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

      Older patients with acute decompensated heart failure (ADHF) have persistently poor outcomes including frequent rehospitalization despite guidelines-based therapy. We hypothesized that such patients have multiple, severe impairments in physical function, cognition, and mood that are not addressed by current care pathways. We prospectively examined frailty, physical function, cognition, mood, and quality of life in 27 consecutive older patients with ADHF at 3 medical centers and compared these with 197 participants in 3 age-matched cohorts: stable heart failure (HF) with preserved ejection fraction (n = 80), stable HF with reduced ejection fraction (n = 56), and healthy older adults (n = 61). Based on Fried criteria, frailty was present in 56% of patients with ADHF versus 0 for the age-matched chronic HF and health cohorts. Patients with ADHF had markedly reduced Short Physical Performance Battery score (5.3 ± 2.8) and 6-minute walk distance (178 ± 102 m) (p <0.001 vs other cohorts), with severe deficits in all domains of physical function: balance, mobility, strength, and endurance. In the patients with ADHF, cognitive impairment (78%) and depression (30%) were common, and quality of life was poor. In conclusion, older patients with ADHF are frequently frail with severe and widespread impairments in physical function, cognition, mood, and quality of life that may contribute to their persistently poor outcomes, are frequently unrecognized, are not addressed in current ADHF care paradigms, and are potentially modifiable with targeted interventions.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to American Journal of Cardiology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Kociol R.D.
        • Peterson E.D.
        • Hammill B.G.
        • Flynn K.E.
        • Heidenreich P.A.
        • Pina I.L.
        • Lytle B.L.
        • Albert N.M.
        • Curtis L.H.
        • Fonarow G.C.
        • Hernandez A.F.
        National survey of hospital strategies to reduce heart failure readmissions: findings from the Get with the Guidelines-Heart Failure Registry.
        Circ Heart Fail. 2012; 5: 680-687
        • Cheng R.K.
        • Cox M.
        • Neely M.L.
        • Heidenreich P.A.
        • Bhatt D.L.
        • Eapen Z.J.
        • Hernandez A.F.
        • Butler J.
        • Yancy C.W.
        • Fonarow G.C.
        Outcomes in patients with heart failure with preserved, borderline, and reduced ejection fraction in the Medicare population.
        Am Heart J. 2014; 168: 721-730
        • Krumholz H.M.
        Post-hospital syndrome—an acquired, transient condition of generalized risk.
        N Engl J Med. 2013; 368: 100-102
        • Sanchez E.
        • Vidan M.T.
        • Serra J.A.
        • Fernandez-Aviles F.
        • Bueno H.
        Prevalence of geriatric syndromes and impact on clinical and functional outcomes in older patients with acute cardiac diseases.
        Heart. 2011; 97: 1602-1606
        • Kitzman D.W.
        • Hundley W.G.
        • Brubaker P.H.
        • Morgan T.M.
        • Moore J.B.
        • Stewart K.P.
        • Little W.C.
        A randomized double-blind trial of enalapril in older patients with heart failure and preserved ejection fraction: effects on exercise tolerance and arterial distensibility.
        Circ Heart Fail. 2010; 3: 477-485
        • Kitzman D.W.
        • Little W.C.
        • Brubaker P.H.
        • Anderson R.T.
        • Hundley W.G.
        • Marburger C.T.
        • Brosnihan B.
        • Morgan T.M.
        • Stewart K.P.
        Pathophysiological characterization of isolated diastolic heart failure in comparison to systolic heart failure.
        JAMA. 2002; 288: 2144-2150
        • Haykowsky M.J.
        • Brubaker P.H.
        • Morgan T.M.
        • Kritchevsky S.
        • Eggebeen J.
        • Kitzman D.W.
        Impaired aerobic capacity and physical functional performance in older heart failure patients with preserved ejection fraction: role of lean body mass.
        J Gerontol A Biol Sci Med Sci. 2013; 68: 968-975
        • Rich M.W.
        • Beckham V.
        • Wittenberg C.
        • Leven C.L.
