Aims: Frailty commonly coexists with heart failure and each condition has a bidirectional impact on the other. This study aimed to examine the impact frailty has on the management of heart failure in an Australian cohort.
Methods: This multicentre prospective observational cohort study included adults admitted to three Australian hospitals with heart failure. Frailty was assessed using the Clinical Frailty Scale (CFS ≥4). Baseline characteristics and discharge prescription of guideline directed medical therapy (GDMT) were compared between frail and non-frail participants. A subgroup of participants also had data for 30-day follow up GDMT, self-reported adherence, adverse drug reactions and referral to multidisciplinary heart failure clinic collected.
Results: 337 participants enrolled in this study, 252 (75%) were classified as frail. Frail participants were older (mean 76.7 ± 13.4 vs 64.6 ± 15.8) and had more comorbidities (Charlson Comorbidity Index 7.3 ± 2.7 vs 4.9 ± 2.6) than non-frail participants. They were less likely to be prescribed GDMT despite no significant difference in rates of adverse drug reactions (9.6% vs 4.5%;p=0.29) or self-reported medication adherence (Medication Adherence Rating Scale 24.4 ± 1.7 vs 24.0 ±2.7; p=0.21).
Conclusion: Frailty was prevalent in this cohort of heart failure hospital admissions. Frail patients were less likely to be prescribed GDMT and at lower doses compared with non-frail participants despite similar adherence and tolerability. Frail patients were less likely to be referred for multidisciplinary outpatient follow up. More research is required to investigate targets for therapy and barriers to implementation in this common and growing population.