Care interventions in the development of heart failure and frailty and their impact on outcomes: a cohort study

Study type
Date of Approval
Study reference ID
Lay Summary

Heart Failure is a condition, often of the older person, that is characterised by multiple problems and high levels of healthcare in the community and hospitals. High disease and treatment burden to patients are indicators and risks for the development of 'frailty'. Frailty refers to a person’s mental and physical resilience, or their ability to bounce back and recover from events like illness and injury. Heart failure is common in older people and is often associated with deterioration in health and recovery over time. The key challenge for the NHS is whether care delivery focuses on the heart failure or in fact care delivery adopts a more holistic model that includes how frail the person is, to improve overall health.

Using the CPRD databases, we will first look at how patterns of conditions and care influences how heart failure develops, and how these change after diagnosis. Second, we will look at how heart failure and frailty develop together and impact on subsequent hospital admissions and death. Third, we will develop models that help predict which patients with heart failure and frailty are more at risk of hospital admissions and death. These findings will provide the evidence for the NHS and policy makers to bring together the management of heart failure and frailty in better ways to shift away from looking at a person as just with the disease to thinking more of the person's health as a whole when they are older.

Technical Summary

Background: It is known that Heart Failure (HF) is associated with poor prognosis for emergency hospital admissions and death, and it is also one of the key conditions that associated with the development of frailty. Data-driven approaches have been used to define frailty in health care records, and frailty without a fixed disease context, is associated with poor outcomes in older populations. However, it is unknown how HF and frailty develops and how the combination of HF and frailty influences real-world healthcare and clinical outcomes.

Design: Historical cohort studies

Methods: In the populations aged 40 years and over, the CPRD Gold and Aurum datasets will be used to identify an incident HF cohort and compared to a cardiovascular cohort without HF and a randomly age and gender matched cohort. The outcomes data will be ascertained from primary care data linked to Hospital Episode Statistics (HES) and ONS death data. In three phases, using longitudinal mixed models, flexible parametric models and machine learning methods to investigate trajectories, time-dependent effects on outcomes and predictive models. There will be an investigation of patient (age, gender, socioeconomic status, ethnicity), clinical (comorbid conditions and severity), care factors (multiple medications use, routine tests [physiological markers, devices and imaging], contact patterns), and how they relate to the development of HF and frailty and the subsequent prognosis of the outcomes of hospital admissions and death.

Outcomes: This investigation will determine the key patient, clinical and care factors that contribute to development of HF, and frailty before and after the diagnosis of new HF and the impact on unplanned admissions and death in HF patients. HF and frailty are major NHS and public health policies and investigating the relationship between HF and frailty provides potential new opportunities for earlier interventions to improve the care of the older populations.

Health Outcomes to be Measured

(i) Heart failure; frailty
(ii) planned and unplanned hospital admissions
(iii) all-cause-mortality and HF-specific mortality


Umesh Kadam - Chief Investigator - University of Exeter
Umesh Kadam - Corresponding Applicant - University of Exeter
Ke Li - Collaborator - University of Exeter
Krasimira Tsaneva-Atanasova - Collaborator - University of Exeter
Sarah Bailey - Collaborator - University of Exeter


HES Accident and Emergency;HES Admitted Patient Care;HES Outpatient;ONS Death Registration Data;Patient Level Index of Multiple Deprivation;Practice Level Index of Multiple Deprivation