A prognostic model of adverse cardiovascular events in patients with chronic heart failure depending on the presence of frailty syndrome
Background. Chronic heart failure (CHF) in patients 80 years and older is often accompanied by frailty syndrome (FS), which worsens the prognosis and increases the risk of death and hospitalizations. Existing prognosis assessment scales for patients with CHF do not take frailty into account, and traditional biomarkers are of limited value in this patient cohort. Objective: To develop and validate a prognostic model for the combined endpoint of cardiovascular death or hospitalization for HF in patients with CHF, depending on the presence of FS. Material and methods. The study included 161 patient (≥ 80 years) with arterial hypertension (AH) and CHF: Group 1 – patients with FS (n = 84), Group 2 – patients without FS (n = 77). FS was verified using a questionnaire, battery of tests, and a comprehensive geriatric assessment. All the participants underwent laboratory (NT-proBNP, sST2) and instrumental (transthoracic echocardiography, 24-hour blood pressure monitoring with calculation of vascular stiffness and central aortic pressure) tests. The primary endpoint was cardiovascular death or hospitalization for HF within 12 months. Stepwise logistic regression and ROC analysis were used. Results. In the group of patients with CHF + FS, the prognostic model for the composite endpoint included six predictors: atrial fibrillation, sST2 level, left ventricular ejection fraction, E/e’ ratio, aortic pulse wave velocity, and nocturnal systolic blood pressure variability. In the group of patients with CHF without FS, the model included four predictors: chronic kidney disease, sST2 level, left ventricular ejection fraction, and left ventricular myocardial mass index. The models were statistically significant (χ² = 38.04 and 44.99, respectively; p <0.001). ROC analysis determined the threshold values for the K prognostic criterion: 0.32 for group 1 (sensitivity 93.1%, specificity 90.1%) and 0.28 for group 2 (sensitivity 87.8%, specificity 81.2%). Conclusion. The presence of frailty syndrome determines the structure of predictors of an unfavorable prognosis in elderly patients with CHF. The developed model allows for highly accurate risk stratification based on asthenia status, which justifies its use in clinical practice to optimize the management of patients with this comorbidity.V.A. Safronenko, A.I. Chesnikova, T.V. Tayutina, N.D. Bogunova
Keywords
chronic heart failure
frailty syndrome
predictors of an unfavorable prognosis
adverse cardiovascular events
prognostic model
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About the Authors
Victoria A. Safronenko, MD, Dr. Sci. (Medicine), associate professor of the Department of internal medicine No. 1, Rostov State Medical University, Rostov-on-Don, Russian Federation.E-mail: v.chugunova@mail.ru
ORCID: https://orcid.org/0000-0002-6965-5019
Anna I. Chesnikova, MD, Dr. Sci. (Medicine), professor, head of the Department of internal medicine No. 1, Rostov State Medical University, Rostov-on-Don, Russian Federation.
E-mail: rostov-ossn@yandex.ru
ORCID: https://orcid.org/0000-0002-9323-592X
Tatiana V. Tayutina, MD, Dr. Sci. (Medicine), associate professor of the Department of internal medicine No. 1, Rostov State Medical University, Rostov-on-Don, Russian Federation.
E-mail: tarus76@mail.ru.
ORCID: https://orcid.org/0000-0002-5421-4202
Natalya D. Bogunova, 6th-year student, Rostov State Medical University, Rostov-on-Don, Russian Federation.
E-mail: Nosacevaelena77@gmail.com
ORCID: https://orcid.org/0009-0009-7790-6998
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