Associations between Frailty and Sex, and Frailty and Race in Hospitalized Chronic Heart Failure Patients: An Exploratory Study

Using a descriptive correlational design, a secondary analysis was conducted to explore frailty in hospitalized heart failure (HF) patients. This study examined differences in a) frailty and sex, b) frailty and race, and c) relationships between frailty and comorbidity, depression, disability, health status, and urinary incontinence. Frailty was determined by the presence of at least three of the five following criteria: BMI 30.0 kg/m2; albumin <3.8 g/dl; hemoglobin <13.5 g/dl for men or <12.5 g/dl for women, and NYHA class III or IV HF and/or ejection fraction <40%. The sample consisted of 154 HF patients 50-94 years old who were admitted to the Heart Failure Center of a large teaching hospital. Results. Overall prevalence of frailty in HF patients was 38% (58/154). Female subjects were approximately 3 times more likely to be frail (OR=3.38, 95% CI =1.57 to 7.31; p=.002) and frail females were 27 times more likely to be anemic (OR=26.85, 95% CI=10.78 to 66.88; p<.0001) compared to males, when stratified by age group. Significant differences in the odds of being anemic or in late HF found in HF patients by race did not persist in frail HF patients. Significant (p=.05) differences in Late HF occurred in 80% (32 out of 40) of older (over 65 years) males compared to 60% (22 out of 37) older females. Self-report of poor health increased the likelihood of frailty more than three times that of self- report of excellent to fair health (OR=3.57, 95%CI=1.56 to 8.14; p=.002). Subjects with two or more additional chronic illnesses were more than five times more likely to be frail (OR=5.36, 95%CI=1.85 to 15.49; p=.042). Conclusion: Significant differences in prevalence and frequency of frailty characteristics by sex but not by race suggest that males and females develop frailty by different pathways. Anemia was found to be an important indicator of frailty in women and could be a significant factor in the ability of females to respond to physical therapy. Further study is needed to determine whether similar indicators can be found for males or by race