AimsFrailty is highly prevalent in patients with heart failure (HF), but a concordant definition of this condition is lacking. The Heart Failure Association of the European Society of Cardiology (HFA‐ESC) proposed in 2019 a new multi‐domain definition of frailty, but it has never been validated.Methods and resultsPatients from the HELP‐HF registry were stratified according to the number of HFA‐ESC frailty domains fulfilled and to the cumulative deficits frailty index (FI) quintiles. Prevalence of frailty and of each domain was reported, as well as the rate of the composite of all‐cause death and HF hospitalization, its single components, and cardiovascular death in each group and quintile. Among 854 included patients, 37 (4.3%), 206 (24.1%), 365 (42.8%), 217 (25.4%), and 29 (3.4%) patients fulfilled zero, one, two, three, or four domains, respectively, while 179 patients had a FI < 0.21 and were considered not frail. The 1‐year risk of adverse events increased proportionally to the number of domains fulfilled (for each criterion increase, all‐cause death or HF hospitalization: hazard ratio [HR] 1.43, 95% confidence interval [CI] 1.27–1.62; all‐cause death: HR 1.72, 95% CI 1.46–2.02, HF hospitalizations: subHR 1.21, 95% CI 1.04–1.31; cardiovascular death: HR 1.77, 95% CI 1.45–2.15). Consistent results were found stratifying the cohort for FI quintiles. The FI as a continuous variable demonstrated higher discriminative ability than the number of domains fulfilled (area under the curve = 0.68 vs. 0.64, p = 0.004).ConclusionFrailty in patients at risk for advanced HF, assessed via a multi‐domain approach and the FI, is highly prevalent and identifies those at increased risk of adverse events. The FI was found to be slightly more effective in identifying patients at increased risk of mortality.

中文翻译：

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根据 2019 年 HFA-ESC 定义，有晚期心力衰竭风险的患者存在虚弱：来自 HELP-HF 登记处的见解

衰弱在心力衰竭 (HF) 患者中非常普遍，但这种情况缺乏一致的定义。欧洲心脏病学会心力衰竭协会 (HFA-ESC) 于 2019 年提出了新的虚弱多领域定义，但从未得到验证。 方法和结果 HELP-HF 登记处的患者根据衰弱的数量进行分层满足 HFA-ESC 脆弱域并达到累积缺陷脆弱指数 (FI) 五分位数。报告了每个领域的衰弱患病率，以及每组和五分位的全因死亡和心力衰竭住院的复合率、其单一组成部分以及心血管死亡的发生率。在 854 名患者中，分别有 37 名 (4.3%)、206 名 (24.1%)、365 名 (42.8%)、217 名 (25.4%) 和 29 名 (3.4%) 患者满足零、一、二、三或四个领域，而 179 名患者的 FI < 0.21 被认为并不虚弱。不良事件的 1 年风险与满足的领域数量成比例增加（对于每个标准的增加，全因死亡或心衰住院：风险比 [HR] 1.43，95% 置信区间 [CI] 1.27-1.62；所有-导致死亡：HR 1.72，95% CI 1.46–2.02，心衰住院：亚HR 1.21，95% CI 1.04–1.31；心血管死亡：HR 1.77，95% CI 1.45–2.15）。对 FI 五分位数的队列进行分层后发现了一致的结果。 FI 作为连续变量表现出比满足的域数量更高的判别能力（曲线下面积 = 0.68 vs. 0.64，p= 0.004）。 结论 通过多领域方法和 FI 进行评估，有晚期心力衰竭风险的患者中的虚弱现象非常普遍，并识别出不良事件风险增加的患者。研究发现，FI 在识别死亡风险较高的患者方面稍微更有效一些。