Prognostic value of fractures in hospitalized patients with heart failure: insights from the JROADHF-NEXT registry
Y Singh, T Nakade, Y Fujimoto, T Ide, K Kida, S Matsushima, N Enzan, M Ikeda, T Kitai, T Taniguchi, T Okumura, T Tohyama, H Tsutsui, T Minamino, Y MatsueAbstract
Background
Fractures are one of the important non-cardiovascular complications in patients with heart failure and often lead to a loss of function and independence. Frailty is also highly prevalent in older patients with heart failure and is considered a major contributor to fracture risk. However, the relationship between frailty and fractures and their prognostic implications in patients with heart failure remain unclear.
Purpose
To evaluate the prognostic value of fractures in hospitalized patients with heart failure.
Method
This study was a post-hoc analysis of the Japanese Registry of Acute Decompensated Heart Failure-Next (JROADHF-NEXT), a prospective, nationwide registry enrolling patients hospitalized for heart failure across Japan. The occurrence of fractures after discharge was prospectively captured and its association with frailty, measured by Clinical Frailty Scale (CFS), was evaluated. To evaluate the impact of fracture on subsequent mortality, fracture onset was treated as a time-dependent variable in a Cox proportional hazards model.
Results
We analyzed 3,118 hospitalized patients with heart failure (median 75 years, 61.3% male). Fractures occurred in 144 patients, and the 2-year incidence of fractures was 4.6%. Out of 144 patients with fractures, detailed information on the incident date, fracture site, and hospitalization status was retrospectively obtained in 136 (94.4%), 134 (93.1%), and 129 (89.6%) patients, respectively. The vertebra was the most common site of fracture (37.3%), followed by hip (32.8%), other sites (17.9%), humerus (9.0%), and forearm (3.0%). Hospitalization due to fracture was observed in 95 (73.6%) patients. Patients who experienced fractures were older and more female, and exhibited lower body mass index and worse physical and cognitive function. The 2-year cumulative incidence of fractures increased in a stepwise manner across higher CFS groups (Gray’s test, P < 0.001). During the follow-up period, 268 patients died, and a Cox proportional hazards model adjusted for the MAGGIC risk score and log-transformed BNP showed that the occurrence of fracture was significantly associated with a higher subsequent risk of mortality (HR, 3.69; 95% CI, 2.46–5.53; P < 0.001).
Conclusion
Fractures occurred predominantly in patients with greater frailty and required hospitalization in more than 70% of cases after discharge following hospitalization for heart failure. The incidence of fractures was significantly associated with subsequent 2-year all-cause mortality.For image description, please refer to the figure legend and surrounding text.