Frailty is a state of reduced physiological capacity across multiple body systems that increases vulnerability and adverse health outcomes in older adults. While frailty is a known key contributing factor to morbidity and death in patients with heart failure (HF), the link between frailty and health status is not well understood in patients with HF with preserved ejection fraction (HFpEF), a type of HF that occurs when the muscle in the left ventricle stiffens and is unable to pump out enough blood to meet the body’s needs.
In this secondary analysis of the VITALITY-HFpEF trial, published in JACC: Heart Failure, the authors examined the links between:
- patient-reported frailty, measured by the Fried frailty phenotype (five criteria for assessing frailty), functional status as measured by the Kansas City Cardiomyopathy Questionnaire Physical Limitation Score (KCCQ-PLS, a self-administered measure of health status for HF patients), 6-minute walking distance (6MWD, testing aerobic endurance), and other patient data collected at the beginning of the study;
- frailty at the beginning of the study compared with KCCQ-PLS and 24-week 6MWD;
- frailty and changes in KCCQ-PLS and 6MWD; and
- vericiguat (a drug used to reduce the risk of death and HF hospitalization in people with chronic HF) and frailty at 24 weeks.
Among 739 patients from the VITALITY-HFpEF trial, 27.3% were classified as not frail, 37.6% as prefrail, and 35% as frail based on patient-reported number of frailty symptoms. Those patients categorized as frail were slightly older, more likely to be women, and less likely to be from Asia. The researchers found that patient-reported frailty was common and modestly associated with lesser KCCQ-PLS and shorter 6MWD at the beginning of the study. Their findings also provided prognostic insight – beyond those conventional metrics of age and sex alone – into the 6MWD at 24 weeks, and demonstrated that frailty status can change, with almost half the patients reporting improvements over 24 weeks, followed by increased physical function as demonstrated by greater 6MWD. However, treatment with vericiguat was found to have no impact on improvement in frailty over time.
This research was conducted on behalf of the VITALITY-HFpEF study group, and CVC co-authors include Drs. Padma Kaul, Cindy Westerhout, Justin Ezekowitz, and Paul Armstrong, and Sarah Rathwell.
