Frailty, quality of life and nutritional status for the prediction of morbidity and mortality in individuals with chronic heart failure in southern Brazil (FPROHEART): a cohort study protocol

Introduction Heart failure (HF) is a debilitating condition associated with high morbidity, mortality and healthcare resource use. Frailty in HF patients is associated with poorer outcomes, including increased morbidity, mortality and reduced quality of life (QoL). Nutritional disorders, such as mal...

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Main Authors: Lívia Adams Goldraich, Nadine Clausell, Daniela Meirelles do Nascimento, Pâmela Iná Wolffenbüttel, Beatriz Schaan
Format: Article
Language:English
Published: BMJ Publishing Group 2025-08-01
Series:BMJ Open
Online Access:https://bmjopen.bmj.com/content/15/8/e101819.full
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author Lívia Adams Goldraich
Nadine Clausell
Daniela Meirelles do Nascimento
Pâmela Iná Wolffenbüttel
Beatriz Schaan
author_facet Lívia Adams Goldraich
Nadine Clausell
Daniela Meirelles do Nascimento
Pâmela Iná Wolffenbüttel
Beatriz Schaan
author_sort Lívia Adams Goldraich
collection DOAJ
description Introduction Heart failure (HF) is a debilitating condition associated with high morbidity, mortality and healthcare resource use. Frailty in HF patients is associated with poorer outcomes, including increased morbidity, mortality and reduced quality of life (QoL). Nutritional disorders, such as malnutrition, are common in patients with HF and contribute to functional decline and increased mortality. The Meta-Analysis Global Group in Chronic HF (MAGGIC) risk score was developed to predict 1-year and 3-year hospitalization and mortality in patients with HF. This study aims to assess the added value of frailty, QoL and nutritional status to the MAGGIC risk score.Methods and analysis This prospective cohort study, conducted at a tertiary public hospital in southern Brazil, will include 316 patients with chronic HF who are followed up at the HF Outpatient Clinic. Frailty will be assessed using the Fried scale, health-related QoL will be assessed using the Minnesota Living with Heart Failure Questionnaire (MLHFQ) and nutritional status will be assessed using the Mini Nutritional Assessment. These variables will be incorporated into the MAGGIC risk score. Continuous variables with a normal distribution will be described as mean±SD, skewed variables as median±IQR and categorical variables as absolute and relative frequencies. Survival analysis will be performed using the Kaplan-Meier method with log-rank test comparisons. The prognostic value of frailty, its components, the MLHFQ score and nutritional status will be assessed by Cox regression, which will be adjusted for the MAGGIC risk score. Net Reclassification Improvement and Integrated Discrimination Improvement will assess the accuracy of the MAGGIC score when including frailty, MLHFQ and nutritional status. A p value <0.05 will be considered statistically significant.Ethics and dissemination This study adheres to the Declaration of Helsinki and was approved by the Institutional Committee for Scientific Ethics and Research (No 20220558) and the Brazilian Government Registry (No 66474223200005327). The data will be available on reasonable request from the corresponding author. The results will be disseminated via peer-reviewed manuscripts and shown at national and international conferences.
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spelling doaj-art-11f0f5d14d0144dfbe23efabf5e69de82025-08-20T03:03:17ZengBMJ Publishing GroupBMJ Open2044-60552025-08-0115810.1136/bmjopen-2025-101819Frailty, quality of life and nutritional status for the prediction of morbidity and mortality in individuals with chronic heart failure in southern Brazil (FPROHEART): a cohort study protocolLívia Adams Goldraich0Nadine Clausell1Daniela Meirelles do Nascimento2Pâmela Iná Wolffenbüttel3Beatriz Schaan4Heart Transplant Program, Division of Cardiology, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, BrazilHeart Transplant Program, Division of Cardiology, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, BrazilLaboratory of Physical Activity, Diabetes and Cardiovascular Disease, Clinical Research Center, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, BrazilLaboratory of Physical Activity, Diabetes and Cardiovascular Disease, Clinical Research Center, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, BrazilLaboratory of Physical Activity, Diabetes and Cardiovascular Disease, Clinical Research Center, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, BrazilIntroduction Heart failure (HF) is a debilitating condition associated with high morbidity, mortality and healthcare resource use. Frailty in HF patients is associated with poorer outcomes, including increased morbidity, mortality and reduced quality of life (QoL). Nutritional disorders, such as malnutrition, are common in patients with HF and contribute to functional decline and increased mortality. The Meta-Analysis Global Group in Chronic HF (MAGGIC) risk score was developed to predict 1-year and 3-year hospitalization and mortality in patients with HF. This study aims to assess the added value of frailty, QoL and nutritional status to the MAGGIC risk score.Methods and analysis This prospective cohort study, conducted at a tertiary public hospital in southern Brazil, will include 316 patients with chronic HF who are followed up at the HF Outpatient Clinic. Frailty will be assessed using the Fried scale, health-related QoL will be assessed using the Minnesota Living with Heart Failure Questionnaire (MLHFQ) and nutritional status will be assessed using the Mini Nutritional Assessment. These variables will be incorporated into the MAGGIC risk score. Continuous variables with a normal distribution will be described as mean±SD, skewed variables as median±IQR and categorical variables as absolute and relative frequencies. Survival analysis will be performed using the Kaplan-Meier method with log-rank test comparisons. The prognostic value of frailty, its components, the MLHFQ score and nutritional status will be assessed by Cox regression, which will be adjusted for the MAGGIC risk score. Net Reclassification Improvement and Integrated Discrimination Improvement will assess the accuracy of the MAGGIC score when including frailty, MLHFQ and nutritional status. A p value <0.05 will be considered statistically significant.Ethics and dissemination This study adheres to the Declaration of Helsinki and was approved by the Institutional Committee for Scientific Ethics and Research (No 20220558) and the Brazilian Government Registry (No 66474223200005327). The data will be available on reasonable request from the corresponding author. The results will be disseminated via peer-reviewed manuscripts and shown at national and international conferences.https://bmjopen.bmj.com/content/15/8/e101819.full
spellingShingle Lívia Adams Goldraich
Nadine Clausell
Daniela Meirelles do Nascimento
Pâmela Iná Wolffenbüttel
Beatriz Schaan
Frailty, quality of life and nutritional status for the prediction of morbidity and mortality in individuals with chronic heart failure in southern Brazil (FPROHEART): a cohort study protocol
BMJ Open
title Frailty, quality of life and nutritional status for the prediction of morbidity and mortality in individuals with chronic heart failure in southern Brazil (FPROHEART): a cohort study protocol
title_full Frailty, quality of life and nutritional status for the prediction of morbidity and mortality in individuals with chronic heart failure in southern Brazil (FPROHEART): a cohort study protocol
title_fullStr Frailty, quality of life and nutritional status for the prediction of morbidity and mortality in individuals with chronic heart failure in southern Brazil (FPROHEART): a cohort study protocol
title_full_unstemmed Frailty, quality of life and nutritional status for the prediction of morbidity and mortality in individuals with chronic heart failure in southern Brazil (FPROHEART): a cohort study protocol
title_short Frailty, quality of life and nutritional status for the prediction of morbidity and mortality in individuals with chronic heart failure in southern Brazil (FPROHEART): a cohort study protocol
title_sort frailty quality of life and nutritional status for the prediction of morbidity and mortality in individuals with chronic heart failure in southern brazil fproheart a cohort study protocol
url https://bmjopen.bmj.com/content/15/8/e101819.full
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