Frailty Linked to Lower Use of Guideline Treatments in HFrEF


  • The multicenter observational study included 1041 patients with acute heart failure with reduced ejection fraction (HfrEF) (mean age, 72 years); 71% were men.

  • Researchers created a prognostic score of physical frailty based on grip strength, walking speed, and other factors. They grouped patients into increasingly severe categories of frailty: I, ≤3 points; II, 4–8 points; III, 9–12 points; and IV, 14 points. (A score of 13 did not exist in the calculation.)

  • They gathered information on prescription rates of guideline-recommended therapies, including angiotensin-converting enzyme inhibitors (ACEIs)/angiotensin receptor blockers (ARBs), β-blockers, and mineralocorticoid receptor antagonists (MRAs).

  • The primary outcome was all-cause death or first HF rehospitalization up to 2 years from discharge.


  • Severity of physical frailty was an independent predictor for nonuse of ACEs/ARBs (odds ratio [OR], 1.23 per 1 category increase) and β-blockers (OR, 1.32), but not MRAs.

  • The proportion of patients who received triple therapy decreased as physical frailty increased (for trend, <.001), with about half the rate in the frailest patients (23.4%) compared with the least frail patients (40.2%).

  • Physical frailty remained an independent predictor of low prescription rates after adjusting for more advanced age and comorbidity.

  • Patients who used fewer drugs had a worse prognosis in terms of all-cause death or HF hospitalization, regardless of severity of physical frailty.



An effective strategy to improve medical therapy, accounting for physical frailty, is urgently needed, said the authors.