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Frailty and incident heart failure in older men: The British Regional Heart Study

Lookup NU author(s): Professor Sheena Ramsay



This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).


© 2021 BMJ Publishing Group. All rights reserved.Objective Frailty and heart failure (HF) are cross-sectionally associated. Published longitudinal data are very limited. We sought to investigate associations between frailty and incident HF. Methods Prospective study of 1722 men, examined at age 72-91 years. Scores based on the Fried phenotype, Gill index and a novel frailty score, based on the Health Ageing and Body Composition Battery, incorporating slow walking speed, low chair-stand time and subjective difficulty with balance, were calculated. Associations between these scores and incident HF were analysed with Cox proportional hazard modelling. Results 1445 men with frailty data and without prevalent HF were included. 99 developed HF (mean follow-up 6.1 years). Men scoring 3/3 on our novel frailty score had elevated risk of incident HF (HR 2.77, 95% CI 1.25 to 6.15), which persisted after adjustment for established risk factors and interleukin-6 (HR 3.14, 95% CI 1.35 to 7.31). This risk remained increased, although attenuated, after excluding HF events within 2 years of baseline (HR 2.05, 95% CI 0.61 to 6.92). The frailty phenotype showed a non-significant association with HF (age-adjusted HR 1.92, 95% CI 0.99 to 3.73), which was further attenuated after adjustment for prevalent coronary heart disease and Body mass index (HR 1.60, 95% CI 0.81 to 3.15). Gill-type scores were weakly associated with HF risk after these adjustments (HR 1.31, 95% CI 0.47 to 3.70). Conclusion In these older men, the combination of slow walk speed, low sit-stand time and balance problems were associated with high risk of incident HF, independent of established risk factors and inflammatory markers. However, undiagnosed HF at baseline may still be a confounder. There is a differential association between aspects of the frailty phenotype and incident HF.

Publication metadata

Author(s): McKechnie DGJ, Papacosta AO, Lennon LT, Ramsay SE, Whincup PH, Wannamethee SG

Publication type: Article

Publication status: Published

Journal: Open Heart

Year: 2021

Volume: 8

Issue: 1

Online publication date: 04/06/2021

Acceptance date: 16/05/2021

Date deposited: 24/10/2023

ISSN (print): 2398-595X

ISSN (electronic): 2053-3624

Publisher: BMJ Publishing Group


DOI: 10.1136/openhrt-2021-001571


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Funder referenceFunder name
British Heart Foundation
National Institute for Health Research