Frailty is detrimental to prognosis in older patients with heart failure, and nutritional status—specifically GNRI and HDL—is closely related to prognosis in frail older patients with heart failure.
Key Findings
Results
Frailty was associated with significantly higher mortality and readmission rates in older adults with heart failure over a 6-month follow-up.
200 older patients with heart failure were included; 92 were assigned to the frailty (experimental) group and 108 to the non-frailty (control) group.
Mortality was higher in the frailty group than the non-frailty group: 4/92 (4.35%) vs. 1/108 (0.93%), P < 0.05.
Readmission rate was higher in the frailty group: 13/92 (14.13%) vs. 2/108 (1.85%), P < 0.05.
Follow-up duration was 6 months; the study was a single-center retrospective design conducted at Yuncheng Central Hospital, China, between March 2020 and February 2023.
Results
The prevalence of malnutrition was high among frail older patients with heart failure, with 45.65% classified as moderate-to-severe malnutrition.
Among the 92 frail patients, 19 (20.65%) were classified as normal nutrition, 31 (33.70%) as mild malnutrition, and 42 (45.65%) as moderate-to-severe malnutrition.
A two-stage grouping strategy was used; nutritional assessment was performed only within the experimental (frailty) group.
Nutritional subgroups were defined using standardized nutritional assessment tools applied within the experimental group.
Results
Adverse outcomes in frail patients increased progressively with worsening nutritional status.
Adverse outcomes occurred in 1/19 (5.26%) normal nutrition patients, 5/31 (16.13%) mild malnutrition patients, and 11/42 (26.19%) moderate-to-severe malnutrition patients.
The incidence of adverse outcomes increased as nutritional status worsened (P < 0.05).
Adverse outcomes included mortality and readmission during the 6-month follow-up period.
Results
Serum albumin, prealbumin, GNRI scores, and the proportion of patients with HDL ≥ 0.8 mmol/L were progressively lower with worsening nutritional status among frail patients.
ALB, PAB, GNRI scores, and proportion of patients with HDL ≥ 0.8 mmol/L were all lower in the two malnutrition subgroups compared to the normal nutrition subgroup (all P < 0.05).
These indicators were also lower in the moderate-to-severe malnutrition subgroup compared to the mild malnutrition subgroup (all P < 0.05).
These biomarkers served as nutritional indicators differentiating the three nutritional-status subgroups within the frailty group.
Results
Multivariable Cox proportional hazards regression identified GNRI and HDL as independent factors associated with adverse prognosis in frail older patients with heart failure.
Both GNRI and HDL were statistically significant in the multivariable Cox regression model (both P < 0.05).
The analysis was conducted to evaluate factors associated with adverse prognosis among the frail patient group.
Specific hazard ratios and confidence intervals were not reported in the abstract.
Appropriate parametric or nonparametric tests were used for group comparisons prior to regression modeling.
What This Means
This research suggests that frailty—a condition of reduced physical and physiological reserve common in older adults—significantly worsens outcomes for elderly patients hospitalized with heart failure. In a study of 200 older heart failure patients followed for six months, those identified as frail were nearly five times more likely to be readmitted to the hospital and had higher mortality rates compared to non-frail patients. These findings highlight frailty as an important risk factor that clinicians may want to identify and address in this population.
Among the frail patients, the study further found that nutritional status played a critical role in determining outcomes. Nearly half of frail patients (45.65%) had moderate-to-severe malnutrition, and the rate of adverse events—including death and rehospitalization—rose steadily as nutritional status worsened, from about 5% in well-nourished frail patients to over 26% in those with the worst nutritional status. Two specific measures—the Geriatric Nutritional Risk Index (GNRI), a tool combining body weight and albumin levels, and HDL cholesterol (often called 'good cholesterol')—were independently linked to worse prognosis in statistical modeling.
This research suggests that routinely screening older heart failure patients for both frailty and nutritional status could help identify those at highest risk of poor outcomes. The authors emphasize that intervening to improve nutritional status in frail heart failure patients may offer an opportunity to reduce hospitalizations and improve survival, though as a retrospective single-center study, further research would be needed to confirm whether nutritional interventions actually change outcomes.
Li J, Liu M, Wang J. (2026). Frailty and nutritional status as prognostic factors in older adults with heart failure: a public health perspective.. Frontiers in public health. https://doi.org/10.3389/fpubh.2026.1893715