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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Frailty and outcomes in heart failure patients from high-, middle-, and low-income countries
European Heart Journal, Volume 44, No. 42, Year 2023
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Description
Background and There is little information on the incremental prognostic importance of frailty beyond conventional prognostic variables in Aims heart failure (HF) populations from different country income levels. Methods A total of 3429 adults with HF (age 61 ± 14 years, 33% women) from 27 high-, middle- and low-income countries were prospectively studied. Baseline frailty was evaluated by the Fried index, incorporating handgrip strength, gait speed, physical activity, unintended weight loss, and self-reported exhaustion. Mean left ventricular ejection fraction was 39 ± 14% and 26% had New York Heart Association Class III/IV symptoms. Participants were followed for a median (25th to 75th percentile) of 3.1 (2.0–4.3) years. Cox proportional hazard models for death and HF hospitalization adjusted for country income level; age; sex; education; HF aetiology; left ventricular ejection fraction; diabetes; tobacco and alcohol use; New York Heart Association functional class; HF medication use; blood pressure; and haemoglobin, sodium, and creatinine concentrations were performed. The incremental discriminatory value of frailty over and above the MAGGIC risk score was evaluated by the area under the receiver-operating characteristic curve. Results At baseline, 18% of participants were robust, 61% pre-frail, and 21% frail. During follow-up, 565 (16%) participants died and 471 (14%) were hospitalized for HF. Respective adjusted hazard ratios (95% confidence interval) for death among the pre-frail and frail were 1.59 (1.12–2.26) and 2.92 (1.99–4.27). Respective adjusted hazard ratios (95% confidence interval) for HF hospitalization were 1.32 (0.93–1.87) and 1.97 (1.33–2.91). Findings were consistent among different country income levels and by most subgroups. Adding frailty to the MAGGIC risk score improved the discrimination of future death and HF hospitalization. Conclusions Frailty confers substantial incremental prognostic information to prognostic variables for predicting death and HF hospitalization. The relationship between frailty and these outcomes is consistent across countries at all income levels. © The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology.
Authors & Co-Authors
Leong, Darryl P.
Canada, Hamilton
Hamilton Health Sciences
Canada, Hamilton
Mcmaster University
Joseph, Philip G.
Canada, Hamilton
Hamilton Health Sciences
Canada, Hamilton
Mcmaster University
Rouleau, Jean Lucien
Canada, Montreal
University of Montreal
Maggioni, Aldo Pietro
Italy, Florence
Associazione Nazionale Medici Cardiologi Ospedalieri
Sharma, Sanjib Kumar
Nepal, Dharan
B.p. Koirala Institute of Health Sciences
Núñez, Julio E.
Spain, Valencia
Hospital Clinico Universitario de Valencia
Mohan, Bishav V.Murali
Unknown Affiliation
Ogah, Okechukwu Samuel
Nigeria, Ibadan
University of Ibadan
Mielniczuk, Lisa Marie
Canada, Ottawa
Institut de Cardiologie de L'université D'ottawa
Balasubramanian, Kumar
Canada, Hamilton
Hamilton Health Sciences
McCready, Tara
Canada, Hamilton
Hamilton Health Sciences
Grinvalds, Alex J.
Canada, Hamilton
Hamilton Health Sciences
Yusuf, Salim
Canada, Hamilton
Hamilton Health Sciences
Canada, Hamilton
Mcmaster University
Statistics
Citations: 2
Authors: 13
Affiliations: 11
Identifiers
Doi:
10.1093/eurheartj/ehad595
ISSN:
0195668X
Research Areas
Environmental
Noncommunicable Diseases
Substance Abuse
Study Design
Cohort Study
Participants Gender
Female