Prognostic impact of Clinical Frailty Scale in patients with heart failure with preserved ejection fraction
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- Akihiro Sunaga
- Department of Cardiovascular Medicine, Graduate School of Medicine Osaka University Suita Japan
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- Shungo Hikoso
- Department of Cardiovascular Medicine, Graduate School of Medicine Osaka University Suita Japan
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- Takahisa Yamada
- Division of Cardiology Osaka General Medical Center Osaka Japan
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- Yoshio Yasumura
- Division of Cardiology Amagasaki Chuo Hospital Amagasaki Japan
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- Masaaki Uematsu
- Cardiovascular Division National Hospital Organization Osaka National Hospital Osaka Japan
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- Shunsuke Tamaki
- Division of Cardiology Osaka General Medical Center Osaka Japan
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- Haruhiko Abe
- Cardiovascular Division National Hospital Organization Osaka National Hospital Osaka Japan
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- Yusuke Nakagawa
- Division of Cardiology Kawanishi City Hospital Kawanishi Japan
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- Yoshiharu Higuchi
- Cardiovascular Division Osaka Police Hospital Osaka Japan
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- Hisakazu Fuji
- Division of Cardiology Kobe Ekisaikai Hospital Kobe Japan
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- Toshiaki Mano
- Cardiovascular Center Kansai Rosai Hospital Amagasaki Japan
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- Hiroyuki Kurakami
- Department of Medical Innovation Osaka University Hospital Suita Japan
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- Tomomi Yamada
- Department of Medical Innovation Osaka University Hospital Suita Japan
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- Tetsuhisa Kitamura
- Department of Social and Environmental Medicine, Graduate School of Medicine Osaka University Suita Japan
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- Taiki Sato
- Department of Cardiovascular Medicine, Graduate School of Medicine Osaka University Suita Japan
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- Bolrathanak Oeun
- Department of Cardiovascular Medicine, Graduate School of Medicine Osaka University Suita Japan
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- Hirota Kida
- Department of Cardiovascular Medicine, Graduate School of Medicine Osaka University Suita Japan
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- Takayuki Kojima
- Department of Cardiovascular Medicine, Graduate School of Medicine Osaka University Suita Japan
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- Yohei Sotomi
- Department of Cardiovascular Medicine, Graduate School of Medicine Osaka University Suita Japan
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- Tomoharu Dohi
- Department of Cardiovascular Medicine, Graduate School of Medicine Osaka University Suita Japan
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- Katsuki Okada
- Department of Cardiovascular Medicine, Graduate School of Medicine Osaka University Suita Japan
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- Shinichiro Suna
- Department of Cardiovascular Medicine, Graduate School of Medicine Osaka University Suita Japan
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- Hiroya Mizuno
- Department of Cardiovascular Medicine, Graduate School of Medicine Osaka University Suita Japan
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- Daisaku Nakatani
- Department of Cardiovascular Medicine, Graduate School of Medicine Osaka University Suita Japan
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- Yasushi Sakata
- Department of Cardiovascular Medicine, Graduate School of Medicine Osaka University Suita Japan
説明
<jats:title>Abstract</jats:title><jats:sec><jats:title>Aims</jats:title><jats:p>Frailty is associated with prognosis of cardiovascular diseases. However, the significance of frailty in patients with heart failure with preserved ejection fraction (HFpEF) remains to be elucidated. The purpose of this study was to examine the prognostic significance of the Clinical Frailty Scale (CFS) in real‐world patients with HFpEF using data from a prospective multicentre observational study of patients with HFpEF (PURSUIT‐HFpEF study).</jats:p></jats:sec><jats:sec><jats:title>Method and Results</jats:title><jats:p>We classified 842 patients with HFpEF enrolled in the PURSUIT‐HFpEF study into two groups using CFS. The registry enrolled patients hospitalized with a diagnosis of decompensated heart failure. Median age was 82 [interquartile range: 77, 87], and 45% of the patients were male. Of 842 patients, 406 were classified as high CFS (CFS ≥ 4, 48%) and 436 as low CFS (CFS ≤ 3, 52%). The primary endpoint was the composite of all‐cause mortality and heart failure admission. Secondary endpoints were all‐cause mortality and heart failure admission. Patients with high CFS were older (85 vs. 79 years, <jats:italic>P</jats:italic> < 0.001), predominantly female (65% vs. 46%, <jats:italic>P</jats:italic> < 0.001) and more likely to have New York Heart Association (NYHA) ≥ 2 (75% vs. 53%, <jats:italic>P</jats:italic> < 0.001) and a higher level of NT‐proBNP (1360 vs 838 pg/mL, <jats:italic>P</jats:italic> < 0.001) than those with low CFS. Patients with high CFS had a significantly greater risk of composite endpoint (Kaplan–Meier estimated 1‐year event rate 39% vs. 23%, log‐rank <jats:italic>P</jats:italic> < 0.001), all‐cause mortality (Kaplan–Meier estimated 1‐year event rate 17% vs. 7%, log‐rank <jats:italic>P</jats:italic> < 0.001) and heart failure admission (Kaplan–Meier estimated 1‐year event rate 28% vs. 19%, log‐rank <jats:italic>P</jats:italic> = 0.002) than those with low CFS. Multivariable Cox regression analysis revealed that high CFS was significantly associated with composite endpoint (adjusted HR 1.92, 95% CI 1.35–2.73, <jats:italic>P</jats:italic> < 0.001), all‐cause mortality (adjusted HR 2.54, 95% CI 1.39–4.66, <jats:italic>P</jats:italic> = 0.003) and heart failure admission (adjusted HR 1.55, 95% CI 1.03–2.32, <jats:italic>P</jats:italic> = 0.035) even after adjustment for covariates. Moreover, change in CFS grade was also significantly associated with composite endpoint (adjusted HR 1.23, 95% CI 1.11–1.36, <jats:italic>P</jats:italic> < 0.001), all‐cause mortality (adjusted HR 1.32, 95% CI 1.13–1.55, <jats:italic>P</jats:italic> = 0.001) and heart failure admission (adjusted HR 1.15, 95% CI 1.02–1.30, <jats:italic>P</jats:italic> = 0.021).</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>Frailty assessed by the CFS was associated with poor prognosis in patients with HFpEF.</jats:p></jats:sec>
収録刊行物
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- ESC Heart Failure
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ESC Heart Failure 8 (4), 3316-3326, 2021-06-20
Wiley