Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Current Heart Failure Reports
Published in: Current Heart Failure Reports 3/2014

01-09-2014 | Self-Care and Health Outcomes (T Jaarsma, Section Editor)

Frailty in Heart Failure

Authors: Izabella Uchmanowicz, Maria Łoboz-Rudnicka, Przemysław Szeląg, Beata Jankowska-Polańska, Krystyna Łoboz-Grudzień

Published in: Current Heart Failure Reports | Issue 3/2014

Login to get access

Abstract

Considering the increasing age of individuals affected with heart failure (HF), a specific approach to their treatment is required, with more attention paid to geriatric conditions such as poor mobility, multiple disabilities, and cognitive impairment. Frailty is a distinct biological syndrome reflecting decreased physiologic reserve and resistance to stressors. It was shown to occur frequently in patients with heart failure, with the prevalence ranging from 15 to 74 %, depending on the studied population and the method of assessment. We reviewed literature data on the influence of frailty, skeletal abnormalities, comorbidities and geriatric condition on diagnosis, treatment, and outcomes in elderly patients with HF. Identification of frailty in patients with HF is important from the clinical point of view, as this condition exerts unfavorable effects on the course of heart failure. Frailty contributes to a higher frequency of visits to emergency departments, hospitalizations, and mortality in patients with HF. Exercise may improve mobility, and nursing support can be implemented to help the patients adhere to medications. Therefore, frail patients should be diagnosed and treated according to available guidelines, and successfully educated about their condition.
Literature
1.
Go AS, Mozaffarian D, Roger VL, Benjamin EJ, Berry JD, Borden WB, et al. Heart disease and stroke statistics–2013 update: a report from the American Heart Association. Circulation. 2013;127:e6–245.PubMedCrossRef
2.•
Chaudhry SI, Wang Y, Gill TM, Krumholz HM. Geriatric conditions and subsequent mortality in older patients with heart failure. J Am Coll Cardiol. 2010;55:309–16. This study, conducted in a large cohort of older individuals with heart failure, showed a strong association between geriatric condition and both short- and long-term mortality.PubMedCentralPubMedCrossRef
3.••
Morley JE, Vellas B, van Kan GA, Anker SD, Bauer JM, Bernabei R, et al. Frailty consensus: a call to action. J Am Med Dir Assoc. 2013;14:392–7. In this paper, a consensus group including delegates from international, European, and American societies, defined the term of frailty.PubMedCentralPubMedCrossRef
4.••
Afilalo J, Alexander KP, Mack MJ, Maurer MS, Green P, Allen LA, et al: Frailty assessment in the cardiovascular care of older adults. J Am Coll Cardiol 2014;63:747–62. The authors of this review synthesized the existing body of evidence regarding frailty in cardiovasculardisease and discussed on the perspectives of incorporatingfrailty into clinical practice.
5.
Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001;56:M146–56.PubMedCrossRef
6.
Cacciatore F, Abete P, Mazzella F, Viati L, Della Morte D, D'Ambrosio D, et al. Frailty predicts long-term mortality in elderly subjects with chronic heart failure. Eur J Clin Investig. 2005;35:723–30.CrossRef
7.
Lupon J, Gonzalez B, Santaeugenia S, Altimir S, Urrutia A, Mas D, et al. Prognostic implication of frailty and depressive symptoms in an outpatient population with heart failure. Rev Esp Cardiol. 2008;61:835–42.CrossRef
8.•
McNallan SM, Chamberlain AM, Gerber Y, Singh M, Kane RL, Weston SA, et al. Measuring frailty in heart failure: a community perspective. Am Heart J. 2013;166:768–74. This paper presents the deficit index as a feasible alternative to other methods of ascertaining frailty.PubMedCrossRef
9.
10.
de Vries NM, Staal JB, van Ravensberg CD, Hobbelen JS, Olde Rikkert MG, Nijhuis-van der Sanden MW. Outcome instruments to measure frailty: a systematic review. Ageing Res Rev. 2011;10:104–14.PubMedCrossRef
11.
Shulman KI, Pushkar Gold D, Cohen CA, Zucchero CA. Clock-drawing and dementia in the community: a longitudinal study. Int J Geriatr Psychiatry. 1993;8:487–96.CrossRef
12.
Wells JL, Seabrook JA, Stolee P, Borrie MJ, Knoefel F. State of the art in geriatric rehabilitation. Part I: review of frailty and comprehensive geriatric assessment. Arch Phys Med Rehabil. 2003;84:890–7.PubMedCrossRef
