Clinical characteristics and frailty status in heart failure with preserved vs. reduced ejection fraction

Tomoyuki Hamada, Toru Kubo, Kazuya Kawai, Yoko Nakaoka, Toshikazu Yabe, Takashi Furuno, Eisuke Yamada, Hiroaki Kitaoka, Kochi YOSACOI study, Tomoyuki Hamada, Toru Kubo, Kazuya Kawai, Yoko Nakaoka, Toshikazu Yabe, Takashi Furuno, Eisuke Yamada, Hiroaki Kitaoka, Kochi YOSACOI study

Abstract

Aims: The aim of this study was to elucidate the clinical characteristics, including frailty status, of patients with heart failure with preserved ejection fraction (HFpEF) in comparison with those in patients with heart failure with reduced ejection fraction (HFrEF) in a super-aged region of Japan.

Methods and results: Of the 1061 Japanese patients enrolled in the Kochi YOSACOI study, a multicentre registry, we divided 645 patients (median age of 81 years [interquartile range, 72-87 years]; women, 49.1%) into two groups, HFpEF patients (61.2%) and HFrEF patients (38.8%). Physical frailty was diagnosed on the basis of the Japanese version of Cardiovascular Health (J-CHS) Study criteria. Patients for whom left ventricular ejection fraction data were not available (n = 19), patients with heart failure with mildly reduced ejection fraction (n = 172), and patients who were not assessed by the J-CHS criteria (n = 225) were excluded. The median ages of the HFpEF and HFrEF patients were 84 and 76 years, respectively. The proportion of patients with HFpEF gradually increased with advance of age. The proportion of patients with three or more comorbidities was larger in HFpEF patients than in HFrEF patients (77.9% vs. 65.6%, P = 0.003). Handgrip strength was significantly lower in HFpEF patients than in HFrEF patients for both men (P < 0.001) and women (P = 0.041). Comfortable 5 m walking speed was significantly slower in HFpEF patients than in HFrEF patients (P < 0.001). The proportions of patients with physical frailty were 55.2% in HFpEF patients and 46.8% in HFrEF patients, and the proportion was significantly higher in HFpEF patients (P = 0.043). In multivariate analysis, physical frailty was associated with advanced age [odds ratio (OR), 1.030; 95% confidence interval (CI), 1.010-1.050; P = 0.023] and low albumin level (OR, 0.334; 95% CI, 0.192-0.582; P < 0.001) in HFpEF patients, and physical frailty was associated with women (OR, 2.150; 95% CI, 1.030-4.500; P = 0.042) and anaemia (OR, 2.840; 95% CI, 1.300-6.230; P = 0.003) in HFrEF patients.

Conclusions: In a super-aged population of HF patients in Japan, HFpEF patients are more likely to be frail/have a high frailty status compared with HFrEF patients. The results suggested that physical frailty is associated with extracardiac factors in both HFpEF patients and HFrEF patients.

Keywords: Elderly; Frailty; Heart failure; Heat failure with preserved ejection fraction; Physical function.

Conflict of interest statement

H.K. reports the receipt of personal fees from Takeda Pharmaceutical Company, Ltd, Daiichi‐Sankyo Company, Mitsubishi Tanabe Pharm Corporation, Ltd., and grants from Takeda Pharmaceutical Company, Ltd, Daiichi‐Sankyo Company, Bayer Yakuhin Ltd, Otsuka Pharmaceutical, Ltd, Actelion Pharmaceuticals Japan, Ltd.

© 2022 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.

Figures

Figure 1
Figure 1
Proportions of HFpEF patients and HFrEF patients according to age category. Cochran–Armitage trend test P < 0.001. HFpEF, heart failure with preserved ejection fraction; HFrEF, heart failure with reduced ejection fraction.
Figure 2
Figure 2
Prevalences of comorbidities in HFpEF patients and HFrEF patients. P = 0.003. HFpEF, heart failure with preserved ejection fraction; HFrEF, heart failure with reduced ejection fraction.
Figure 3
Figure 3
Comparison of physical function and frailty in HFpEF patients and HFrEF patients. HFpEF, heart failure with preserved ejection fraction; HFrEF, heart failure with reduced ejection fraction.
Figure 4
Figure 4
Percentage of patients who met the criteria for each component of the Japanese version of Cardiovascular Health Study criteria. *P < 0.05, †P < 0.001. HFpEF, heart failure with preserved ejection fraction; HFrEF, heart failure with reduced ejection fraction.

