Study Suggests Frailty as a Predictor of Readmission and Mortality in Heart Failure

November 15, 2018

Frailty in the elderly has long been associated with an increased risk of falls, functional limitations, hospitalizations, and death. Now a new study in the November issue of JAMDA shows frailty as a significant predictor of all-cause mortality and hospital readmissions in patients with heart failure.

In “Frailty and Clinical Outcomes in Heart Failure: A Systematic Review and Meta-analysis,” the authors analyzed studies in the PubMed and Embase databases that involved patients with a definite diagnosis of heart failure and frailty that was quantified and related to the primary endpoints of all-cause mortality or hospitalization. The analysis demonstrated a 1.59-fold increase in the risk of all-cause mortality for frail patients, compared with non-frail patients. Additionally, they observed a significantly higher risk of hospital readmissions between the frail and non-frail patients. The study also suggested that patients with frailty, compared to non-frail patients, had a significantly increased risk of all-cause mortality after undergoing ventricular assist device (VAD) implantation.

The authors noted that frailty has an estimated prevalence of 44.5% in heart failure and thus may be a critical factor in influencing outcomes in this population. The question of why frailty has a negative impact on clinical outcomes in heart failure, the authors said, “can be appreciated from preclinical, clinical, and meta-analytical studies.” Frailty and prefrailty, they indicated, are associated with higher levels of oxidative stress and reduced antioxidant abilities, as well as significantly higher pro-inflammatory activities. They suggested that frailty is also related to comorbid conditions such as hypertension and atrial fibrillation, which can increase the risk of stroke.

Clinicians who actively seek to identify patients with frailty, the authors said, can intervene by promoting physical activity, offering nutrition and vitamin supplements, and reducing polypharmacy. They added that palliative care to treat frailty might improve prognosis. The authors further suggested that frailty assessment can aid risk stratification by identifying those who may benefit most from invasive management and interventions such as VAD implantation. Finally, they said, previous cost analyses “revealed that frailty was associated with a significant increase in hospitalization costs after cardiac surgery.”

The study was conducted by researchers at the Department of Cardiology, Tianjin Institute of Cardiology; Second Hospital of Tianjin Medical University, Tianjin, RP China; and the Li Ka Shing Institute of Health Sciences, Faculty of Medicine, Chinese University of Hong Kong, SAR, PR China.

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JAMDA is the official journal of AMDA – The Society for Post-Acute and Long-Term Care Medicine. JAMDA publishes peer-reviewed articles including original studies, reviews, clinical experience articles, case reports, and more, on all topics more important to post-acute and long-term care medicine. Visit for more information.

About the Society for Post-Acute and Long-Term Care Medicine
AMDA – The Society for Post-Acute and Long-Term Care Medicine is the only medical specialty society representing the community of over 50,000 medical directors, physicians, nurse practitioners, physician assistants, and other practitioners working in the various post-acute and long-term care (PA/LTC) settings. Dedicated to defining and improving quality, we advance our mission through timely professional development, evidence-based clinical guidance, and tireless advocacy on behalf of members, patients, families, and staff. Visit for more information.