        • Freedland K.E.
        • Carney R.M.
        A multidisciplinary intervention to prevent the readmission of elderly patients with congestive heart failure.
        N Engl J Med. 1995; 333: 1190-1195
        • Schocken D.D.
        • Arrieta M.I.
        • Leaverton P.E.
        • Ross E.A.
        Prevalence and mortality rate of congestive heart failure in the United States.
        J Am Coll Cardiol. 1992; 20: 301-306
        • Fried L.P.
        • Tangen C.M.
        • Walston J.
        • Newman A.B.
        • Hirsch C.
        • Gottdiener J.
        • Seeman T.
        • Tracy R.
        • Kop W.J.
        • Burke G.
        • McBurnie M.A.
        Frailty in older adults: evidence for a phenotype.
        J Gerontol A Biol Sci Med Sci. 2001; 56: M146-M156
        • McNallan S.M.
        • Singh M.
        • Chamberlain A.M.
        • Kane R.L.
        • Dunlay S.M.
        • Redfield M.M.
        • Weston S.A.
        • Roger V.L.
        Frailty and Healthcare Utilization among patients with heart failure in the community.
        JACC Heart Fail. 2013; 1: 135-141
        • Afilalo J.
        • Alexander K.P.
        • Mack M.J.
        • Maurer M.S.
        • Green P.
        • Allen L.A.
        • Popma J.J.
        • Ferrucci L.
        • Forman D.E.
        Frailty assessment in the cardiovascular care of older adults.
        J Am Coll Cardiol. 2014; 63: 747-762
        • Guyatt G.H.
        • Sullivan M.
        • Thompson P.J.
        • Fallen E.L.
        • Pugsley S.O.
        • Taylor D.W.
        • Berman L.B.
        The 6-minute walk: a new measure of exercise capacity in patients with chronic heart failure.
        Can Med Assoc J. 1985; 132: 919-923
        • Guralnik J.M.
        • Ferrucci L.
        • Simonsick E.M.
        • Salive M.E.
        • Wallace R.B.
        Lower-extremity function in persons over the age of 70 years as a predictor of subsequent disability.
        N Engl J Med. 1995; 332: 556-561
        • Roberts H.C.
        • Denison H.J.
        • Martin H.J.
        • Patel H.P.
        • Syddall H.
        • Cooper C.
        • Sayer A.A.
        A review of the measurement of grip strength in clinical and epidemiological studies: towards a standardised approach.
        Age Ageing. 2011; 40: 423-429
        • Nasreddine Z.S.
        • Phillips N.A.
        • Bedirian V.
        • Charbonneau S.
        • Whitehead V.
        • Collin I.
        • Cummings J.L.
        • Chertkow H.
        The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment.
        J Am Geriatr Soc. 2005; 53: 695-699
        • Almeida O.P.
        • Almeida S.A.
        Short versions of the geriatric depression scale: a study of their validity for the diagnosis of a major depressive episode according to ICD-10 and DSM-IV.
        Int J Geriatr Psychiatry. 1999; 14: 858-865
        • Green C.P.
        • Porter C.B.
        • Bresnahan D.R.
        • Spertus J.A.
        Development and evaluation of the Kansas City Cardiomyopathy Questionnaire: a new health status measure for heart failure.
        J Am Coll Cardiol. 2000; 35: 1245-1255
        • Rodriguez-Pascual C.
        • Vilches-Moraga A.
        • Paredes-Galan E.
        • Ferrero-Marinez A.I.
        • Torrente-Carballido M.
        • Rodriguez-Artalejo F.
        Comprehensive geriatric assessment and hospital mortality among older adults with decompensated heart failure.
        Am Heart J. 2012; 164: 756-762
        • Rogers J.G.
        • Aaronson K.D.
        • Boyle A.J.
        • Russell S.D.
        • Milano C.A.
        • Pagani F.D.
        • Edwards B.S.
        • Park S.
        • John R.
        • Conte J.V.
        • Farrar D.J.
        • Slaughter M.S.
