Frailty and Bleeding Events in Heart Failure: Insights from the JROADHF-NEXT

IF 2.1 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

CJC Open Pub Date : 2026-10-01 Epub Date: 2026-06-22 DOI:10.1016/j.cjco.2026.06.006

Taisuke Nakade MD, Yudai Fujimoto MD, Tomomi Ide MD, PhD, Keisuke Kida MD, PhD, Shouji Matsushima MD, PhD, Hidetaka Kaku MD, PhD, Nobuyuki Enzan MD, PhD, Masataka Ikeda MD, PhD, Takeshi Kitai MD, PhD, Tatsunori Taniguchi MD, PhD, Takahiro Okumura MD, PhD, Takeshi Tohyama MD, PhD, Hiroyuki Tsutsui MD, PhD, Yuya Matsue MD, PhD

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引用次数: 0

Abstract

Background

Frail patients are considered to be at higher risk of bleeding than non-frail patients; however, the association between frailty and bleeding risk in patients with heart failure (HF) remains unclear. Therefore, this study aims to evaluate the prevalence of bleeding events, examine the relationship between frailty severity and bleeding risk, and assess the association between bleeding events and subsequent mortality in patients with HF receiving antiplatelet or anticoagulant therapy.

Methods

This post hoc analysis used data from the Japanese Registry of Acute Decompensated Heart Failure–Next, a prospective, multicentre, nationwide registry. Frailty was evaluated using the Clinical Frailty Scale (CFS). Bleeding events were defined as major or clinically relevant non-major bleeding, based on the International Society on Thrombosis and Haemostasis Bleeding Scale.

Results

Among 4016 patients, 3029 (75.4%) were discharged on antiplatelet or anticoagulant medication. After excluding 89 with missing CFS data, 2940 patients were analyzed (mean age: 75 ± 12 years; 64.0% male). Patients were grouped by CFS scores: 1-3 (n = 1033); 4-5 (n = 1364); and 6-9 (n = 543). At 2 years, 149 (5.0%) experienced bleeding. Higher CFS scores were associated with increased bleeding risk (CFS score 4-5: hazard ratio [HR]: 1.53, 95% confidence interval [CI]: 1.00-2.34; CFS score 6-9: HR: 1.75; 95% CI: 1.04-2.93). In addition, bleeding events were associated with a higher risk of mortality (HR: 2.80; 95% CI: 1.88-4.17, P < 0.001).

Conclusions

Frailty is associated with bleeding risk in patients with HF receiving antithrombotic therapy. Bleeding events were associated with a higher risk of subsequent death.

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心力衰竭的虚弱和出血事件：来自JROADHF-NEXT的见解

背景：虚弱的患者被认为比非虚弱的患者有更高的出血风险；然而，心力衰竭（HF）患者虚弱和出血风险之间的关系尚不清楚。因此，本研究旨在评估出血事件的发生率，检查衰弱严重程度与出血风险之间的关系，并评估接受抗血小板或抗凝治疗的心衰患者出血事件与随后死亡率之间的关系。方法：这项事后分析使用了日本急性失代偿性心力衰竭登记处- next的数据，这是一项前瞻性、多中心、全国性的登记处。使用临床虚弱量表（CFS）评估虚弱程度。出血事件定义为根据国际血栓和止血学会出血量表的重大或临床相关的非重大出血。结果4016例患者中，3029例（75.4%）在出院时使用抗血小板或抗凝药物。剔除89例CFS资料缺失者后，共分析2940例患者（平均年龄：75±12岁，男性64.0%）。患者按CFS评分分组：1-3 (n = 1033)；4-5 (n = 1364)；6-9 （n = 543）2年时，149例（5.0%）出现出血。较高的CFS评分与出血风险增加相关（CFS评分4-5：风险比[HR]: 1.53, 95%可信区间[CI]: 1.00-2.34； CFS评分6-9:HR: 1.75; 95% CI: 1.04-2.93）。此外，出血事件与较高的死亡风险相关（HR: 2.80; 95% CI: 1.88-4.17, P < 0.001）。结论心衰患者接受抗栓治疗与出血风险相关。出血事件与随后死亡的高风险相关。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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