References

    1. Redfield NM. Heart failure—an epidemic of uncertain proportions. N Engl J Med 2002; 347: 1442–1444.
    1. Benjamin EL, Blaha MJ, Chiuve SE, Cushman M, Das SR, Deo R, de Ferranti SD, Floyd J, Fornage M, Gillespie C, Isasi CR, Jiménez MC, Jordan LC, Judd SE, Lackland D, Lichtman JH, Lisabeth L, Liu S, Longenecker CT, Mackey RH, Matsushita K, Mozaffarian D, Mussolino ME, Nasir K, Neumar RW, Palaniappan L, Pandey DK, Thiagarajan RR, Reeves MJ, Ritchey M, Rodriguez CJ, Roth GA, Rosamond WD, Sasson C, Towfighi A, Tsao CW, Turner MB, Virani SS, Voeks JH, Willey JZ, Wilkins JT, Wu JH, Alger HM, Wong SS, Muntner P, American Heart Association Statistics Committee and Stroke Statistics Subcommittee . Heart disease and strokes statistics—2017 update: a report from the American Heart Association. Circulation 2017; 135: e146–e603.
    1. Komajda M, Hanon O, Hochadel M, Follath F, Swedberg K, Gitt A, Cleland JG. Management of octogenarians hospitalized for heart failure in Euro Heart Failure Survey. Eur Heart J 2007; 28: 1310–1318.
    1. Komajda M, Hanon O, Hochadel M, Lopez‐Sendon JL, Follath F, Ponikowski P, Harjola VP, Drexler H, Dickstein K, Tavazzi L, Nieminen M. Contemporary management of octogenarians hospitalized for heart failure in Europe: Euro Heart Failure Survey II. Eur Heart J 2009; 30: 478–486.
    1. Hamaguchi S, Kinugawa S, Goto D, Tsuchihashi‐Makaya M, Yokota T, Yamada S, Yokoshiki H, Takeshita A, Tsutsui H, JCARE‐CARD Investigators . Predictors of long‐term adverse outcomes in elderly patients over 80 years hospitalized with heart failure—a report from the Japanese Cardiac Registry of Heart Failure in Cardiology (JCARE‐CARD). Circ J 2011; 75: 2403–2410.
    1. Van Deursen VM, Urso R, Laroche C, Damman K, Dahlström U, Tavazzi L, Maggioni AP, Voors AA. Co‐morbidities in patients with heart failure: an analysis of the European Heart Failure Pilot Survey. Eur J Heart Fail 2014; 16: 103–111.
    1. Vidán MT, Martín Sánchez FJ, Sánchez E, Ortiz FJ, Serra‐Rexach JA, Martínez‐Sellés M, Bueno H. Most elderly patients hospitalized for heart failure lack the abilities needed to perform the tasks required for self‐care: impact on outcomes. Eur J Heart Fail 2019; 21: 1434–1442.
    1. Mentz RJ, Kelly JP, Von Lueder TG, Voors AA, Lam CSP, Cowie MR, Kjeldsen K, Jankowska EA, Atar D, Butler J, Fiuzat M, Zannad F, Pitt B, O'Connor CM. Noncardiac comorbidities in heart failure with reduced versus preserved ejection fraction. J Am Coll Cardiol 2014; 64: 2281–2293.
    1. McDonagh J, Ferguson C, Newton PJ. Frailty assessment in heart failure: an overview of the multi‐domain approach. Curr Heart Fail Rep 2018; 15: 17–23.
    1. Warraich HJ, Kitzman DW, Whellan DJ, Duncan PW, Mentz RJ, Pastva AM, Nelson MB, Upadhya B, Reeves GR. Physical function, frailty, cognitive, depression, and quality of life in hospitalized adults ≥60 years with acute decompensated heart failure with preserved versus reduced ejection fraction. Circ Heart Fail 2018; 11: e005254.
