{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T16:09:46Z","timestamp":1792253386342,"version":"4.4.0"},"reference-count":41,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2024,1,30]],"date-time":"2024-01-30T00:00:00Z","timestamp":1706572800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100020595","name":"National Science and Technology Council","doi-asserted-by":"publisher","award":["NSTC 112\u20102923\u2010B\u2010A49\u2010002\u2010MY2"],"award-info":[{"award-number":["NSTC 112\u20102923\u2010B\u2010A49\u2010002\u2010MY2"]}],"id":[{"id":"10.13039\/100020595","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100020595","name":"National Science and Technology Council","doi-asserted-by":"publisher","award":["NSTC 112\u20102622\u20108\u2010A49\u2010016\u2010IE"],"award-info":[{"award-number":["NSTC 112\u20102622\u20108\u2010A49\u2010016\u2010IE"]}],"id":[{"id":"10.13039\/100020595","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J cachexia sarcopenia muscle"],"published-print":{"date-parts":[[2024,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Frailty often coexists with heart failure (HF), which significantly aggravates the clinical outcomes of older adults. However, studies investigating the interplay between frailty and HF in older adults are scarce. We aimed to assess the prevalence of frailty using the cumulative deficit approach and evaluate the impacts of frailty on health utilization, use of HF\u2010related medications and adverse clinical outcomes (all\u2010cause mortality, all\u2010cause readmissions and HF readmissions) among older HF patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A total of 38\u00a0843 newly admitted HF patients were identified from Taiwan's National Health Insurance Research Database and categorized into three frailty subgroups (fit, mild frailty and severe frailty) based on the multimorbidity frailty index. Cox regression models and Fine and Gray subdistribution hazard models were used to estimate the impacts of frailty on clinical outcomes at 1 and 2\u00a0years of follow\u2010up. Generalized estimating equation models were further conducted to evaluate the associations between longitudinal and time\u2010varying use of HF\u2010related medications and clinical outcomes among distinct frailty subgroups.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of 38\u00a0843 older HF patients (mean age 80.4\u00a0\u00b1\u00a08.5\u00a0years, 52.3% females) identified, 68.3% were categorized as frail (47.5% of mild frailty and 20.8% of severe frailty). The median number of readmissions (fit: 1 [inter\u2010quartile range\u2014IQR 2], mild frailty: 1 [IQR 2] and severe frailty: 2 [IQR 3]) increased with the severity of frailty. Only 27.3% of HF patients died of cardiovascular diseases regardless of their frailty status. Compared with the fit group, the severe frailty group was associated with increased risk of all\u2010cause mortality (adjusted hazard ratio 1.16, 95% confidence interval [CI] 1.11\u20131.21), all\u2010cause readmissions (subdistributional hazard ratio (sHR) 1.21, 95% CI 1.16\u20131.25) and HF\u2010related readmissions (sHR 1.14, 95% CI 1.09\u20131.20) at 2\u00a0years of follow\u2010up. Those who used triple or more HF\u2010related medications were at lower risk for all\u2010cause readmissions (adjusted odds ratio [aOR] 0.49, 95% CI 0.44\u20130.54) and HF\u2010related readmissions (aOR 0.42, 95% CI 0.37\u20130.47) at 2\u00a0years of follow\u2010up even in the severe frailty group.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Frailty is highly prevalent and associated with increased risk of all\u2010cause mortality, all\u2010cause readmissions and HF readmissions among older HF patients. Those who were using triple or more HF\u2010related medications were at lower risk of adverse clinical outcomes across distinct frailty subgroups. Further studies are needed to optimize the treatment strategies for older HF patients with distinct frailty status.