Frailty burden and clinical characteristics in patients aged over 65 years referred to a specialist heart failure clinic
E Higgisson, T Mannion, A Cummiskey, V MaherAbstract
Introduction
Frailty has been referred to as a "new vital sign" in heart failure (HF). Frailty is associated with worse outcomes, including recurrent hospitalizations, functional decline, reduced quality of life, and increased mortality in the HF population. Importantly, frailty is dynamic, it can improve or worsen over time, making its timely assessment and management critical in HF care.
Purpose
We sought to describe the burden of frailty and its association with clinical severity, treatment patterns and biomarkers in patients aged ≥65 years at time of referral to a specialist HF clinic.
Methods
We conducted a retrospective observational analysis of consecutive patients aged ≥65 years referred to a tertiary specialist HF clinic. Frailty was assessed using the Clinical Frailty Scale (CFS) and categorised as non-frail (CFS 1–3), vulnerable (CFS 4) or frail (CFS 5–9). Clinical characteristics, New York Heart Association (NYHA) class, recent HF hospitalisation (<3 months), guideline-directed medical therapy (GDMT), QUAD score at first review, renal function (eGFR) and NT-proBNP were analysed descriptively across frailty categories.
Results
Among 80 patients aged ≥65 years, 41 (51.3%) were frail, 18 (22.5%) vulnerable and 21 (26.3%) non-frail. Frailty was strongly associated with a marked increase in symptom burden, with NYHA class III–IV present in 10% of non-frail, 61% of vulnerable, and 93% of frail patients (Figure 1). Recent HF hospitalisation was common in frail patients (63.4%). Frail patients demonstrated worse renal function (median eGFR 48.0 mL/min) and markedly higher NT-proBNP concentrations (median 2808 pg/mL) compared with non-frail patients (64.0 mL/min and 1638 pg/mL, respectively). Loop diuretic use was more frequent in frail patients (78.0%), while use of disease-modifying therapies remained high across all frailty categories (Figure 2). QUAD scores were modest overall and did not significantly decrease with increasing frailty burden.
Conclusion
Frailty is highly prevalent among patients aged ≥65 years at the time of specialist heart failure referral and is associated with greater functional impairment and clinical complexity. Despite broadly preserved use of GDMT, frailty is associated with advanced symptoms, higher biomarker burden and impaired renal function. Frailty is dynamic; interventions including exercise training, nutritional support, and psychosocial care can mitigate frailty progression. Routine frailty assessment may help identify high-risk patients and inform holistic, multidisciplinary HF care pathways.Figure 1:Baseline CharacteristicsFor image description, please refer to the figure legend and surrounding text.Figure 2:NYHA Class by Clinical FrailtyFor image description, please refer to the figure legend and surrounding text.