    1. Hamada T, Kubo T, Kawai K, Nakaoka Y, Yabe T, Furuno T, Yamada E, Kitaoka H. Frailty in patients with acute decompensated heart failure in a super‐aged regional Japanese cohort. ESC Heart Fail 2021; 8: 2876–2888.
    1. Mebazaa A, Gheorghiade M, Piña IL, Harjola VP, Hollenberg SM, Follath F, Rhodes A, Plaisance P, Roland E, Nieminen M, Komajda M, Parkhomenko A, Masip J, Zannad F, Filippatos G. Practical recommendations for prehospital and early in‐hospital management of patients presenting with acute heart failure syndromes. Crit Care Med 2008; 36: S129–S139.
    1. Satake S, Shimada H, Yamada M, Kim H, Yoshida H, Gondo Y, Matsubayashi K, Matsushita E, Kuzuya M, Kozaki K, Sugimoto K, Senda K, Sakuma M, Endo N, Arai H. Prevalence of frailty among community‐dwellers and outpatients in Japan as defined by the Japanese version of the cardiovascular health study criteria. Geriatr Gerontol Int 2017; 17: 2629–2634.
    1. Fied LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, Seeman T, Tracy R, Kop WJ, Burke G, McBurnie MA, Cardiovascular Health Study Collaborative Research Group . Frailty in older adults: evidence for phenotype. J Gerontol A Biol Sci Med Sci 2001; 56: M146–M157.
    1. Chen LK, Liu LK, Woo J, Assantachai P, Auyeung TW, Bahyah KS, Chou MY, Chen LY, Hsu PS, Krairit O, Lee JSW, Lee WJ, Lee Y, Liang CK, Limpawattana P, Lin CS, Peng LN, Satake S, Suzuki T, Won CW, Wu CH, Wu SN, Zhang T, Zeng P, Akishita M, Arai H. Sarcopenia in Asia; consensus report of the Asian Working Group for Sarcopenia. J Am Med Dir Assoc 2014; 15: 95–101.
    1. Satake S, Senda K, Hong YJ, Miura H, Endo H, Sakurai T, Kondo I, Toba K. Validity of the Kihon Checklist for assessing frailty status. Geriatr Gerontol Int 2016; 16: 709–715.
    1. Yamada K, Furuya R, Takita T, Maruyama Y, Yamaguchi Y, Ohkawa S, Kumagai H. Simplified nutritional screening tools for patients on maintenance hemodialysis. Am J Clin Nutr 2008; 87: 106–113.
    1. Goyal P, Almarzooq ZI, Horn EM, Karas MG, Sobol I, Swaminathan RV, Feldman DN, Minutello RM, Singh HS, Bergman GW, Wong SC, Kim LK. Characteristics of hospitalizations for heart failure with preserved ejection fraction. Am J Med 2016; 129: 635.e15–e26.
    1. Tsuchihashi‐Makaya M, Hamaguchi S, Kinugawa S, Yokota T, Goto D, Yokoshiki H, Kato N, Takeshita A, Tsutsui H, JCARE‐CARD Investigators . Characteristics and outcomes of hospitalized patients with heart failure and reduced vs preserved ejection fraction—a report from the Japanese Registry of Heart Failure in Cardiology (JCARE‐CARD). Circ J 2009; 73: 1893–1900.
    1. Yagawa M, Nagatomo Y, Izumi Y, Mahara K, Tomoike H, Shiraishi Y, Kohno T, Mizuno A, Goda A, Kohsaka S, Yoshikawa T, West Tokyo Heart Failure (WET‐HF) Registry Collaborative Group . Effect of obesity on the prognostic impact of atrial fibrillation in heart failure with preserved ejection fraction. Circ J 2017; 81: 966–973.
    1. Haass M, Kitzman DW, Anand IS, Miller A, Zile MR, Massie BM, Carson PE. Body mass index and adverse cardiovascular outcomes in heart failure patients with preserved ejection fraction: results from the Irbesartan in Heart Failure with Preserved Ejection Fraction (I‐PRESERVE) trial. Circ Heart Fail 2011; 4: 324–331.
