Clinical benefit of combined assessment of physical and psychological frailty in patients with heart failure

Abstract Objectives Physical frailty becomes a robust risk factor in patients with heart failure (HF) and coexistence of physical and psychological frailty is likely to be a prognostic indicator. This study aimed to analyze the prognosis of coexistence of these two factors in patients with HF. Methods This study was a secondary analysis of a multicenter prospective cohort study (FLAGSHIP). We analyzed data from 2502 patients with HF from the FLAGSHIP study in Japan. We divided the patients into four physical frailty categories using a frailty score ranging from 0 to 14 (<4: I, 4–8: II, 9–12: III, and 14: IV, the score 13 does not exist in calculation). The higher category indicates more severe physical frailty. Psychological frailty was defined as the presence of cognitive decline and/or depressive symptoms. The study outcome was a 2‐year composite outcome of rehospitalization for HF or all‐cause mortality after hospital discharge. Results During the 3734.7 person‐year follow‐up, 774 patients experienced the composite outcome. After adjusting for confounders, physical and psychological frailty were independently associated with adverse outcomes. Using physical frailty category I, without psychological frailty as the reference, adjusted hazard ratios for adverse outcomes were 1.29 [95% confidence interval (CI) 0.86–1.92] for category I with psychological frailty, 0.99 (95% CI 0.71–1.37) for category II without psychological frailty, 1.61 (95% CI 1.16–2.23) for category II with psychological frailty, 1.56 (95% CI 1.14–2.15) for category III without psychological frailty, 1.62 (95% CI 1.20–2.20) for category III with psychological frailty, 1.50 (95% CI 1.05–2.14) for category IV without psychological frailty, and 2.16 (95% CI 1.59–2.94) for category IV with psychological frailty, respectively. Conclusions Combined assessment of physical and psychological frailty leads to more detailed risk stratification of patients with HF.