Abstract 4147657: Are Females More Fraily than Males at Time of Heart Failure Diagnosis?

Background: In chronic heart failure (HF), physical frailty is more prevalent in females than males, and studies have shown that frailty is associated with worse symptoms. However, sex differences in frailty at the time of HF diagnosis are not well understood, including associations with symptoms.

Research Question: What are the relationships between frailty, sex, and symptom burden at the time of initial HF diagnosis?

Aims: 1) to quantify sex differences in frailty at the time of HF diagnosis, and 2) to determine if sex influences the association between frailty and symptoms at time of HF diagnosis.

Methods: This was an analysis of data collected from a study of symptoms among patients with a new diagnosis of Stage C HF and New York Heart Association (NYHA) Functional Classification I-IV symptoms. Frailty was measured using the FRAIL Scale (Fatigue, Resistance, Ambulation, Illnesses,&Loss of Weight). Symptom burden was measured using the Heart Failure Somatic Perceptions Scale (HFSPS). We used comparative statistics to examine differences in frailty (frail vs. robust or pre-frail) by sex, age, and HFSPS score. Then, we used robust linear regression with an interaction between sex and frailty to examine the relationship between HFSPS score and frailty.

Results: The sample (n=50) was 58.2±16.4 years old, 46% female, and 63% NYHA Classification III/IV. There were no sex differences in HF type, with the majority of participants with HF with reduced ejection fraction (n=38 (67%)). Females were more likely to be frail than males (n=16 (67%), p=0.005, Cohen’s d=.85). Age was not significantly different between those who were frail or not. Frail participants reported higher symptom burden in the HFSPS (=47.4±20.8) compared to those who were not (=35.8±21.9), t(48)=-1.91, p=0.06, Cohen’s d=-.54). Frailty, sex, and age accounted for 17.1% of the variability in HFSPS (F(4, 45)=2.54, p.05). Individuals who were frail were significantly more symptomatic as measured by the HFSPS (β=22.8± 9.6; 95%CI (3.3, 42.2)), controlling for sex and age. There was a not a significant interaction between frailty and sex (b=20.2, 95% CI (-44.9, 4.5)).

Conclusions: At the time of HF diagnosis, female patients are more frail and frail patients are more symptomatic, but sex does not moderate the relationship between frailty and symptoms. Larger studies of the role of sex in frailty and symptoms in new HF may contribute to more timely diagnosis and treatment, particularly in females.