Frontiers in medicine · 2026
Identification of frailty heterogeneity and its transition trajectories in patients with chronic heart failure: a latent transition analysis.
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Zhang Shun, Huang Yuqin, Zhai Xiaohan, Huang Hongrong, Hou Ming, Wang Yan
Аннотация
OBJECTIVE: To explore the transitions of potential frailty subtypes and their influencing factors in patients with chronic heart failure (CHF), and to provide evidence for the development of targeted frailty intervention strategies.
METHODS: A longitudinal follow-up study was conducted. A total of 324 hospitalized CHF patients were consecutively and conveniently enrolled from the cardiovascular departments of two general hospitals in Xinjiang, China, between December 2024 and April 2025. Baseline assessments were performed on the second day of hospitalization (T1), and follow-up surveys were carried out at 3 months (T2) and 6 months (T3) after discharge. Latent Profile Analysis (LPA) was adopted to identify frailty subtypes, Latent Transition Analysis (LTA) was used to analyze the dynamic transition characteristics of different frailty subtypes, and multivariate logistic regression analysis was applied to explore the factors associated with subtype transitions.
RESULTS: Three relatively stable frailty subtypes were identified among CHF patients, namely healthy type with low frailty, social-dominant type with moderate frailty, and psychological-dominant type with high frailty. The social-dominant moderate frailty subtype was mainly characterized by insufficient social support, while the psychological-dominant high frailty subtype presented with heavier psychological burden and more severe functional impairment. Dynamic transitions were observed across all subtypes during follow-up. The moderate frailty subtype had the lowest stability and was prone to progression toward the high frailty subtype. The transition rate from moderate frailty to high frailty was 24.4% during the T1→T2 period, which further increased to 34.0% in the T2→T3 period. Age, medical insurance status, New York Heart Association (NYHA) functional classification, N-terminal pro-brain natriuretic peptide (NT-proBNP), estimated glomerular filtration rate (eGFR), insomnia, depression and home volume management level were significant influencing factors for frailty subtype transitions (P < 0.05).
CONCLUSION: Frailty among CHF patients is not a single static condition, but presents obvious heterogeneity and dynamism. Patients with social-dominant moderate frailty represent a high-risk group for frailty deterioration, and those with psychological-dominant high frailty suffer from severe psychological burden and functional impairment. Stratified management targeting different frailty subtypes, with special attention to elderly patients, patients without medical insurance, those with poor cardiac function, renal impairment, insomnia and inadequate home volume management, may help reduce the risk of frailty progression and improve long-term health outcomes.
METHODS: A longitudinal follow-up study was conducted. A total of 324 hospitalized CHF patients were consecutively and conveniently enrolled from the cardiovascular departments of two general hospitals in Xinjiang, China, between December 2024 and April 2025. Baseline assessments were performed on the second day of hospitalization (T1), and follow-up surveys were carried out at 3 months (T2) and 6 months (T3) after discharge. Latent Profile Analysis (LPA) was adopted to identify frailty subtypes, Latent Transition Analysis (LTA) was used to analyze the dynamic transition characteristics of different frailty subtypes, and multivariate logistic regression analysis was applied to explore the factors associated with subtype transitions.
RESULTS: Three relatively stable frailty subtypes were identified among CHF patients, namely healthy type with low frailty, social-dominant type with moderate frailty, and psychological-dominant type with high frailty. The social-dominant moderate frailty subtype was mainly characterized by insufficient social support, while the psychological-dominant high frailty subtype presented with heavier psychological burden and more severe functional impairment. Dynamic transitions were observed across all subtypes during follow-up. The moderate frailty subtype had the lowest stability and was prone to progression toward the high frailty subtype. The transition rate from moderate frailty to high frailty was 24.4% during the T1→T2 period, which further increased to 34.0% in the T2→T3 period. Age, medical insurance status, New York Heart Association (NYHA) functional classification, N-terminal pro-brain natriuretic peptide (NT-proBNP), estimated glomerular filtration rate (eGFR), insomnia, depression and home volume management level were significant influencing factors for frailty subtype transitions (P < 0.05).
CONCLUSION: Frailty among CHF patients is not a single static condition, but presents obvious heterogeneity and dynamism. Patients with social-dominant moderate frailty represent a high-risk group for frailty deterioration, and those with psychological-dominant high frailty suffer from severe psychological burden and functional impairment. Stratified management targeting different frailty subtypes, with special attention to elderly patients, patients without medical insurance, those with poor cardiac function, renal impairment, insomnia and inadequate home volume management, may help reduce the risk of frailty progression and improve long-term health outcomes.