Review Article

Prognostic Value of Frailty for Older Patients with Heart Failure: A Systematic Review and Meta-Analysis of Prospective Studies

Table 2

Main findings and quality of eligible studies.

First AuthorEndpointsComparisonsAssociationAdjusted FactorsNOS

Boxermortalityfrail/nonfrailHR 1.58; 95%CI=1.15-2.17 P=0.005Adjusted for age (5-year categories); CRP levels; NYHA classifications; interleukin-69

Cacciatoremortalityfrail
class(2-3)/ 1
HR 1.48; 95%CI=1.04-2.11 P=0.032Adjusted for age; sex; NYHA class; comorbidity; systolic blood pressure; diastolic blood pressure; diuretics; ACE-inhibitors; nitrates and digoxin and ischaemic aetiology9

Martín-Sánchezall-cause mortalityfrail/nonfrailHR 2.5; 95% CI = 1.0–6.0; P= 0.047Adjusted by sex; arterial hypertension; atrial fibrillation; previous diagnostic of heart failure; Barthel index; baseline NYHA class; tachycardia;
hypoxemia; anemia; CHF risk model; NT-proBNP
7

Pulignano(2006)1-year mortality
1-year HF hospital re-admissions
frail
class(2-4)/1
HR 1.74; 95% CI= 1.10-2.75
HR 3.11; 95% CI= 1.61-6.03
Advanced age; EF<20%; SBP<100 mmHg; anemia no BB therapy7

Rodríguez-Pascualall-cause mortality, readmission incident functional limitationfrail/nonfrailHR 2.15; 95% CI=1.23–3.76; P=0.005
HR 1.65; 95% CI=1.11–2.46; P<0.05
HR 1.55; 95% CI=0.91–2.66; P<0.05
Adjusted for age, sex, dementia, serum creatinine level, limitation in IADL, NYHA III–IV functional class, Charlson comorbidity index, LVEF ⩽ 45%, previous admission due to HF, treatment with beta-blockers, and treatment with ACEI/ARB.8

Vidán1-year all-cause mortality
1-year readmission
30-day functional decline
frail/nonfrailHR 2.13; 95%CI=1.07–4.23; P=0.031
OR 1.96; 95% CI=1.14–3.34; P<0.05
OR 2.20; 95% CI=1.19–4.08; P<0.05
Adjusted for age; gender; chronic co-morbidity; presence of other acute diseases; LVEF; NYHA class; NT-proBNP levels9

Chaudhryall-cause hospitalizationsweak grip/normal
slow gait/normal
HR 1.19; 95%CI=1.00–1.42; P=0.050
HR 1.28; 95%CI=1.06–1.55; P=0.010
Adjusted for Demographics (age sex education); Heart failure Status (Ejection fraction < 45% NYHA III/IV Not taking Beta-blocker); Medical history(Diabetes mellitus Chronic kidney disease Stroke); Depression9

chiarantinimortalitySPPB0 or 1-4 /SPPB9-120 HR6.06; 95% CI=2.19-16.76; P=0.001
1-4HR4.78; 95%CI=1.63-14.02; P=0.004
Adjusted for demographics; study site; left ventricular ejection fraction; comorbidity;
New York Heart Association class
8

Madanall-cause hospitalization or death
all-cause hospitalizations
subgroup
non-HF–related hospitalizations
HF-related hospitalizations
frail/prefrailHR 1.95; 95% CI=1.06–3.59; P =0.031
HR 1.92; 95% CI=1.12–3.27; P =0.017
subgroup
HR 3.31; 95% CI=1.14- 9.6; P =0 .028
HR 1.31; 95% CI=0.68–2.49; P = 0.380
Adjusting for diabetes; age; sex9

Pulignano(2016)all-cause mortality
all cause hospitalization
HF-related hospitalizations
highest tertiles/the lowest tertileHR 0.62; 95% CI= 0.43 -0.88; P=0.008
HR 0.74; 95% CI= 0.61 -0.90; P=0.002
HR 0.70; 95% CI= 0.55 -0.90; P=0.004
Adjusted by Age; SBP; No beta-blocker therapy; NYHA class III/IV (yes vs. no); LVEF <20%; Anemia8

Abbreviations: ACE, angiotensin-converting enzyme; ACEI, angiotensin converting enzyme inhibitors; ARB, angiotensin receptor blockers; CHF, congestive heart failure; CI, confidence interval; CRP, C-reactive protein; HR, hazard ratio; IADL, Instrumental Activities of Daily Living; LVEF, left ventricle ejection fraction; NT-proBNP, N-terminal prohormone B-type natriuretic peptide; NYHA, New York Heart Association; SBP, systolic blood pressure.