Frailty and fatigue in heart failure and cancer
S Petropoulou-Natsou, K Keramida, I Alexanian, S Xydonas, A SiderisAbstract
Background
Heart failure (HF) and cancer consist major health issues, which present a bidirectional relationship with overlapping biological pathways. Research on the two populations, comparing frailty and fatigue, is scarce, even though both syndromes are strongly associated to clinical outcomes.
Purpose
This study compared HF and cancer patients in relation to their frailty and fatigue status, using the same validated assessment scales.
Methods
We conducted a prospective study, including consecutive patients with HF and cancer, visiting the HF and the cardio-oncology outpatients clinics of our hospital. HF patients had reduced, mildly reduced, or preserved ejection fraction and were clinically stable, defined by the absence of acute decompensation and no HF–related hospitalization or emergency department visit within the preceding three months. The cancer group comprised patients with solid and hematological malignancies (stages I–IV), on current or previous antineoplastic treatment. The screening tool used to assess frailty syndrome was the Fried Frailty Phenotype. Patients with a score of 0 were classified as non-frail, those with 1-2 as prefrail and those with ≥3 as frail, according to the original definitions. Regarding fatigue assessment, we used the Fatigue Assessment Scale (FAS), a 10-item self- reported questionnaire assessing physical and mental fatigue. Fatigue was defined as a score ≥22 and extreme fatigue as a score ≥35.
Results
We analyzed data from 103 patients (49.5% HF, 50.5% cancer). For cancer patients, mean and median fatigue score was 22.52±6.53 and 21.5 (17-27), respectively, whereas for those with HF, mean score was 22.80±8.33 and median 20 (16-28), with no significant difference between the two groups. For cancer patients, mean frailty score was 1.96±1.36 and median score was 2 (1-3). Mean frailty score for HF patients was 1.88±1.67 and median score was 2 (IQR: 0-3), without being significantly different compared to the cancer patients. The percentages of patients in each frailty subgroup were similar in both populations. With respect to individual frailty components, they were not differentially affected by the presence of heart failure or cancer. Frailty score increased significantly as age increased, but it was not affected by gender or BMI. Greater frailty score was also significantly associated with greater fatigue in both HF and cancer patients.
Conclusion
Our findings suggest that patients with HF are comparably affected by the underlying condition to those with cancer, in terms of mental and physical capacity impairment.Figures Tables