13.
14.
Rockwood K, Andrew M, Mitnitski A. A comparison of two approaches to measuring frailty in elderly people. J Gerontol A Biol Sci Med Sci. 2007;62:738–43.PubMedCrossRef
15.
Gobbens RJ, van Assen MA, Luijkx KG, Schols JM. The predictive validity of the Tilburg Frailty Indicator: disability, health care utilization, and quality of life in a population at risk. Gerontologist. 2012;52:619–31.PubMedCrossRef
16.
Abellan van Kan G, Rolland Y, Bergman H, Morley JE, Kritchevsky SB, Vellas B. The I.A.N.A Task Force on frailty assessment of older people in clinical practice. J Nutr Health Aging. 2008;12:29–37.PubMedCrossRef
17.
Altimir S, Lupon J, Gonzalez B, Prats M, Parajon T, Urrutia A, et al. Sex and age differences in fragility in a heart failure population. Eur J Heart Fail. 2005;7:798–802.PubMedCrossRef
18.
Khan H, Kalogeropoulos AP, Georgiopoulou VV, Newman AB, Harris TB, Rodondi N, et al. Frailty and risk for heart failure in older adults: the health, aging, and body composition study. Am Heart J. 2013;166:887–94.PubMedCrossRef
19.
Newman AB, Gottdiener JS, McBurnie MA, Hirsch CH, Kop WJ, Tracy R, et al. Associations of subclinical cardiovascular disease with frailty. J Gerontol A Biol Sci Med Sci. 2001;56:M158–66.PubMedCrossRef
20.
Woods NF, LaCroix AZ, Gray SL, Aragaki A, Cochrane BB, Brunner RL, et al. Frailty: emergence and consequences in women aged 65 and older in the Women's Health Initiative Observational Study. J Am Geriatr Soc. 2005;53:1321–30.PubMedCrossRef
21.
Jencks SF, Williams MV, Coleman EA. Rehospitalizations among patients in the Medicare fee-for-service program. N Engl J Med. 2009;360:1418–28.PubMedCrossRef
22.
Braunstein JB, Anderson GF, Gerstenblith G, Weller W, Niefeld M, Herbert R, et al. Noncardiac comorbidity increases preventable hospitalizations and mortality among Medicare beneficiaries with chronic heart failure. J Am Coll Cardiol. 2003;42:1226–33.PubMedCrossRef
23.
Walston J, McBurnie MA, Newman A, Tracy RP, Kop WJ, Hirsch CH, et al. Frailty and activation of the inflammation and coagulation systems with and without clinical comorbidities: results from the Cardiovascular Health Study. Arch Intern Med. 2002;162:2333–41.PubMedCrossRef
24.
Schaap LA, Pluijm SM, Deeg DJ, Harris TB, Kritchevsky SB, Newman AB, et al. Higher inflammatory marker levels in older persons: associations with 5-year change in muscle mass and muscle strength. J Gerontol A Biol Sci Med Sci. 2009;64:1183–9.PubMedCrossRef
25.
Chang SS, Weiss CO, Xue QL, Fried LP. Association between inflammatory-related disease burden and frailty: results from the Women's Health and Aging Studies (WHAS) I and II. Arch Gerontol Geriatr. 2012;54:9–15.PubMedCentralPubMedCrossRef
26.
Alonso-Bouzon C, Carcaillon L, Garcia-Garcia FJ, Amor-Andres MS, El Assar M, Rodriguez-Manas L. Association between endothelial dysfunction and frailty: the Toledo Study for Healthy Aging. Age. 2013;20:20.
27.
Varadhan R, Chaves PH, Lipsitz LA, Stein PK, Tian J, Windham BG, et al. Frailty and impaired cardiac autonomic control: new insights from principal components aggregation of traditional heart rate variability indices. J Gerontol A Biol Sci Med Sci. 2009;64:682–7.PubMedCrossRef
28.
Cruz-Jentoft AJ, Baeyens JP, Bauer JM, Boirie Y, Cederholm T, Landi F, et al. Sarcopenia: European consensus on definition and diagnosis: report of the European Working Group on Sarcopenia in Older People. Age Ageing. 2010;39:412–23.PubMedCentralPubMedCrossRef
29.
Baumgartner RN, Koehler KM, Gallagher D, Romero L, Heymsfield SB, Ross RR, et al. Epidemiology of sarcopenia among the elderly in New Mexico. Am J Epidemiol. 1998;147:755–63.PubMedCrossRef
30.
Landi F, Cruz-Jentoft AJ, Liperoti R, Russo A, Giovannini S, Tosato M, et al. Sarcopenia and mortality risk in frail older persons aged 80 years and older: results from ilSIRENTE study. Age Ageing. 2013;42:203–9.PubMedCrossRef
31.
Fulster S, Tacke M, Sandek A, Ebner N, Tschope C, Doehner W, et al. Muscle wasting in patients with chronic heart failure: results from the studies investigating co-morbidities aggravating heart failure (SICA-HF). Eur Heart J. 2013;34:512–9.PubMedCrossRef
32.
Pureza V, Florea VG. Mechanisms for cachexia in heart failure. Curr Heart Fail Rep. 2013;10:307–14.PubMedCrossRef
33.
