Bendopnea prevalence and prognostic value in older patients with heart failure: FRAGILE-HF–SONIC-HF post hoc analysis

Abstract Aims This study aimed to investigate the prevalence, clinical characteristics, and prognostic value of bendopnea in older patients hospitalized for heart failure. Methods and results This post hoc analysis was performed using two prospective, multicentre, observational studies: the FRAGILE-HF (main cohort) and SONIC-HF (validation cohort) cohorts. Patients were categorized based on the presence of bendopnea, which was evaluated before discharge. The primary endpoint was 2-year all-cause mortality after discharge. Among the 1243 patients (median age, 81 years; 57.2% male) in the FRAGILE-HF cohort and 225 (median age, 79 years; 58.2% men) in the SONIC-HF cohort, bendopnea was observed in 31 (2.5%) and 10 (4.4%) patients, respectively. Over a 2-year follow-up period, all-cause death occurred in 20.8 and 21.9% of the patients in the FRAGILE-HF and SONIC-HF cohorts, respectively. Kaplan–Meier survival curves demonstrated significantly higher mortality rates in patients with bendopnea than in those without bendopnea in the FRAGILE-HF (log-rank P = 0.006) and SONIC-HF cohorts (log-rank P = 0.014). Cox proportional hazard analysis identified bendopnea as an independent prognostic factor for all-cause mortality in both the FRAGILE-HF [hazard ratio (HR) 2.11, 95% confidence interval (CI) 1.18–3.78, P = 0.012] and SONIC-HF cohorts (HR 4.20, 95% CI 1.63–10.79, P = 0.003), even after adjusting for conventional risk factors. Conclusion Bendopnea was observed in a relatively small proportion of older patients hospitalized for heart failure before discharge. However, its presence was significantly associated with an increased risk of all-cause mortality. Lay Summary This study investigated how common it is for older patients with heart failure to have trouble breathing when they bend forward, and whether this affects their chances of survival. The study found that although this problem is not very common, it is linked to a higher risk of death. Graphical Abstract Graphical abstract The investigation was conducted using two distinct cohorts, namely, the main cohort, FRAGILE-HF, and the validation cohort, SONIC-HF. Bendopnea was detected in 2.5 and 4.4% of patients, respectively. Bendopnea was significantly associated with 2-year mortality in both cohorts, and these findings remained robust even after adjusting for other known risk factors.