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

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.