Evans WJ, Morley JE, Argiles J, Bales C, Baracos V, Guttridge D, et al. Cachexia: a new definition. Clin Nutr. 2008;27:793–9.PubMedCrossRef
34.
McMurray JJ, Adamopoulos S, Anker SD, Auricchio A, Bohm M, Dickstein K, et al. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: the Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association (HFA) of the ESC. Eur Heart J. 2012;33:1787–847.PubMedCrossRef
35.
Anker SD, Laviano A, Filippatos G, John M, Paccagnella A, Ponikowski P, et al. ESPEN guidelines on parenteral nutrition: on cardiology and pneumology. Clin Nutr. 2009;28:455–60.PubMedCrossRef
36.
Anker SD, Ponikowski P, Varney S, Chua TP, Clark AL, Webb-Peploe KM, et al. Wasting as independent risk factor for mortality in chronic heart failure. Lancet. 1997;349:1050–3.PubMedCrossRef
37.
Stephen WC, Janssen I. Sarcopenic-obesity and cardiovascular disease risk in the elderly. J Nutr Health Aging. 2009;13:460–6.PubMedCrossRef
38.
39.
Feinstein AR, Landis JR. The role of prognostic stratification in preventing the bias permitted by random allocation of treatment. J Chronic Dis. 1976;29:277–84.PubMedCrossRef
40.
Guralnik JM. Assessing the impact of comorbidity in the older population. Ann Epidemiol. 1996;6:376–80.PubMedCrossRef
41.
Ather S, Chan W, Bozkurt B, Aguilar D, Ramasubbu K, Zachariah AA, et al. Impact of noncardiac comorbidities on morbidity and mortality in a predominantly male population with heart failure and preserved versus reduced ejection fraction. J Am Coll Cardiol. 2012;59:998–1005.PubMedCrossRef
42.
Wong CH, Weiss D, Sourial N, Karunananthan S, Quail JM, Wolfson C, et al. Frailty and its association with disability and comorbidity in a community-dwelling sample of seniors in Montreal: a cross-sectional study. Aging Clin Exp Res. 2010;22:54–62.PubMedCrossRef
43.
Kelaiditi E, Cesari M, Canevelli M, van Kan GA, Ousset PJ, Gillette-Guyonnet S, et al. Cognitive frailty: rational and definition from an (I.A.N.A./I.A.G.G.) international consensus group. J Nutr Health Aging. 2013;17:726–34.PubMedCrossRef
44.
Nguyen HT, Black SA, Ray LA, Espino DV, Markides KS. Cognitive impairment and mortality in older mexican americans. J Am Geriatr Soc. 2003;51:178–83.PubMedCrossRef
45.
Zuccala G, Marzetti E, Cesari M, Lo Monaco MR, Antonica L, Cocchi A, et al. Correlates of cognitive impairment among patients with heart failure: results of a multicenter survey. Am J Med. 2005;118:496–502.PubMedCrossRef
46.
Vogels RL, Scheltens P, Schroeder-Tanka JM, Weinstein HC. Cognitive impairment in heart failure: a systematic review of the literature. Eur J Heart Fail. 2007;9:440–9.PubMedCrossRef
47.
Lundin-Olsson L, Nyberg L, Gustafson Y. Attention, frailty, and falls: the effect of a manual task on basic mobility. J Am Geriatr Soc. 1998;46:758–61.PubMed
48.
Persad CC, Jones JL, Ashton-Miller JA, Alexander NB, Giordani B. Executive function and gait in older adults with cognitive impairment. J Gerontol A Biol Sci Med Sci. 2008;63:1350–5.PubMedCrossRef
49.
Luppa M, Luck T, Weyerer S, Konig HH, Brahler E, Riedel-Heller SG. Prediction of institutionalization in the elderly. A systematic review. Age Ageing. 2010;39:31–8.PubMedCrossRef
50.
Fuat A, Hungin AP, Murphy JJ. Barriers to accurate diagnosis and effective management of heart failure in primary care: qualitative study. BMJ. 2003;326:196.PubMedCentralPubMedCrossRef
51.
Murad K, Kitzman DW. Frailty and multiple comorbidities in the elderly patient with heart failure: implications for management. Heart Fail Rev. 2012;17:581–8.PubMedCentralPubMedCrossRef
52.
Manzano L, Escobar C, Cleland JG, Flather M. Diagnosis of elderly patients with heart failure. Eur J Heart Fail. 2012;14:1097–103.PubMedCrossRef
53.
Lam CS, Donal E, Kraigher-Krainer E, Vasan RS. Epidemiology and clinical course of heart failure with preserved ejection fraction. Eur J Heart Fail. 2011;13:18–28.PubMedCentralPubMedCrossRef
54.
Paulus WJ, Tschope C. A novel paradigm for heart failure with preserved ejection fraction: comorbidities drive myocardial dysfunction and remodeling through coronary microvascular endothelial inflammation. J Am Coll Cardiol. 2013;62:263–71.PubMedCrossRef
55.
Lien CT, Gillespie ND, Struthers AD, McMurdo ME. Heart failure in frail elderly patients: diagnostic difficulties, co-morbidities, polypharmacy and treatment dilemmas. Eur J Heart Fail. 2002;4:91–8.PubMedCrossRef
