Fragility is a key determinant of survival in heart failure patients

Paloma Gastelurrutia, Josep Lupón, Salvador Altimir, Marta De Antonio, Beatriz González, Roser Cabanes, Margarita Rodríguez, Agustín Urrutia, Mar Domingo, Elisabet Zamora, Crisanto Díez, Ramon Coll, Antoni Bayes-Genis

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35 Citations (Scopus)


Background Heart failure (HF) is a chronic condition with poor prognosis, and has a high prevalence among older adults. Due to older age, fragility is often present among HF patients. However, even young HF patients show a high degree of fragility. The effect of fragility on long-term prognosis in HF patients, irrespective of age, remains unexplored. The aim of this study was to assess the influence of fragility on long-term prognosis in outpatients with HF. Methods and results At least one abnormal evaluation among four standardized geriatric scales was used to identify fragility. Predefined criteria for such scales were: Barthel Index, < 90; OARS scale, < 10 in women and < 6 in men; Pfeiffer Test, > 3 (± 1, depending on educational grade); and ≥ 1 positive response for depression on the abbreviated Geriatric Depression Scale (GDS). We assessed 1314 consecutive HF outpatients (27.8% women, mean age years 66.7 ± 12.4 years with different etiologies. Fragility was detected in 581 (44.2%) patients. 626 deaths occurred during follow-up; the median follow-up was 3.6 years [P25-P75: 1.8-6.7] for the total cohort, and 4.9 years [P25-P75: 2.5-8.4] for living patients. Fragility and its components were significantly associated with decreased survival by univariate analysis. In a comprehensive multivariable Cox regression analysis, fragility remained independently associated with survival in the entire cohort, and in age and left ventricular ejection fraction subgroups. Conclusion Fragility is a key determinant of survival in ambulatory patients with HF across all age strata. © 2014 Elsevier Ireland Ltd.
Original languageEnglish
Pages (from-to)62-66
JournalInternational Journal of Cardiology
Issue number1
Publication statusPublished - 15 Jul 2014


  • Fragility
  • Frailty
  • Heart failure
  • Prognosis
  • Survival


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