Lower-Extremity Function as a Marker of Frailty and Outcomes of Heart Failure With Preserved Ejection Fraction in Older Adults

Heart failure with preserved ejection fraction (HFpEF) remains predominantly a disease of aging and older adults. 1 Owan T.E. Hodge D.O. Herges R.M. Jacobsen S.J. Roger V.L. Redfield M.M. Trends in prevalence and outcome of heart failure with preserved ejection fraction. N Engl J Med. 2006; 355: 251-259 Crossref PubMed Scopus (3182) Google Scholar Disease management programs have centered on management of heart failure without addressing coexisting geriatric conditions and have not successfully reduced hospitalizations in older adults with HFpEF. 2 Dharmarajan K. Chaudhry S.I. New approaches to reduce readmissions in patients with heart failure. JAMA Intern Med. 2016; 176: 318-320 Crossref PubMed Scopus (11) Google Scholar Clinical management is uniquely challenged by complexities that result from the high burden of geriatric conditions, such as multimorbidity and frailty. 3 Goldfarb M. Sheppard R. Afilalo J. Prognostic and therapeutic implications of frailty in older adults with heart failure. Curr Cardiol Rep. 2015; 17: 92 Crossref PubMed Scopus (19) Google Scholar In fact, the rate of hospitalizations for reasons other than heart failure in this population is at least as high as or higher than that of heart failure hospitalizations. 4 Carson P.E. Anand I.S. Win S. et al. The hospitalization burden and post-hospitalization mortality risk in heart failure with preserved ejection fraction: results from the I-PRESERVE trial (Irbesartan in Heart Failure and Preserved Ejection Fraction). JACC Heart Fail. 2015; 3: 429-441 Crossref PubMed Scopus (63) Google Scholar Focused efforts to conquer a disease of the heart may lose sight of the person as a whole and ultimately fail to deliver meaningful clinical outcomes. 5 Kitzman D.W. Upadhya B. Reeves G. Hospitalizations and prognosis in elderly patients with heart failure and preserved ejection fraction: time to treat the whole patient. JACC Heart Fail. 2015; 3: 442-444 Crossref PubMed Scopus (17) Google Scholar