The SARC-CalF and FRAIL scales are sensitive for identifying high-risk older adults with HFpEF, and their combined use improves predictive specificity and accuracy compared with either scale alone.
Key Findings
Results
Patients with HFpEF were older, had a higher burden of polypharmacy, and had higher FRAIL scores than those in the non-HFpEF group.
Study included 134 patients aged ≥60 years from a single centre in China, conducted July to December 2024
Patients were divided into HFpEF group (n = 50) and non-HFpEF group (n = 84)
All between-group differences for age, polypharmacy burden, and FRAIL scores were statistically significant (all p <0.05)
Observational cross-sectional design at the Department of Geriatrics, Mindong Hospital Affiliated to Fujian Medical University
Results
The FRAIL score was independently associated with HFpEF in adjusted multivariate analysis with an odds ratio of 3.68.
Odds ratio for FRAIL score: 3.68 (95% CI, 1.83–8.39)
Variable selection was performed using LASSO regression prior to multivariable logistic regression
The optimal diagnostic threshold for the FRAIL scale was 1.5 points, indicating pre-frailty
The AUC for the FRAIL scale in ROC analysis was 0.88
Results
The SARC-CalF score was independently associated with HFpEF in adjusted multivariate analysis with an odds ratio of 1.47.
Odds ratio for SARC-CalF score: 1.47 (95% CI, 1.21–1.86)
The optimal diagnostic threshold for the SARC-CalF scale was 11 points
The AUC for the SARC-CalF scale in ROC analysis was 0.89
SARC-CalF was used to assess sarcopenia risk as part of the CGA protocol
Results
Combined use of the FRAIL and SARC-CalF scales improved predictive specificity and accuracy for HFpEF compared with either scale alone.
ROC curve analysis was used to evaluate diagnostic performance of each tool individually and in combination
The combination approach improved specificity and accuracy beyond what either individual scale achieved
Both tools individually demonstrated relatively strong prediction utility with AUCs of 0.88 and 0.89 respectively
Authors describe the dual-scale approach as 'a practical and efficient preliminary screening tool for HFpEF in geriatric care'
Methods
The CGA protocol assessed multiple geriatric domains including frailty, sarcopenia risk, nutritional status, cognitive function, basic activities of daily living, and fall risk.
Frailty was evaluated using the FRAIL scale
Sarcopenia risk was assessed using the SARC-CalF score
All 134 included patients aged ≥60 years received standard CGA
Statistical analysis included initial univariate screening, LASSO regression for variable selection, multivariable logistic regression, and ROC curve analysis
What This Means
This research suggests that two simple clinical assessment tools commonly used in elderly care — the FRAIL scale (which measures frailty) and the SARC-CalF score (which screens for muscle loss, or sarcopenia) — can help identify older patients who have a type of heart failure called heart failure with preserved ejection fraction (HFpEF). HFpEF is a condition where the heart pumps normally but is too stiff to fill properly, and it is particularly common and difficult to diagnose in older adults. The study followed 134 hospitalized patients aged 60 and older in China, comparing those diagnosed with HFpEF to those with other forms of heart failure.
The study found that patients with HFpEF tended to be older, take more medications, and score higher on frailty measures. After accounting for other factors, both the FRAIL score and the SARC-CalF score were strongly and independently linked to HFpEF. The FRAIL scale had a diagnostic accuracy (AUC) of 0.88 and the SARC-CalF had an AUC of 0.89 — both considered strong performers. Importantly, using both tools together was more accurate than using either one alone, particularly in terms of correctly ruling out HFpEF in those who do not have it.
This research suggests that routine geriatric assessments already performed in elderly care settings could double as preliminary screening tools for HFpEF, potentially helping clinicians identify at-risk patients earlier and more efficiently. Since these scales are already in wide use and require no specialized equipment, this approach could be especially practical in settings with limited diagnostic resources. The study was limited by its single-centre, cross-sectional design and relatively small sample size, so larger studies are needed to confirm these findings.
Yu Y, Xue Z. (2026). Relationship Between Comprehensive Geriatric Assessment and Heart Failure with Preserved Ejection Fraction in Elderly Patients.. Journal of the College of Physicians and Surgeons--Pakistan : JCPSP. https://doi.org/10.29271/jcpsp.2026.09.1107