Frailty and healthcare utilization among patients with heart failure in the community

JACC Heart Fail. 2013 Apr;1(2):135-41. doi: 10.1016/j.jchf.2013.01.002.


Objectives: The aim of this study was to determine the prevalence of frailty in a community cohort of patients with heart failure (HF) and to determine whether frailty is associated with healthcare utilization.

Background: Frailty is associated with death in patients with HF, but its prevalence and impact on healthcare utilization in patients with HF are poorly characterized.

Methods: Residents of Olmsted, Dodge, and Fillmore counties in Minnesota with HF between October 2007 and March 2011 were prospectively recruited to undergo frailty assessment. Frailty was defined as 3 or more of the following: unintentional weight loss, exhaustion, weak grip strength, and slowness and low physical activity measured by the SF-12 physical component score. Intermediate frailty was defined as 1 or 2 components. Negative binomial regression was used to examine the association between outpatient visits and frailty; Andersen-Gill models were used to determine if frailty predicted emergency department (ED) visits or hospitalizations.

Results: Among 448 patients (mean age 73 ± 13 years, 57% men), 74% had some degree of frailty (19% frail, 55% intermediate frail). Over a mean follow-up period of 2.0 ± 1.1 years, 20,164 outpatient visits, 1,440 ED visits, and 1,057 hospitalizations occurred. After adjustment for potential confounders, frailty was associated with a 92% increased risk for ED visits and a 65% increased risk for hospitalizations. The population-attributable risk associated with any degree of frailty was 35% for ED visits and 19% for hospitalizations.

Conclusions: Frailty is common among community patients with HF and is a strong and independent predictor of ED visits and hospitalizations. Because frailty is potentially modifiable, it should be incorporated in the clinical evaluation of patients with HF.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Aged
  • Delivery of Health Care / statistics & numerical data*
  • Female
  • Frail Elderly*
  • Heart Failure / therapy*
  • Humans
  • Male
  • Prospective Studies
  • Risk Assessment