Prognostic impact of frailty and exercise capacity in patients with acute decompensated heart failure and preserved ejection fraction in relation to MAGGIC Score ~PURSUIT-HFpEF Registry~
T Kondo, T Yamada, M Asai, M Seo, M Yano, T Hayashi, A Nakagawa, S Tamaki, Y Yasumura, Y Sotomi, S Hikoso, K Okada, D Nakatani, M Fukunami, Y SakataAbstract
Background
Frailty and exercise capacity have been reported to be associated with clinical outcome in patients with heart failure and preserved ejection fraction (HFpEF). However, it remains uncertain whether the combination of frailty and exercise capacity has prognostic value in patients with acute decompensated heart failure and preserved ejection fraction (ADHF-HFpEF), in relation to other risk scores such as MAGGIC score.
Purpose
We investigated whether the combination of frailty and exercise capacity could provide prognostic information in patients with ADHF-HFpEF in relation to MAGGIC score.
Methods
We prospectively studied 620 patients admitted for ADHF-HFpEF in our multicenter-prospective cohort study (PURSUIT-HFpEF registry). Frailty and exercise capacity are assessed using clinical frailty scale (CFS) and 6-minute walk distance (6MWD), respectively. All study patients were divided into 2 groups according to MAGGIC score. The primary outcome was the composite endpoint of all-cause death and rehospitalization for worsening heart failure.
Results
During a mean follow-up period of 2.6±1.7 years, 351 patients experienced primary outcome. After multivariable adjustment, CFS and 6MWD were significantly independently associated with primary outcome both high (≥25) and low (<25) MAGGIC score groups. In low MAGGIC group, patients with both frailty (CFS≧4) and low 6MWD (≦211m defined by ROC curve analysis) had a significantly higher risk than those with either frailty or low 6MWD, who had an even higher risk than those with none of them (non-frail patients with preserved 6MWD). In high MAGGIC score group, patients with either both frailty and low 6MWD or only one of these markers had a significantly higher risk compared with those without frailty and with preserved 6MWD.
Conclusion(s)
The combination of frailty and exercise capacity is useful for risk stratification in patients with acute decompensated heart failure and preserved ejection fraction, regardless of MAGGIC score.Event-free rate in high and low MAGGIC score