Impact of Frailty on Treatment, Hospitalisation and Death in Patients With Chronic Heart Failure

Sarfaroj Khan 


January 08, 2021


  • Frailty in patients with heart failure with reduced ejection fraction (HFrEF) was associated with sub-optimal medical treatment.

  • Frail patients with chronic heart failure (CHF) experienced a far higher rate of death and hospitalisations, but whether frail or not, many events were non-cardiovascular (non-CV).

Why this matters

  • Findings highlight the need for a holistic and patient-centred approach to address the various healthcare needs of patients with CHF, especially in those living with frailty.

Study design

  • Study of 467 ambulatory patients with CHF (67% male; median age, 76 years; median N-terminal pro-B-type natriuretic peptide, 1156 ng/L).

  • Frailty was assessed using the clinical frailty scale (CFS). Those with CFS >4 were classified as frail.

  • Association between frailty, treatments, hospitalisation and death in patients with CHF was evaluated.

  • Funding: None.

Key results

  • Overall, 206 (44%) patients were frail.

  • Of 291 patients with HFrEF, 117 (40%) frail patients were more likely to receive sub-optimal treatment and less likely to be prescribed angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (frail: 25% vs non-frail: 4%), beta-blockers (16% vs 8%) and mineralocorticoid receptor antagonists (50% vs 41%).

  • By 1-year follow-up, there were 56 deaths, of which 46 (82%) deaths occurred in frail patients.

  • In frail patients who died, the cause was non-CV in 43% vs 50% amongst non-frail patients (P=.71).

  • By 1-year follow-up, there were 322 hospitalisations, of which 215 events occurred in 96 (47%) frail patients and 107 events in 54 (21%) non-frail patients.

  • In frail patients, 64% of hospitalisations were because of non-CV causes vs 57% in non-frail patients (P=.25).


  • Limited sample size.

  • Single-centre study.


Sze S, Pellicori P, Zhang J, Weston J, Squire IB, Clark AL. Effect of frailty on treatment, hospitalisation and death in patients with chronic heart failure. Clin Res Cardiol. 2021 Jan 5 [Epub ahead of print]. doi: 10.1007/s00392-020-01792-w. PMID: 33399955 View abstract  

This clinical summary originally appeared on Univadis, part of the Medscape Professional Network.


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