–1.77, P < 0.001) for inpatients and outpatients, respectively. Across clinical contexts, frailty in chronic HF is associated with an average of 48% and 40% increase in the hazard of all-cause mortality and hospitalization, respectively. The relationship between frailty and all-cause mortality is similar across clinical settings and comparing measurement using Fried's phenotype or other measures.

Original languageEnglish (US)
Pages (from-to)3427-3437
Number of pages11
JournalESC heart failure
Volume7
Issue number6
DOIs
StatePublished - Dec 2020

Keywords

  • Frailty
  • Fried's phenotype
  • Heart failure
  • Hospitalization
  • Meta-analysis
  • Mortality

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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