{
  "abstract": "Introduction Heart failure with preserved ejection fraction (HFpEF) accounts for around half of all heart failure cases and is strongly associated with ageing. Frailty is common in HFpEF and identifies patients at increased risk of hospitalisation and mortality, yet frailty assessment is not routinely embedded in heart failure services. Understanding local frailty prevalence, documentation quality, and associated outcomes will help to inform service development. This audit evaluated frailty prevalence, frailty recording, and clinical outcomes in patients aged ≥65 years with NT-proBNP >2000 ng/L and HFpEF attending the Rapid Access Heart Failure clinic (HF Hub)Methods A retrospective audit was conducted using Epic EPR data for patients aged ≥65 years with NT-proBNP >2000 ng/L and HFpEF seen in the HF Hub at the Royal Devon and Exeter Hospital between 1 July 2022 and 1 July 2024. Data collected included age, frailty assessment (Clinical Frailty Score, CFS) recorded in clinic letters or elsewhere in the notes or estimated CFS where missing, discharged back to GP from clinic, any-cause hospital admissions within two years, and one-year mortality.Results Over the two-year period, 502 patients with NT-proBNP >2000 ng/L attended the HF Hub: 241 (48%) had HFpEF, 76 HFmrEF, 155 HFrEF, and 30 were not diagnosed with HF. Of the HFpEF group, 221 (92%) were aged ≥65 years (median age 86 [IQR 81–90]); 185 (84%) were discharged back to their GP. Only 32 patients (14%) had a CFS formally recorded in the HF Hub clinic letter, of whom 13 (40%) were frail (CFS ≥5). Among the 189 without Hub letter documentation, 57 (30%) were frail when CFS was recorded or estimated from the notes. Overall, 70 patients (32%) were frail, and the median CFS was 4 (IQR 3–5). One-year mortality was 14% (n=32), higher in frail than non-frail patients (24% vs 10%). Within two years, 55 patients (20%) had ≥2 hospital admissions, again more common in frail patients (40% vs 16%).Conclusion Older adults with HFpEF seen in the HF Hub represent an elderly population with a high burden of frailty, yet formal frailty documentation at HF Hub was low. Frailty was associated with substantially worse outcomes, with frail patients experiencing more than double the mortality and hospitalisation rates of non-frail patients. These findings highlight the importance of routine frailty assessment within HF pathways to support risk stratification and personalised care. Routine CFS recording has now been implemented, with re-audit underway. Research into the role of Comprehensive Geriatric Assessment (CGA) in this population is needed, and the Royal Devon and Exeter Hospital is actively recruiting to the CHART trial investigating CGA for older adults with HFpEF and frailty.",
  "authors": [
    {
      "affiliations": [
        "Royal Devon and Exeter Hospital, Exeter, United Kingdom"
      ],
      "name": "Sarah Merson"
    },
    {
      "affiliations": [
        "Royal Devon and Exeter Hospital, Exeter, United Kingdom"
      ],
      "name": "Munya Mohamed"
    }
  ],
  "title": "555 Frailty in older adults with heart failure with preserved ejection fraction: audit of patients with nt-probnp >2000 ng/L seen in a rapid access heart failure clinic",
  "uid": "7d9f11f6-2e9a-5d96-9357-948dd2e81c03"
}