56.
Hanon O, Assayag P, Belmin J, Collet JP, Emeriau JP, Fauchier L, et al. Expert consensus of the French Society of Geriatrics and Gerontology and the French Society of Cardiology on the management of atrial fibrillation in elderly people. Arch Cardiovasc Dis. 2013;106:303–23.PubMedCrossRef
57.
van Diepen S, Majumdar SR, Bakal JA, McAlister FA, Ezekowitz JA. Heart failure is a risk factor for orthopedic fracture: a population-based analysis of 16,294 patients. Circulation. 2008;118:1946–52.PubMedCrossRef
58.
Agostini JV, Han L, Tinetti ME. The relationship between number of medications and weight loss or impaired balance in older adults. J Am Geriatr Soc. 2004;52:1719–23.PubMedCrossRef
59.
Ledwidge M, Travers B, Ryder M, Ryan E, McDonald K. Specialist care of heart failure improves appropriate pharmacotherapy at the expense of greater polypharmacy and drug-interactions. Eur J Heart Fail. 2004;6:235–43.PubMedCrossRef
60.
Pulignano G, Del Sindaco D, Di Lenarda A, Tarantini L, Cioffi G, Gregori D, et al. Usefulness of frailty profile for targeting older heart failure patients in disease management programs: a cost-effectiveness, pilot study. J Cardiovasc Med (Hagerstown). 2010;11:739–47.CrossRef
61.
Martinez-Selles M, Garcia Robles JA, Munoz R, Serrano JA, Frades E, Dominguez Munoa M, et al. Pharmacological treatment in patients with heart failure: patients knowledge and occurrence of polypharmacy, alternative medicine and immunizations. Eur J Heart Fail. 2004;6:219–26.PubMedCrossRef
62.
von Haehling S, Lainscak M, Springer J, Anker SD. Cardiac cachexia: a systematic overview. Pharmacol Ther. 2009;121:227–52.CrossRef
63.
Lefkovits M. Cardiac rehabilitation in patients with heart failure–is there a treatment beyond pharmacotherapy, surgery and device implantation? Ther Umsch. 2011;68:119–24.PubMedCrossRef
64.
Davies EJ, Moxham T, Rees K, Singh S, Coats AJ, Ebrahim S, et al. Exercise training for systolic heart failure: Cochrane systematic review and meta-analysis. Eur J Heart Fail. 2010;12:706–15.PubMedCentralPubMedCrossRef
65.
Travison TG, Basaria S, Storer TW, Jette AM, Miciek R, Farwell WR, et al. Clinical meaningfulness of the changes in muscle performance and physical function associated with testosterone administration in older men with mobility limitation. J Gerontol A Biol Sci Med Sci. 2011;66:1090–9.PubMedCrossRef
66.
Caminiti G, Volterrani M, Iellamo F, Marazzi G, Massaro R, Miceli M, et al. Effect of long-acting testosterone treatment on functional exercise capacity, skeletal muscle performance, insulin resistance, and baroreflex sensitivity in elderly patients with chronic heart failure a double-blind, placebo-controlled, randomized study. J Am Coll Cardiol. 2009;54:919–27.PubMedCrossRef
67.
Boxer RS, Dauser DA, Walsh SJ, Hager WD, Kenny AM. The association between vitamin D and inflammation with the 6-minute walk and frailty in patients with heart failure. J Am Geriatr Soc. 2008;56:454–61.PubMedCrossRef
68.
Bischoff-Ferrari HA, Dietrich T, Orav EJ, Hu FB, Zhang Y, Karlson EW, et al. Higher 25-hydroxyvitamin D concentrations are associated with better lower-extremity function in both active and inactive persons aged > or =60 y. Am J Clin Nutr. 2004;80:752–8.PubMed
69.
Alexander KP, Newby LK, Cannon CP, Armstrong PW, Gibler WB, Rich MW, et al. Acute coronary care in the elderly, part I: Non-ST-segment-elevation acute coronary syndromes: a scientific statement for healthcare professionals from the American Heart Association Council on Clinical Cardiology: in collaboration with the Society of Geriatric Cardiology. Circulation. 2007;115:2549–69.PubMedCrossRef
70.
71.•
McNallan SM, Singh M, Chamberlain AM, Kane RL, Dunlay SM, Redfield MM, et al. Frailty and healthcare utilization among patients with heart failure in the community. JACC: Heart Failure. 2013;1:135–41. The authors present the deficit index as a feasible alternative to other methods of ascertaining frailty.PubMedCentralPubMed
Metadata
Title
Frailty in Heart Failure
Authors
Izabella Uchmanowicz
Maria Łoboz-Rudnicka
Przemysław Szeląg
Beata Jankowska-Polańska
Krystyna Łoboz-Grudzień
Publication date
01-09-2014
Publisher
Springer US
Published in
Current Heart Failure Reports / Issue 3/2014
Print ISSN: 1546-9530
Electronic ISSN: 1546-9549
DOI
https://doi.org/10.1007/s11897-014-0198-4