    1. Tromp J, Shen L, Jhund PS, Anand IS, Carson PE, Desai AS, Granger CB, Komajda M, McKelvie RS, Pfeffer MA, Solomon SD, Køber L, Swedberg K, Zile MR, Pitt B, Lam CSP, Mcmurray JJV. Age‐related characteristics and outcomes of patients with heart failure with preserved ejection fraction. J Am Coll Cardiol 2019; 74: 601–612.
    1. Reeves GR, Whellan DJ, Patel MJ, O'Connor CM, Duncan P, Eggebeen JD, Morgan TM, Hewston LA, Pastva AM, Kitzman DW. Comparison of frequency of frailty and severely impaired physical function in patients ≥60 years hospitalized with acute decompensated heart failure versus chronic stable heart failure with reduced and preserved left ventricular ejection fraction. Am J Cardiol 2016; 117: 1953–1958.
    1. Konishi M, Kagiyama N, Kamiya K, Saito H, Saito K, Ogasahara Y, Maekawa E, Misumi T, Kitai T, Iwata K, Jujo K, Wada H, Kasai T, Nagamatsu H, Ozawa T, Izawa K, Yamamoto S, Aizawa N, Makino A, Oka K, Momomura SI, Matsue Y. Impact of sarcopenia on prognosis in patients with heart failure with reduced and preserved ejection fraction. Eur J Prev Cardiol 2020; 28: zwaa117–zwaa1029.
    1. Kitzman DW, Whellan DJ, Duncan P, Pastva AM, Mentz RJ, Reeves GR, Nelson MB, Chen H, Upadhya B, Reed SD, Espeland MA, Hewston L, O'Connor CM. Physical rehabilitation for older patients hospitalized for heart failure. N Engl J Med 2021; 385: 203–216.
    1. Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JG, Coats AJ, Falk V, González‐Juanatey JR, Harjola VP, Jankowska EA, Jessup M, Linde C, Nihoyannopoulos P, Parissis JT, Pieske B, Riley JP, Rosano GM, Ruilope LM, Ruschitzka F, Rutten FH, van der Meer P, Authors/Task Force Members , Document Reviewers . 2016 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure: the task force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur J Heart Fail 2016; 18: 891–975.
    1. Anker SD, Butler J, Filippatos G, Ferreira JP, Bocchi E, Böhm M, Brunner‐La Rocca HP, Choi DJ, Chopra V, Chuquiure‐Valenzuela E, Giannetti N, Gomez‐Mesa JE, Janssens S, Januzzi JL, Gonzalez‐Juanatey JR, Merkely B, Nicholls SJ, Perrone SV, Piña IL, Ponikowski P, Senni M, Sim D, Spinar J, Squire I, Taddei S, Tsutsui H, Verma S, Vinereanu D, Zhang J, Carson P, Lam CSP, Marx N, Zeller C, Sattar N, Jamal W, Schnaidt S, Schnee JM, Brueckmann M, Pocock SJ, Zannad F, Packer M, EMPEROR‐Preserved Trial Investigators . Empagliflozin in heart failure with a preserved ejection fraction. N Engl J Med 2021; 385: 1451–1461.
    1. Sanders NA, Supiano MA, Lewis EF, Liu J, Claggett B, Pfeffer MA, Desai AS, Sweitzer NK, Solomon SD, Fang JC. The frailty syndrome and outcomes in the TOPCAT trial. Eur J Heart Fail 2018; 20: 1570–1577.
    1. Kamiya K, Sato Y, Takahashi T, Tsuchihashi‐Makaya M, Kotooka N, Ikegame T, Takura T, Yamamoto T, Nagayama M, Yoichi G, Makita S, Isobe M. Multidisciplinary cardiac rehabilitation and long‐term prognosis in patients with heart failure. Circ Heart Fail 2020; 13: e006798.

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