Frailty and Metabolic Vulnerability in Heart Failure: A Community Cohort study

Authors

• MD Marks
• S Ramos-Maciel
• N Westcott
• AJ Kesner

Abstract

BACKGROUND: Frailty is common in heart failure (HF) and associated with mortality but not routinely captured clinically. Frailty is linked with inflammation and malnutrition, which can be assessed by a novel plasma multimarker score: the Metabolic Vulnerability Index (MVX). We sought to evaluate the associations between frailty and MVX, and their prognostic impact.
METHODS: In a HF community cohort (2003-2012), we measured frailty as a proportion of deficits present out of 32 physical limitations and comorbidities, MVX by nuclear magnetic resonance spectroscopy and collected extensive longitudinal clinical data. Patients were categorized by frailty score (≤0.15; >0.15 and ≤0.27; >0.27) and MVX score (≤50; >50 and ≤60; >60 and ≤70; >70). Cox models estimated associations of frailty and MVX with mortality, adjusted for Meta-Analysis Global Group in Chronic HF (MAGGIC) score and NT-proBNP. Uno’s C-statistic measured incremental value of MVX beyond frailty and clinical factors. Weibull’s accelerated failure time regression assessed whether MVX mediated the association between frailty and mortality.
RESULTS: We studied 985 patients (median age 77, 48% women). Frailty and MVX were weakly correlated (Spearman ρ=0.21). The highest frailty group experienced an increased rate of death, independent of MVX, MAGGIC score and NT-proBNP (HR=3.3, 95% CI: 2.6, 4.2). Frailty improved Uno’s c-statistic beyond MAGGIC score and NT-proBNP (0.71 to 0.73). MVX mediated <10% of the association between frailty and mortality.
CONCLUSIONS: In this HF cohort, frailty and MVX are weakly correlated. Both independently contribute stratifying the risk of death suggesting they capture distinct domains of vulnerability in HF.

Scientific Focus Area: Epidemiology

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