Document Type



Medicine and Health Sciences


Heart failure is the most rapidly increasing cardiovascular disease in the US and the primary discharge diagnosis for Medicare recipients. There are approximately 5.7 million people who have the diagnosis of HF in the US.1 Heart failure constitutes the most common cause for re-hospitalization and has been identified by the Medicare Payment Advisory Commission as the highest cost to the healthcare system.2, 3 Hospitalizations of older patients can result in functional deterioration leading to dependency and disability.4, 5 Due to the unpredictable trajectory of heart failure exacerbations it is difficult to discern which patients are at the greatest risk for repeat hospitalizations, functional decline and mortality. The frailty syndrome defined as a poor ability to cope with physiological stress, has demonstrated a strong association with a diagnosis of heart failure in observational studies.59 Frail patients with or without heart failure often experience functional decline and have an increased risk of death compared to their more robust counterparts. The difficulty has been to identify patients who are frail in order to increase resources available to these patients in hopes of improving health outcomes. There is no direct clinical test to measure frailty, and the challenge is to identify proxy measures which can serve as an indicator of this vulnerable state. Since heart failure and frailty have an association, patients with heart failure are an ideal population to study to further understand frailty. We have previously found an association between frailty, poor endurance, vitamin D, and C-reactive protein in a cross-sectional analysis of patients with heart failure.10 This study is a 4 year follow up of the original cohort of patients to determine if measures of frailty and endurance are useful predictors of outcomes in older patients with heart failure.


Author manuscript; available in PMC 2011 January 26. Published in final edited form as: Congest Heart Fail. 2010 Sep–Oct; 16(5): 208–213.
doi: 10.1111/j.1751-7133.2010.00151.x.