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jcsm.13412","type":"journal-article","created":{"date-parts":[[2024,1,31]],"date-time":"2024-01-31T03:28:27Z","timestamp":1706671707000},"page":"660-670","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":42,"title":["The burden of frailty in heart failure: Prevalence, impacts on clinical outcomes and the role of heart failure medications"],"prefix":"10.1002","volume":"15","author":[{"given":"Hsi\u2010Yu","family":"Lai","sequence":"first","affiliation":[{"name":"Graduate Institute of Clinical Pharmacy, College of Medicine National Taiwan University  Taipei Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shih\u2010Tsung","family":"Huang","sequence":"additional","affiliation":[{"name":"Center for Healthy Longevity and Aging Sciences National Yang Ming Chiao Tung University  Taipei Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefan D.","family":"Anker","sequence":"additional","affiliation":[{"name":"Department of Cardiology (CVK) of German Heart Center Charit\u00e9; Institute of Health Center for Regenerative Therapies (BCRT), German Centre for Cardiovascular Research (DZHK) partner site Berlin Charit\u00e9 Universit\u00e4tsmedizin Berlin  Berlin Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephan","family":"von Haehling","sequence":"additional","affiliation":[{"name":"Department of Cardiology and Pneumology University of G\u00f6ttingen Medical Center  G\u00f6ttingen Germany"},{"name":"German Centre for Cardiovascular Research (DZHK) partner site G\u00f6ttingen, G\u00f6ttingen  G\u00f6ttingen Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masahiro","family":"Akishita","sequence":"additional","affiliation":[{"name":"Department of Geriatric Medicine University of Tokyo  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hidenori","family":"Arai","sequence":"additional","affiliation":[{"name":"National Center for Geriatrics and Gerontology  Obu Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2387-8508","authenticated-orcid":false,"given":"Liang\u2010Kung","family":"Chen","sequence":"additional","affiliation":[{"name":"Center for Healthy Longevity and Aging Sciences National Yang Ming Chiao Tung University  Taipei Taiwan"},{"name":"Center for Geriatrics and Gerontology Taipei Veterans General Hospital  Taipei Taiwan"},{"name":"Taipei Municipal Gan\u2010Dau Hospital (Managed by Taipei Veterans General Hospital)  Taipei Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1660-9120","authenticated-orcid":false,"given":"Fei\u2010Yuan","family":"Hsiao","sequence":"additional","affiliation":[{"name":"Graduate Institute of Clinical Pharmacy, College of Medicine National Taiwan University  Taipei Taiwan"},{"name":"School of Pharmacy College of Medicine, National Taiwan University  Taipei Taiwan"},{"name":"Department of Pharmacy National Taiwan University Hospital  Taipei Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,1,30]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.archger.2022.104875"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1093\/ageing\/afaa112"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.arr.2020.101233"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.archger.2022.104737"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.archger.2021.104568"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.archger.2022.104661"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.archger.2023.104951"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcard.2012.09.128"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCHEARTFAILURE.115.002594"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1002\/ehf2.12892"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.archger.2022.104698"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1038\/nrcardio.2016.25"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jchf.2019.10.005"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1136\/openhrt-2021-001571"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1093\/ageing\/aft160"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12877-020-01801-7"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.archger.2022.104646"},{"key":"e_1_2_9_19_1","doi-asserted-by":"publisher","DOI":"10.1177\/2047487319827460"},{"key":"e_1_2_9_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2021.11.029"},{"key":"e_1_2_9_21_1","doi-asserted-by":"publisher","DOI":"10.1093\/ageing\/afw039"},{"key":"e_1_2_9_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacasi.2021.09.006"},{"key":"e_1_2_9_23_1","doi-asserted-by":"publisher","DOI":"10.1097\/HCO.0000000000000489"},{"key":"e_1_2_9_24_1","first-page":"99","article-title":"Using Taiwan's National Health Insurance Research Database for pharmacoepidemiology research","volume":"15","author":"Hsiao F\u2010Y","year":"2007","journal-title":"J Food Drug Anal"},{"key":"e_1_2_9_25_1","unstructured":"WHO.ATC\/DDD index 2022.2022. 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