Frailty in older people with chronic heart failure: impact on quality of life and self-care

Background: Despite great progress in the areas of knowledge, prevention, research, treatment and counseling of patients with chronic heart failure, there is still a high burden of disease and premature death.
Heart failure can occur at all ages, but is a prevalent condition in the elderly, often with multiple diseases. In the case of frail older people, heart failure can have an even greater influence on self-care and quality of life. Increased vulnerability can also lead to more hospital admissions and re-admissions due to disrupted heart failure.
Objective: To determine the degree of vulnerability (fragility), self-care, quality of life and their mutual influences in elderly patients with chronic heart failure, and the relationship with hospital (re) admission within one year.
Study design: An exploratory, prospective, observational cohort study, in one center (ZGT: Hospital Group Twente, Almelo and Hengelo, The Netherlands).
Study population: Patients with stable chronic heart failure, who are 70 years of age or older, and who are being treated in the ZGT heart failure outpatient clinic. A total of 250 patients will participate in the study.
Key study parameters: During a visit to the Heart Failure Outpatient Clinic, medical examination, physical history and ECG are performed in the context of regular patient care. Standard blood taken to check for kidney function, electrolytes, and NT-proBNP. Patients are asked to complete questionnaires about their heart failure, self-care and quality of life. They are also asked to undergo geriatric and cognitive function tests. These form a basis for the degree of fragility. The course can be analyzed by repeated testing during the individual 1-year study period.
Patient burden: Completing the questionnaires takes approximately 20 minutes. The geriatric and cognitive function tests last approximately 1 hour. The physical tests (duration around 30 minutes) are placed under the physioconsult standard care.
Participation is voluntary and there are no risks associated with the research. Patients can stop participating in the study at any time during the study without giving a reason and without consequences for further treatment and care.

Public summary Heart failure is a disease with a high disease burden that occurs in more than 10% of people over seventy in the Netherlands. Most have multiple diseases and use many different drugs, which makes heart failure care complex. Counseling in a heart failure outpatient clinic can improve disease insight and therapy compliance (self-care). Increased vulnerability and mental and / or physical decline often occur in people over the age of seventy. This can have a negative impact on their self-care and there is more chance of heart failure being disrupted.
The aim of our research, to determine the degree of vulnerability, self-care and quality of life in 250 elderly patients with heart failure. We also investigate the mutual influences of these aspects and what the chance is of hospitalization. Participation is voluntary and there are no risks involved.

The degree of vulnerability (fragility) negatively impacts self-care, quality of life and their mutual influences in elderly patients with chronic heart failure, and the relationship with hospital (re) admission within one year.

Baseline, 3, 6 and 12 months.

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