Predictors of poor prognosis in chronic heart failure patients according to frailty status: A prospective cohort study

Background. Cardiovascular disease is the leading cause of mortality and readmission among older adults. The coexistence of hypertension and chronic heart failure is observed in the vast majority of patients in this age group. A particular clinical challenge is frailty syndrome; it affects one in four chronic heart failure patients over the age of 80, fundamentally altering the cardiovascular risk profile.

Objective: To identify predictors of adverse outcomes (cardiovascular death or hospitalization for decompensated heart failure) in chronic heart failure patients aged 80 years and older according to frailty status.

Methods. This prospective cohort study evaluated 161 outpatients aged 80 years or older with confirmed hypertension and chronic heart failure over a period of 12 months. The patients were divided into two comparable groups: the first included 84 individuals with confirmed frailty syndrome, and the second comprised 77 patients without this syndrome. The diagnostic workup included enzyme-linked immunosorbent assay of serum NT-proBNP, sST2, and galectin-3 concentrations; transthoracic Doppler echocardiography; and 24-hour ambulatory blood pressure monitoring with calculation of vascular stiffness parameters and central aortic pressure. In order to assess the prognostic significance of quantitative variables, logistic regression combined with ROC analysis was used (inclusion criterion: area under the curve > 0.5 at p < 0.05). Statistical analysis was performed using Statistica 12.0 (StatSoft, USA).

Results. Seven predictors were identified in patients with chronic heart failure and frailty syndrome: the presence of atrial fibrillation, sST2 level ≥ 55.6 ng/mL (OR = 3.7), NT-proBNP level ≥ 683.5 pg/mL (OR = 1.98), left ventricular ejection fraction ≤ 43% (OR = 3.68), early diastolic velocity ratio (E/e’) ≥ 14.2 (OR = 3.63), nocturnal systolic blood pressure variability ≥ 15.3 mmHg (OR = 12.92), and aortic pulse wave velocity ≥ 13.5 m/s (OR = 4.68). In chronic heart failure patients without frailty syndrome, four predictors were identified: the presence of chronic kidney disease, sST2 level ≥ 44.3 ng/mL (OR = 5.53), left ventricular mass index ≥ 165.5 g/m² (OR = 5.0), and left ventricular ejection fraction ≤ 58.5% (OR = 2.1).

Conclusion. In chronic heart failure patients aged 80 years and older, frailty syndrome increases the risk of cardiovascular death or hospitalization for decompensation by 1.77 times, resulting in a qualitatively distinct, expanded prognostic marker profile. Incorporating sST2, nocturnal systolic blood pressure variability, and aortic pulse wave velocity into the diagnostic workup of this patient population, alongside standard clinical parameters, enables more accurate risk stratification and a personalized approach to treatment. 

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