TY - JOUR
T1 - Frailty, Guideline-Directed Medical Therapy, and Outcomes in HFrEF
T2 - From the GUIDE-IT Trial
AU - Khan, Muhammad Shahzeb
AU - Segar, Matthew W.
AU - Usman, Muhammad Shariq
AU - Singh, Sumitabh
AU - Greene, Stephen J.
AU - Fonarow, Gregg C.
AU - Anker, Stefan D.
AU - Felker, G. Michael
AU - Januzzi, James L.
AU - Butler, Javed
AU - Pandey, Ambarish
N1 - Publisher Copyright:
© 2022 American College of Cardiology Foundation
PY - 2022/4
Y1 - 2022/4
N2 - Objectives: In this study, we sought to evaluate the association of frailty with the use of optimal guideline-directed medical therapy (GDMT) and outcomes in heart failure with reduced ejection fraction (HFrEF). Background: The burden of frailty in HFrEF is high, and the patterns of GDMT use according to frailty status have not been studied previously. Methods: A post hoc analysis of patients with HFrEF enrolled in the GUIDE-IT (Guiding Evidence-Based Therapy Using Biomarker Intensified Treatment in Heart Failure) trial was conducted. Frailty was assessed with the use of a frailty index (FI) using a 38-variable deficit model, and participants were categorized into 3 groups: class 1: nonfrail, FI <0.21); class 2: intermediate frailty, FI 0.21-0.31), and class 3: high frailty, FI >0.31). Multivariate-adjusted Cox models were used to study the association of frailty status with clinical outcomes. Use of optimal GDMT over time (beta-blockers, angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, and mineralocorticoid receptor antagonists) across frailty strata was assessed with the use of adjusted linear and logistic mixed-effect models. Results: The study included 879 participants, of which 56.3% had high frailty burden (class 3 FI). A higher frailty burden was associated with a significantly higher risk of HF hospitalization or death in adjusted Cox models: high frailty vs nonfrail HR: 1.76, 95% CI: 1.20-2.58. On follow-up, participants with high frailty burden also had a significantly lower likelihood of achieving optimal GDMT: high frailty vs non-frail GDMT triple therapy use at study end: 17.7% vs 28.4%; P interaction, frailty class × time <0.001. Conclusions: Patients with HFrEF with a high burden of frailty have a significantly higher risk for adverse clinical outcomes and are less likely to be initiated and up-titrated on an optimal GDMT regimen.
AB - Objectives: In this study, we sought to evaluate the association of frailty with the use of optimal guideline-directed medical therapy (GDMT) and outcomes in heart failure with reduced ejection fraction (HFrEF). Background: The burden of frailty in HFrEF is high, and the patterns of GDMT use according to frailty status have not been studied previously. Methods: A post hoc analysis of patients with HFrEF enrolled in the GUIDE-IT (Guiding Evidence-Based Therapy Using Biomarker Intensified Treatment in Heart Failure) trial was conducted. Frailty was assessed with the use of a frailty index (FI) using a 38-variable deficit model, and participants were categorized into 3 groups: class 1: nonfrail, FI <0.21); class 2: intermediate frailty, FI 0.21-0.31), and class 3: high frailty, FI >0.31). Multivariate-adjusted Cox models were used to study the association of frailty status with clinical outcomes. Use of optimal GDMT over time (beta-blockers, angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, and mineralocorticoid receptor antagonists) across frailty strata was assessed with the use of adjusted linear and logistic mixed-effect models. Results: The study included 879 participants, of which 56.3% had high frailty burden (class 3 FI). A higher frailty burden was associated with a significantly higher risk of HF hospitalization or death in adjusted Cox models: high frailty vs nonfrail HR: 1.76, 95% CI: 1.20-2.58. On follow-up, participants with high frailty burden also had a significantly lower likelihood of achieving optimal GDMT: high frailty vs non-frail GDMT triple therapy use at study end: 17.7% vs 28.4%; P interaction, frailty class × time <0.001. Conclusions: Patients with HFrEF with a high burden of frailty have a significantly higher risk for adverse clinical outcomes and are less likely to be initiated and up-titrated on an optimal GDMT regimen.
KW - frailty
KW - guideline-directed medical therapy
KW - heart failure with reduced ejection fraction
KW - mortality
UR - http://www.scopus.com/inward/record.url?scp=85126656151&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85126656151&partnerID=8YFLogxK
U2 - 10.1016/j.jchf.2021.12.004
DO - 10.1016/j.jchf.2021.12.004
M3 - Article
C2 - 35361446
AN - SCOPUS:85126656151
SN - 2213-1779
VL - 10
SP - 266
EP - 275
JO - JACC: Heart Failure
JF - JACC: Heart Failure
IS - 4
ER -