To Compare The Predictive Efficacy Of Different Frailty Scales For Adverse Outcomes In Patients With Heart Failure

Objective:To compare the predictive efficacy of different frailty scales on the adverse outcomes of patients with heart failure after discharge,to find the best frailty assessment tool to predict the prognosis of patients with heart failure.Methods:Patients with heart failure who were hospitalized in the Department of Cardiology of a Grade-A hospital in Jiangxi Province from November 2021 to July 2022 were selected as subjects by convenience sampling method.Basic information about study subjects should be collected,and Frail information could be evaluated by Fried Phenotype(FP),FRAIL Scale(FS),and Clinical Frailty Scale(CFS).Patients were followed up for 6 months after discharge and adverse outcome events(re-hospitalization,death,disability,falls)were recorded.Cox proportional hazard regression model was used to evaluate the relationship between frailty and adverse outcome events assessed by different frailty scales,and hazard ratio(HR)and 95% confidence interval(95%CI)were calculated.The sensitivity and specific receiver operating characteristic curve(ROC)and area under the curve(AUC)were used to evaluate the predictive efficacy of three different frailty assessment tools for adverse outcomes inpatients withheart failure.Results:A total of 317 patients with complete data were enrolled in this study,with an average age of67.37±11.79 years,and 61.1%of them were male.1.The detection rate of frailty in patients with heart failure measured by FP was 47.63%(151/317),the detection rate of FS was 41.32%(131/317)and the detection rate of CFS was 30.28%(96/317).2.The incidence of adverse events after discharge was 37.54%(119/317),mortality 6.94%(22/317),disability 1.26%(4/317),and fall 0.95%(3/317),respectively.3.Cox regression analysis showed that frailty assessed by FP,FS,and CFS increased the risk of re-hospitalization in patients with heart failure after adjusting for age,sex,and comorbidities,with adjusted HRs of 5.5(95%CI: 3.4-8.7,P<0.001)and 4.3(95%CI: 2.8-6.4,P< 0.001),3.0(95%CI:2.0-4.4,P< 0.001).After adjusting for age,sex,and comorbidities,frailty assessed by FP,FS,and CFS increased the risk of all-cause mortality in patients with heart failure,with adjusted HRs of 9.4(95%CI: 2.1-42.1,P=0.003)and 5.5(95%CI: 1.8-16.7,P= 0.002),3.5(95%CI: 1.4-8.7,P= 0.006).However,frailty assessed by FP,FS,and CFS does not increase the risk of disability and falls in patients with heart failure.4.ROC analysis showed that the area under the curve of FP,FS,and CFS for predicting re-hospitalization was 0.711,0.701,and 0.641,respectively,and the area under the curve for predicting death was 0.733,0.718,and 0.679,respectively.Conclusion:1.The prevalence of frailty in hospitalized patients with heart failure is high,and the results of using FP,FS,and CFS toassess frailty in patients with heart failure arequite different.2.Within 6 months after discharge,the adverse outcomes of patients with heart failure in the short term are mainly re-hospitalization,followed by death,and the incidence of falls and disability is low.3.Frailty assessed by FP,FS,and CFS can increase the risk of re-hospitalization and death in patients with heart failure.FP,FS,and CFS have good predictive value for re-hospitalization and death in patients with heart failure within 6 months after discharge.Among them,FP had the best predictive efficiency for re-hospitalization and death.Therefore,the FP scale is recommended to assess frailty in patients with heart failure.