Other articles of this Issue 3/2014

Current Heart Failure Reports 3/2014 Go to the issue

Decompensated Heart Failure (JE Ho, Section Editor)

Hyperglycemia in Acute Heart Failure: An Opportunity to Intervene?

Comorbidities of Heart Failure (CE Angermann, Section Editor)

Cerebral Impairment in Heart Failure

Self-Care and Health Outcomes (T Jaarsma, Section Editor)

Racial Disparities and the Use of Technology for Self-Management in Blacks with Heart Failure: A Literature Review

Self-Care and Health Outcomes (T Jaarsma, Section Editor)

Women with Heart Failure: Do They Require a Special Approach for Improving Adherence to Self-Care?

Comorbidities of Heart Failure (CE Angermann, Section Editor)

Sexual Dysfunction in Heart Failure Patients

Self-Care and Health Outcomes (T Jaarsma, Section Editor)

Learning Self-care After Left Ventricular Assist Device Implantation
Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Reserve your place

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin
Prof. Florian Limbourg
Prof. Anoop Chauhan
Developed by: Springer Medicine
Obesity Clinical Trial Summary

At a glance: The STEP trials

Read more

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Highlights from the ACC 2024 Congress

Year in Review: Pediatric cardiology

Pediatric Cardiology Video

Watch Dr. Anne Marie Valente present the last year's highlights in pediatric and congenital heart disease in the official ACC.24 Year in Review session.

Year in Review: Pulmonary vascular disease

Cardiopulmonary Comorbidity Video

The last year's highlights in pulmonary vascular disease are presented by Dr. Jane Leopold in this official video from ACC.24.

Year in Review: Valvular heart disease

Valvular Heart Disease Video

Watch Prof. William Zoghbi present the last year's highlights in valvular heart disease from the official ACC.24 Year in Review session.

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.

Watch now

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

16-04-2024 Type 2 Diabetes News

Incentivised to exercise

11-04-2024 Lifestyle Modifications News

New intervention for STEMI-related cardiogenic shock

10-04-2024 Myocardial Infarction News

» View more highlights on the ACC 2024 congress hub page

Image Credits