Multidimensional assessment of frailty in older patients with chronic heart failure: data from the TWENTE-HF study
A Kleberger, G C M Linssen, M Vollenbroek-Hutten, T Jaarsma, M Van Den Heuvel, J TimmermanAbstract
Background
Frailty is a multidimensional, dynamic state that is highly prevalent in older patients with heart failure (HF) and is associated with poor quality of life, (re-) hospitalisation, and mortality. Although frailty is recognised as a key determinant of outcomes in HF, data on multidimensional frailty assessment—including medical, physical, psychological-cognitive, and social dimensions—with respect to age- and gender-specific differences remain limited.
Purpose
To study the manifestation of frailty among patients with HF by assessing impairments across four frailty dimensions (medical, physical-functional, psychological-cognitive, and social). In addition, we aimed to explore the distribution and co-occurrence of these impairments, including differences by age and gender.
Methods
Baseline data from TWENTE-HF, a prospective observational cohort study conducted in two large general hospitals in The Netherlands, were analysed. Frailty was assessed across four dimensions: medical (HF-related clinical parameters, comorbidities, medication, hospitalisations, Mini Nutritional Assesment short form (MNA-SF)); physical-functional (handgrip strength, Short Physical Performance Battery (SPPB)); psychological-cognitive (Mini Mental State Examination (MMSE), depression); and social (e.g. health literacy). Overall frailty was assessed using the Tilburg Frailty Indicator (TFI). Variables were dichotomised (normal vs not normal) and additionally analysed by age and gender.
Results
In total, 179 patients with HF participated (mean age 77 years; 34% aged ≥ 80 years; 30% women). A high burden of polypharmacy, hospitalisations and comorbidities were seen. Physical performance (SPPB), poor health literacy were reduced, and one third lived alone. Nearly half of the study population was classified as frail according to the Tilburg Frailty Index (TFI). Individual-level analyses illustrated substantial heterogeneity in the distribution and co-occurrence of impairments across frailty dimensions. Subgroup analyses showed that, compared with men, women more frequently experienced hospital (re-)admissions for HF, had lower physical functioning, suffered from more depressive symptoms, and lived alone. Older patients (≥ 80 years vs < 80 years) had more comorbidities, reduced physical functioning, lower MMSE scores, poorer health literacy, were more likely to live alone, and more frequently met criteria for frailty as measured by the TFI.
Conclusion
Frailty in older patients with HF showed a wide distribution of determinants across the medical, physical, cognitive- and social dimensions. Combinations within the medical and physical dimension were frequently observed, often in conjunction with the social dimension. Frailty was found more in women than in men, and in older age groups. Comprehensive screening across all four dimensions provides important information for healthcare teams to individualise the delivery of patient care.