P6200Getting a grip on heart failure: the nexus between multimorbidity, physical frailty and 12-month mortality in 765 patients hospitalised with heart failure

Abstract

Background: In an increasingly ageing patient population, multimorbidity and physical frailty in those hospitalised with chronic heart failure (CHF) represent potentially important contributors to all‐cause 12 month mortality. Purpose: To characterise the pattern of the ten most common forms of multimorbidity and physical frailty in relation to 12‐month mortality in a high‐risk cohort of patients hospitalized with CHF. Methods: A prospective analysis was conducted on data collected on 765 CHF participants at baseline in a large CHF management multicentre randomised control trial. Participants received a minimum of 12 months follow up to determine allcause mortality. The analysis was conducted using handgrip strength and multimorbidity being the 10 most common concurrent conditions in CHF. We identified frailty according to the lowest quintile of handgrip strength with the highest quintile of handgrip strength. Results: The mean age was 74±12 years (42% female), with left ventricular systolic dysfunction (65%), and NYHA Class III/IV (28%). Overall, there is a linear trend for the majority of the 10 comorbidities across the quintile handgrip strength. Patients with the lowest handgrip strength had the highest prevalence of anaemia (81% in the lowest handgrip strength quintile vs 23% in the highest grip strength quintile), cognitive impairment (63% vs 51%) and depression/anxiety (78% vs 69%). The 12‐month mortality was 22% in males and 17% in females. There was a downward trend in handgrip strength and 12‐month mortality in males, at 33%, 23%, 24%, 18% and 14% for quintile groups 1, 2, 3, 4 and 5 respectively (P=0.007). There was no trend in females (P=0.749). After adjustment for age and the 10 CHF comorbidities, multivariate logistic regression analysis showed that handgrip strength had a significant impact on 12‐month mortality in males independent of age (P=0.020), but not in females (P=0.114). Conclusion: Physical frailty measured by handgrip strength is a promising predictor of 12‐month mortality in men with CHF, independent of age and the common comorbidities associated with CHF. Further research is needed to identify determinants of muscular strength in CHF patients, and to test whether improvement in strength reduces mortality.