Comparison of Frequency of Frailty and Severely Impaired Physical Function in Patients ≥60 Years Hospitalized with Acute Decompensated Heart Failure vs Chronic Stable Heart Failure With Reduced and Preserved Left Ventricular Ejection Fraction

摘要

Older patients with acute decompensated heart failure (ADHF) have persistently poor outcomes including frequent rehospitalization despite guidelines based therapy. We hypothesized that such patients have multiple, severe impairments in physical function, cognition, and mood that are not addressed by current care pathways. We prospectively examined frailty, physical function, cognition, mood and quality of life in 27 consecutive older ADHF patients at 3 medical centers and compared these to 197 participants in 3 age-matched cohorts: stable heart failure with preserved ejection fraction (n=80); stable heart failure with reduced ejection fraction (n=56) and healthy older adults (n=61). Based on Fried criteria, frailty was present in 56% of ADHF patients vs. 0 for the age-matched chronic heart failure and health cohorts. ADHF patients had markedly reduced Short Physical Performance Battery score (5.3±2.8) and six-minute walk distance (178±102 meters) (p<0.001 vs other cohorts), with severe deficits in all domains of physical function: balance, mobility, strength and endurance. In the ADHF patients, cognitive impairment (78%) and depression (30%) were common, and quality of life was poor. In conclusion, older ADHF patients are frequently frail with severe and widespread impairments in physical function, cognition, mood and quality of life that may contribute to their persistently poor outcomes, are frequently unrecognized, are not addressed in current ADHF care paradigms, and are potentially modifiable with targeted interventions.