On predicting outcomes in patients with chronic heart failure with frailty syndrome

Abstract

Background. The presence of frailty negatively affects the prognosis of patients with chronic heart failure, increasing the frequency of hospitalizations, limiting treatment options, and also increasing the mortality of patients.

Aim. To develop a model for predicting mortality in patients with decompensated chronic heart failure, including frailty syndrome.

Material and methods. 107 patients aged 45–95 years with decompensated chronic heart failure were studied. Four age groups were formed: the first — 29 patients aged 45–59 years old (average age 53.9±4.5 years), the second — 31 elderly patients (60–74 years old, average 68.3±5.0 years), the third — 40 senile people (75–90 years, average age 81.5±4.1 years), the fourth — 7 long-lived patients (>90 years, average 92±1.4 years). A comprehensive geriatric assessment was performed using the program “Optimization of care in geriatrics depending on the degree of frailty”. A multivariate logistic regression analysis was performed to select mortality predictors.

Results. The prognostic model included 6 independent variables: age — 1.05 [0.96; 1.17] (p=0.28), male gender — 0.25 [0.03; 1.65] (p=0.17), frailty of severe or terminal degree — 5.56 [1.08; 37.14] (p=0.05), IV functional class according to the classification of New York Heart Association — 3.41 [0.60; 27.35] (p=0.19), ejection fraction 50% or more — 0.29 [0.03; 2.28] (p=0.26), ejection fraction 40–49% — 0.40 [0.05; 2.60] (p=0.36). The sensitivity of the model was 62%, specificity 82%, prognostic effectiveness 88%.

Conclusion. Severe or terminal asthenia is the strongest predictor of mortality, increasing the risk of an unfavorable outcome by 5.56 times.

Keywords

frailty / chronic heart failure / mortality model / old age / senile age

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