In elderly patients with AHF, frailty was more strongly associated with all-cause mortality than with documented non-fatal AHF rehospitalization, carried prognostic information complementary to natriuretic peptides, and added discrimination beyond cardiorenal variables, supporting structured frailty assessment alongside heart-failure-directed therapy.
Key Findings
Results
Frailty was highly prevalent among patients hospitalized with acute heart failure and was linked to a distinct clinical profile.
The study was a prospective single-center registry of 530 consecutive AHF patients (February 2023-June 2025).
Frailty was graded at admission with the Clinical Frailty Scale (CFS) from patient and collateral history; 66.4% had CFS ≥ 5.
Frailty was associated with older age, female sex, renal impairment, right heart failure, multivalvular disease and higher, rather than lower, LVEF.
Results
12-month all-cause mortality rose steeply across frailty strata.
Mortality was 4.5%, 19.3% and 49.7% across the CFS 1-3, 4-5 and 6-9 strata.
The hazard ratio was 3.29 per stratum (95% CI 2.43-4.45).
All-cause mortality at 12 months was the primary outcome.
Results
Frailty was associated with first AHF rehospitalization less steeply than with mortality.
Aalen-Johansen cumulative incidence of first AHF rehospitalization was 4.5%, 29.2% and 33.0% across strata, with death and renal replacement therapy as competing events.
Cause-specific hazard ratio was 1.86 (95% CI 1.42-2.45).
Fine-Gray subdistribution hazard ratio was 1.51 (95% CI 1.19-1.92).
Results
Frailty carried prognostic information complementary to natriuretic peptides.
Frail patients with below-median NT-proBNP had mortality comparable to patients with CFS < 5 and above-median NT-proBNP (24.3% vs. 22.0%).
Results
Adding CFS to a cardiorenal model improved discrimination and model fit.
The cardiorenal model included age, log NT-proBNP, admission eGFR and LVEF.
C-index rose from 0.701 to 0.734; optimism-corrected from 0.694 to 0.726.
Apparent ΔC-index was 0.033 (95% CI 0.007-0.063).
Likelihood-ratio χ2 = 27.7, p < 0.001.
Results
Discharge prescription of disease-modifying therapy declined with increasing frailty.
The abstract reports this gradient without giving specific figures.
What This Means
This study followed 530 older adults admitted to hospital with acute heart failure in Crete-based registry data. On admission, doctors rated each patient's frailty with the Clinical Frailty Scale, a 1-9 score based on how independent and fit someone is in daily life. About two-thirds of patients were at least moderately frail. Frail patients tended to be older, more often women, and had more kidney problems and valve disease, and they often had a higher, not lower, heart pumping fraction.
Frailty was strongly tied to dying within a year: roughly 4.5% of the least frail group died, compared with about 19% in the middle group and about 50% in the most frail group. Frailty was also linked to being readmitted for heart failure, but less strongly, partly because many of the frailest patients died before they could be readmitted. Frail patients whose heart-stress blood marker (NT-proBNP) was low still had a death rate similar to less frail patients with high levels. Adding the frailty score to a model using age, NT-proBNP, kidney function and heart pumping function improved its ability to predict who would die. Frailer patients were also less likely to be prescribed heart-failure medicines at discharge.
This research suggests that routinely assessing frailty in people hospitalized with heart failure could give doctors useful information about prognosis that standard heart and kidney measures miss. The study was done at a single center, so the results may not apply everywhere, and it shows association rather than proving that frailty assessment improves outcomes.
Aletras G, Marketou M, Bachlitzanaki M, Stratinaki M, Tsigaridaki M, Pantazis Y, et al.. (2026). Beyond Cardiorenal Risk Factors: The Prognostic Role of Frailty in Acute Heart Failure.. Medicina (Kaunas, Lithuania). https://doi.org/10.3390/medicina62101942