P2986Frailty and quality of life in heart failure patients with mid-range ejection fraction

Abstract

Background: Heart failure (HF) is a chronic condition with poor prognosis and is one of the most important chronic diseases that cause quality of life (QOL) impairment. As HF is highly prevalent among older people, fragility is often present among HF patients. Even young HF patients show a high degree of fragility, that also contributes to QoL impairment. Objective: As the 2016 Heart Failure (HF) ESC Guidelines boost to investigate the ?new? subgroup of patients with HF and left ventricular ejection fraction (EF) mildly reduced (HFmrEF) our aim was to assess QoL and the prevalence of fragility in outpatients with HFmrEF, compared with those with HF with reduced EF (HFrEF) and with preserved EF (HFpEF). Methods: The Minnesota Living with Heart Failure Questionnaire (MLWHFQ) was used for QoL evaluation. Fragility was defined as having at least one abnormal evaluation among four standardized geriatric scales. Predefined criteria for such scales were: Barthel Index <90; OARS scale <10 in women and <6 in men; Pfeiffer Test >3 (±1, depending on educational grade); and ≥1 positive response for depression on the abbreviated Geriatric Depression Scale (GDS). The MLWHFQ and the basic geriatric evaluation were performed at the first visit to the Unit. Results: 185 patients with HFmrEF were evaluated (127 men and 58 women, mean age 67.7±11.7 years, median duration of HF 12 months [Q1-Q3 2-44], ischemic aetiology 58%, 119 (64.3%) and 59 (31.9%) in NYHA class II and III respectively). The mean score in the MLWHFQ was 30.1±18.3. Ninety patients (48.6%) fulfilled fragility criteria. Forty-five patients (24.3%) had a Barthel Index <90; 25 patients (13.5%) had an anomalous OARS Scale; the score in Pfeiffer Test was abnormal in 10 patients (5.4%); and 60 patients (32.4%) had a positive depression response in abbreviate GDS. Fragility prevalence in HFmrEF patients tended to be higher when compared with 1058 patients with HFrEF (41.9%, p=0.09) and similar when compared with 162 patients with HFpEF (54.3%, p=0.29). In contrast QoL was similar when compared with HFrEF patients (MLWHFQ score 30.8±18.5, p=0.61) and better when compared with HFpEF patients (MLWHFQ score 36.5±20.7, p=0.003). Conclusions: HFmrEF patients showed a similar impairment of QoL than HFrEF patients and lower when compared with HFpEF patients. In HFmrEF a high prevalence of fragility (48.6%) was observed, near to that found in HFpEF patients and slightly higher than that observed in HFrEF patients.