Before Heart Failure Diagnosis, Adults Are Frail and Symptomatic

Few studies have examined comprehensively the characteristics of patients leading up to new diagnoses of heart failure (HF). This study quantified symptoms and clinical characteristics before HF diagnosis, including sex differences.

Adults with new diagnoses of NewYork Heart Association class 1-4 HF within the prior 3 months were enrolled. Clinical characteristics and comorbidities were abstracted from the electronic health record, and the Meta-analysis Global Group in Chronic HF (MAGGIC) score was calculated. Participants reported symptoms in the month prior to diagnosis and health care use in the preceding year. Dyspnea was assessed by using the Heart Failure Somatic Perception Scale-Dyspnea (HFSPS-D) subscale. Frailty was assessed by using the Fatigue Resistance Ambulation Illness Loss of weight (FRAIL) scale. Descriptive and comparative statistics were used to characterize the sample overall and by sex; multiple linear regression was used to identify predictors of dyspnea. The sample (n = 95) was 60.3 ± 16.0 years of age and 47% female. The characteristics of HF were similar according to sex. Nearly half of participants were frail, with higher prevalence among females (P = 0.004). Dyspnea scores averaged 12.0 (IQR 3--22). Pain interference was greater among females (P = 0.05). Nearly 20% of participants had received no health care in the prior year Frailty, but not sex or MAGGIC score, predicted greater dyspnea (P = 0.005).

Adults experience substantial frailty and symptom burdens in the month prior to HF diagnosis. Females had a higher prevalence of frailty. Frailty may be a key target for early HF risk identification.