Frailty and the Risk of Incident Heart Failure in Older Men

Pavankumar Kamat


June 17, 2021


  • Frailty, as measured by the combination of slow gait speed, low chair-stand time and difficulty with balance, was associated with an increased risk of developing heart failure (HF).

  • Frailty as defined by the Fried index demonstrated a weaker association with HF risk.

  • There was no association between the frailty, as measured by the Gill index and HF risk.

Why this matters

  • Findings suggest that interventions to prevent or improve frailty may help to reduce the subsequent development of HF.

Study design

  • The British Regional Heart Study (BRHS) included 1445 older men with frailty data and without prevalent HF.

  • Association between 3 different frailty scores (Fried index, Gill index and Health Ageing and Body Composition) and incident HF was evaluated.

  • Funding: British Heart Foundation.

Key results

  • During a mean follow-up of 6.1 years, 99 men developed HF.

  • In the age-adjusted model, men with the highest vs lowest novel frail score had an increased risk of HF (adjusted HR [aHR], 2.77; 95% CI, 1.25-6.15; P=.01).

  • The risk persisted after adjustment for (aHR; 95% CI):

    • prevalent myocardial infarction (MI) and body mass index (BMI; 2.55; 1.14-5.72; P=.02);

    • additional clinical risk factors (3.06; 1.31-7.14; P=.01); and

    • log interleukin-6 (3.14; 1.35-7.31; P=.008).

  • The risk of HF increased but was attenuated after excluding HF events within 2 years of baseline (aHR, 2.05; 95% CI, 0.61-6.92; P=.25).

  • Frailty score measured by Fried index showed a non-significant association with HF (aHR, 1.92; 95% CI, 0.99-3.73; P=.05), which was further attenuated after adjustment for prevalent MI and BMI (aHR, 1.60; 95% CI, 0.81-3.15; P=.18).

  • After adjustment for prevalent MI and BMI, the frailty score measured by Gill index was weakly associated with HF risk (aHR, 1.31; 95% CI, 0.47-3.70; P=.61).


  • Risk of residual confounding.

McKechnie DG, Papacosta AO, Lennon LT, Ramsay SE, Whincup PH, Wannamethee SG. Frailty and incident heart failure in older men: the British Regional Heart Study. Open Heart. 2021;8(1). doi: 10.1136/openhrt-2021-001571. PMID: 34088788.  View full text

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


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