Frailty, malnutrition and heart failure

Sze, K. Y. S. (Ka Yan Shirley)

September 2019

Thesis or dissertation

© 2019 Ka Yan Shirley Sze. All rights reserved. No part of this publication may be reproduced without the written permission of the copyright holder.

Heart failure (HF) is a common medical condition with significant morbidity and mortality. As the population ages, the prevalence of HF increases. Elderly patients with HF have different characteristics compared to younger patients; with increasing co- morbidities and diminished physiological reserves. However, most clinical trials in HF do not include patients who are elderly and management of these patients remain a medical challenge. Frailty and malnutrition appear to be common in elderly patients, but their role in HF management is currently unknown.

This thesis describes a series of studies which examined in detail frailty and malnutrition in patients with HF. I first studied the prevalence of frailty and malnutrition in different populations of HF patients (acute versus chronic HF; HF with reduced versus normal ejection fraction). I then explored the clinical correlates of frailty and malnutrition, focusing on their relation to age, gender, HF symptoms and severity. Next, in order to identify the best tool to measure frailty and malnutrition in patients with HF, I performed comprehensive frailty and malnutrition evaluations using 18 commonly used tools. I compared the agreement, classification performance and prognostic value of screening versus assessment tools; simple versus multi-dimensional tools and combination scores versus single physical or laboratory tests. Finally, I attempted to explore the underlying pathophysiology of frailty and malnutrition by studying their relation to congestion and sympathetic activation.

I found that frailty and malnutrition are common in patients with HF. They correlate with older age, higher co-morbidity burden, worse symptoms and severity of HF. Furthermore, I demonstrated that frailty and malnutrition, regardless of the tool used, are both independent predictors of a worse prognosis. These findings support routine evaluation of frailty and malnutrition in clinical practice when managing patients with HF. Future studies should focus on interventions targeting frailty and malnutrition in patients with HF.

Hull York Medical School, The University of Hull and The University of York
Clark, Andrew L. (Andrew Lawrence)
Sponsor (Organisation)
Hull York Medical School; British Heart Foundation
Grant number
British Heart Foundation Hope for Hearts Fund
Qualification level
Qualification name
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