Incremental Value of Objective Frailty Assessment to Predict Mortality in Elderly Patients Hospitalized for Heart Failure

Background: The impact of frailty on long-term prognosis in patients with heart failure (HF) remains unclear, and there is no simple and objective assessment for it. This study was performed to examine the association between frailty score and clinical outcome in elderly patients hospitalized for HF. Methods and Results: A retrospective cohort study was performed with 603 elderly patients with HF (mean age 75 +/- 6 years, 378 [62.7%] men). Frailty was measured by a composite of 4 markers combined into a frailty score (possible range 0-12): gait speed, handgrip strength, serum albumin, and activities of daily living status. The patient population was divided into 2 groups with frailty score <5 (non-frail) or >= 5 (frail). The end point was all-cause mortality. Over a mean follow-up period of 1.7 +/- 0.5 years, 89 patients died. After adjustment for several preexisting factors associated with prognosis, the frailty score (hazard ratio [HR] 1.11; P=.014) and frailty (HR 1.75; P=.036) were independently associated with all-cause mortality. The inclusion of frailty score significantly increased both continuous net reclassification improvement (0.341; P=.002) and integrated discrimination improvement (0.016; P=.039) for all-cause mortality. Conclusions: A simple and objective frailty score was associated with health outcome in elderly patients hospitalized for HF.