        • HeartMate II Investigators
        Continuous flow left ventricular assist device improves functional capacity and quality of life of advanced heart failure patients.
        J Am Coll Cardiol. 2010; 55: 1826-1834
        • Kitzman D.W.
        • Nicklas B.
        • Kraus W.E.
        • Lyles M.F.
        • Eggebeen J.
        • Morgan T.M.
        • Haykowsky M.
        Skeletal muscle abnormalities and exercise intolerance in older patients with heart failure and preserved ejection fraction.
        Am J Physiol Heart Circ Physiol. 2014; 306: H1364-H1370
        • Puthucheary Z.A.
        • Rawal J.
        • McPhail M.
        • Connolly B.
        • Ratnayake G.
        • Chan P.
        • Hopkinson N.S.
        • Phadke R.
        • Dew T.
        • Sidhu P.S.
        • Velloso C.
        • Seymour J.
        • Agley C.C.
        • Selby A.
        • Limb M.
        • Edwards L.M.
        • Smith K.
        • Rowlerson A.
        • Rennie M.J.
        • Moxham J.
        • Harridge S.D.
        • Hart N.
        • Montgomery H.E.
        Acute skeletal muscle wasting in critical illness.
        JAMA. 2013; 310: 1591-1600
        • Brown C.J.
        • Redden D.T.
        • Flood K.L.
        • Allman R.M.
        The underrecognized epidemic of low mobility during hospitalization of older adults.
        J Am Geriatr Soc. 2009; 57: 1660-1665
        • Cameron J.
        • Worrall-Carter L.
        • Page K.
        • Riegel B.
        • Lo S.K.
        • Stewart S.
        Does cognitive impairment predict poor self-care in patients with heart failure?.
        Eur J Heart Fail. 2010; 12: 508-515
        • Dodson J.A.
        • Truong T.T.
        • Towle V.R.
        • Kerins G.
        • Chaudhry S.I.
        Cognitive impairment in older adults with heart failure: prevalence, documentation, and impact on outcomes.
        Am J Med. 2013; 126: 120-126
        • Abellan van Kan G.
        • Rolland Y.
        • Bergman H.
        • Morley J.E.
        • Kritchevsky S.B.
        • Vellas B.
        The I.A.N.A Task Force on frailty assessment of older people in clinical practice.
        J Nutr Health Aging. 2008; 12: 29-37
        • Braunstein J.B.
        • Anderson G.F.
        • Gerstenblith G.
        • Weller W.
        • Niefeld M.
        • Herbert R.
        • Wu A.W.
        Noncardiac comorbidity increases preventable hospitalizations and mortality among Medicare beneficiaries with chronic heart failure.
        J Am Coll Cardiol. 2003; 42: 1226-1233
        • Jacques L.
        • J T.
        • Schafer J.
        • Chin J.
        • Issa M.
        Decision memo for cardiac rehabilitation (CR) programs—chronic heart failure.
        in: Services DoHaH. Centers for Medicare and Medicaid Services, 2014 (Available at:) (Accessed on July 1, 2014)
        • Giallauria F.
        • Vigorito C.
        • Tramarin R.
        • Fattirolli F.
        • Ambrosetti M.
        • De Feo S.
        • Griffo R.
        • Riccio C.
        • Piepoli M.
        • ISYDE-Investigators of the Italian Association for Cardiovascular Prevention, Rehabilitation and Prevention
        Cardiac rehabilitation in very old patients: data from the Italian Survey on cardiac Rehabilitation-2008 (ISYDE-2008)—official report of the Italian Association for Cardiovascular Prevention, Rehabilitation, and Epidemiology.
        J Gerontol A Biol Sci Med Sci. 2010; 65: 1353-1361
        • Tilson J.K.
        • Wu S.S.
        • Cen S.Y.
        • Feng Q.
        • Rose D.R.
        • Behrman A.L.
        • Azen S.P.
        • Duncan P.W.
        Characterizing and identifying risk for falls in the LEAPS study: a randomized clinical trial of interventions to improve walking poststroke.
        Stroke. 2012; 43: 446-452