NYHA classification and quality of life in older heart failure inpatients: the mediation effects of social frailty and physical frailty

Objectives: This study explores the health-related quality of life (QOL) level and its factors that influence older heart failure inpatients. It also examines the correlation between social frailty, physical frailty, emotional QOL, and physical QOL and verifies the multiple mediating roles of social frailty and physical frailty in the relationship.

Methods: This cross-sectional study collected four hundred twenty-four questionnaires from Northeast, Northwest, and South China. The research assessment tools include the FRAIL scale (physical frailty), the MLHFQ (emotional and physical QOL), and the HALFT scale (social frailty). Data analysis was performed using multiple regression analysis and the SPSS PROCESS Macro plug-in Model 4. 

Results: Age (B = 0.297, p < 0.001), monthly income (B=-3.087, p < 0.001), and marital status (B=-2.295, p = 0.027) were factors influencing emotional QOL in older heart failure inpatients. Moreover, NYHA classes (B = 3.894, p < 0.001), monthly income (B=-5.531, p < 0.001), and education level (B = 3.956, p = 0.037) were influencing factors of physical QOL. Social frailty [1.6218, 95%CI (1.3006, 1.9444)] mediates between physical frailty and physical QOL. In addition, physical frailty [0.2289, 95%CI (0.0403, 0.4285)] mediates between social frailty and emotional QOL. 

Conclusions: Age, monthly income, and marital status influenced the level of emotional QOL in older heart failure inpatients; NYHA classes, monthly income, and education level are influencing factors of physical QOL. Social frailty mediates between physical frailty and physical QOL; physical frailty mediates between social frailty and emotional QOL.