HFpEF developing after AMI is associated with considerable morbidity and mortality, yet prognostic assessment has traditionally focused on cardiac parameters and comorbidities. Frailty, which reflects reduced physiological reserve and increased vulnerability to stressors, has emerged as a potential determinant of outcomes but has not been well studied in post-AMI HFpEF patients. The investigators sought to address this gap and evaluate whether frailty could offer additional prognostic value and inform more individualized management strategies.
The study included 4,507 patients with HFpEF who were discharged after AMI from 82 hospitals across China between January 2010 and March 2024. Frailty status was evaluated using the Hospital Frailty Risk Score (HFRS), with scores below 5 categorizing patients as non-frail and scores of 5 or higher indicating frailty. Associations between frailty and clinical outcomes were examined using multivariable Cox proportional hazards models adjusted for demographic factors, comorbidities, left ventricular ejection fraction, and in-hospital therapies.
The primary outcomes were all-cause mortality and major adverse cardiovascular events (MACE), defined as a composite of cardiovascular death and heart failure rehospitalization. Secondary outcomes included net adverse clinical events (NACE), comprising all-cause death, stroke, recurrent myocardial infarction, revascularization, and major bleeding, as well as individual components of MACE.
The key findings of the study were as follows:
- Frailty was independently associated with a higher risk of all-cause mortality over one year, with an adjusted hazard ratio of 1.52.
- Frail patients also showed a significantly increased risk of net adverse clinical events, with an adjusted hazard ratio of 1.20.
- At one year, unadjusted all-cause mortality was substantially higher among frail patients (9.0%) compared with non-frail patients (2.9%).
- The unadjusted incidence of net adverse clinical events was greater in the frail group (19.8%) than in the non-frail group (13.7%).
- Frailty was linked to a higher numerical risk of cardiovascular death, but this association did not reach statistical significance.
- No significant relationship was observed between frailty and major adverse cardiovascular events overall.
- Frailty was not significantly associated with heart failure rehospitalization during the one-year follow-up.
The authors conclude that frailty, as measured by HFRS, provides meaningful prognostic information beyond traditional cardiovascular risk factors in patients with HFpEF after AMI.
Routine assessment of frailty at discharge may help identify high-risk individuals who could benefit from closer follow-up, optimized medical therapy, and targeted, frailty-focused interventions. Integrating frailty into clinical decision-making supports a shift toward more holistic, patient-centered care models aimed at improving survival and quality of life in this high-risk group.
Reference:
JI FJ, SHAO X, GU TS, LIU T, CHEN KY. Frailty as an independent predictor of one-year outcomes in patients with HFpEF after acute myocardial infarction: insights from a multicenter retrospective cohort in China. J Geriatr Cardiol 2025; 22(12):964−971. DOI: 10.26599/1671-5411.2025.12.005
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