Prevalence and Prognostic Significance of Frailty in Asian Patients With Heart Failure: Insights From ASIAN-HF

Than Aung; Yan Qin; Wan Ting Tay; Nurul Sahiddah Binte Salahudin Bamadhaj; Chanchal Chandramouli; Wouter Ouwerkerk; Jasper Tromp; Inder Anand; A Mark Richards; Chung-Lieh Hung; Kanako Teramoto; Tiew-Hwa Katherine Teng; Carolyn S P Lam

doi:10.1016/j.jacasi.2021.09.006

Prevalence and Prognostic Significance of Frailty in Asian Patients With Heart Failure: Insights From ASIAN-HF

JACC Asia. 2021 Dec 7;1(3):303-313. doi: 10.1016/j.jacasi.2021.09.006. eCollection 2021 Dec.

Authors

Than Aung¹, Yan Qin¹, Wan Ting Tay², Nurul Sahiddah Binte Salahudin Bamadhaj³, Chanchal Chandramouli², Wouter Ouwerkerk^{2

4}, Jasper Tromp^{5

6

7}, Inder Anand⁸, A Mark Richards^{9

10}, Chung-Lieh Hung¹¹, Kanako Teramoto², Tiew-Hwa Katherine Teng^{2

7

12}, Carolyn S P Lam^{2

6

7}

Affiliations

¹ Department of Internal Medicine, Singapore General Hospital, Singapore.
² National Heart Centre Singapore, Singapore.
³ Biofourmis, Singapore.
⁴ Department of Dermatology, Amsterdam Medical Center, Amsterdam, the Netherlands.
⁵ Saw Swee Hock School of Public Health, National University of Singapore, Singapore.
⁶ Department of Cardiology, University Medical Center Groningen, Groningen, the Netherlands.
⁷ Duke-National University of Singapore Medical School, Singapore.
⁸ Veterans Affairs Medical Center and University of Minnesota, Minneapolis, Minnesota, USA.
⁹ National University Heart Centre, Singapore.
¹⁰ University of Otago, Dunedin, New Zealand.
¹¹ Mackay Memorial Hospital, Taipei, Taiwan.
¹² School of Allied Health, University of Western Australia, Perth, Western Australia, Australia.

Abstract

Background: Frailty is common in patients with heart failure (HF) and can adversely impact outcomes.

Objectives: This study examined the prevalence of frailty among Asian patients with HF, its association with 1-year outcomes, and if race-ethnicity, HF subtypes, and sex modify this relationship.

Methods: In the multinational ASIAN-HF (Asian Sudden Cardiac Death in Heart Failure) registry, a baseline frailty index (FI) was constructed using a cumulative deficits approach with 48 baseline variables, and patients were followed for the 1-year primary outcome of all-cause death or HF hospitalization.

Results: Among 3,881 participants (age 61 ± 13 years, 27% female), the mean FI was 0.28 ± 0.11, and 69% were frail (FI >0.21). Higher FI was associated with older age, Malay ethnicity, and Southeast Asian residency. While comorbidities were more frequent in frail patients (by definition), body mass index was not different across frailty classes. Compared with FI class 1 (<0.21, nonfrail), FI class 2 (0.21-0.31) and FI class 3 (>0.31) had increased risk of the 1-year composite outcome (hazard ratios of 1.84 [95% confidence interval (CI): 1.42-2.38] and 4.51 [95% CI: 3.59-5.67], respectively), even after multivariable adjustment (adjusted hazard ratios of 1.49 [95% CI: 1.13-1.97] and 2.69 [95% CI: 2.06-3.50], respectively). Race-ethnicity modified the association of frailty with the composite outcome (P _interaction = 0.0097), wherein the impact of frailty was strongest among Chinese patients. The association between frailty and outcomes did not differ between men and women (P _interaction = 0.186) or for HF with reduced ejection fraction versus HF with preserved ejection fraction (P _interaction = 0.094).

Conclusions: Most Asian patients with HF are frail despite relatively young age. Our results reveal specific ethnic (Malay) and regional (Southeast Asia) predisposition to frailty and highlight its prognostic importance, especially in Chinese individuals. (ASIAN HF Registry, A Prospective Observational Study [ASIANHF]; NCT01633398).

Keywords: Asia; CI, confidence interval; EF, ejection fraction; FI, frailty index; HF, heart failure; HFpEF, heart failure with preserved ejection fraction; HFrEF, heart failure with reduced ejection fraction; KCCQ, Kansas City Cardiomyopathy Questionnaire; NYHA, New York Heart Association; VAS, visual analog scale; aHR, adjusted hazard ratio; frailty; heart failure; outcomes.

Associated data

ClinicalTrials.gov/NCT01633398