Combined Prognostic Impact of Two Quick Frailty Assessments in Acute Heart Failure

Abstract

Introduction: We aimed to investigate the prognostic impact of frailty (defined by the Study of Osteoporotic Fracture [SOF] index and the Clinical Frailty Scale [CFS]) in hospitalized patients with acute decompensated heart failure (HF).

Methods: A total of 1,053 patients over 75 years of age, who were primarily admitted to hospital with a diagnosis of acute decompensated HF, were enrolled. The prognostic value of frailty by the two tools for predicting all-cause mortality was analyzed using multivariate Cox regression models.

Results: The incidence of frailty was 57.1% when using the SOF index, 37.6% when using the CFS, and 23.3% when using both tools. Frailty, via the SOF index or CFS, was an independent predictor of all-cause mortality in model 1, after adjustment for significantly associated factors by univariate analysis (hazard ratio [HR] 1.38, 95% confidence interval [CI] 1.04-1.84, p = 0.027; HR 1.53, 95% CI 1.15-2.05, p = 0.003, respectively), and in model 2, after adjustment for previously reported prognostic factors (HR 1.42, 95% CI 1.07-1.89, p = 0.015; HR 1.56, 95% CI 1.17-2.07, p = 0.002, respectively). Compared to non-frail patients, frail patients via both tools had a significantly higher incidence of all-cause mortality in models 1 (adjusted HR 2.16, 95% CI 1.42-3.29, p < 0.001) and 2 (adjusted HR 2.30, 95% CI 1.51-3.50, p < 0.001).

Conclusions: Combined frailty screening using the SOF index and CFS contributed to stratify the risk of mortality in patients with acute decompensated HF.

Keywords: Acute heart failure; Clinical Frailty Scale; Frailty; Mortality; Study of Osteoporotic Fracture index.