What is the clinical evidence from this study?

Study design: Cohort. Population: Acute heart failure (n=457). Intervention: Dynamic frailty assessment. Primary outcome: In-hospital mortality (associated with admission Clinical Frailty Scale) (OR 2.26, 95% CI 1.21-4.21, p=0.010).

What question did this study set out to answer?

This study aims to evaluate how different frailty assessment tools relate to mortality in older patients with acute heart failure during hospitalization and after discharge.

April 22, 2026Open Access

Dynamic frailty assessment predicts in-hospital and early post-discharge mortality in older patients hospitalized with acute heart failure: a prospective cohort study

Key Result

Admission frailty (CFS) predicted in-hospital mortality (OR 2.26), while discharge frailty (FI-VIG) predicted 30-day post-discharge mortality (OR 1.75) in older acute heart failure patients.

Key Points

This study aims to evaluate how different frailty assessment tools relate to mortality in older patients with acute heart failure during hospitalization and after discharge.
Conducted a prospective cohort study in a second-level hospital.
Included patients aged ≥ 80 years with acute heart failure admitted to different wards.
Assessed frailty using multiple instruments at baseline, within 48 hours of admission, and at discharge.
High prevalence of frailty was found across all assessment tools (FI-VIG 84.7%, TFI 64.1%).
In-hospital mortality was 8.8% and 30-day post-discharge mortality was 13.0%.
Admission frailty and discharge frailty were independently associated with higher mortality risks, with specific odds ratios provided for each frailty instrument.

Study Design

Type

Cohort (n=457)

Multicenter

Structured PICO

Does dynamic frailty assessment predict in-hospital and early post-discharge mortality in older patients hospitalized with acute heart failure?

Population

457 patients aged ≥ 80 years admitted for acute heart failure (AHF) to Acute Geriatric, Cardiology and Internal Medicine Wards, mean age 88.6 ± 4.4 years, 64.3% female, in Spain.

Intervention

Dynamic frailty assessment using multiple tools (Frail Index–VIG, FRAIL scale, Clinical Frailty Scale, Tilburg Frailty Indicator, and Identification of Seniors at Risk) at baseline, within the first 48 hours of admission, and at discharge.

Outcome

In-hospital and within 30-day post-discharge mortalityhard clinical

Dynamic frailty assessment during acute heart failure hospitalization provides important prognostic information, with admission frailty predicting in-hospital death and discharge frailty predicting early post-discharge mortality.

Main Result

Effect estimate: OR 2.26 (95% CI 1.21-4.21)

p-value: p=0.010

Limitations

Short follow-up period (30 days)
Post-discharge frailty reassessment not systematically performed
Baseline measurements partially based on patient or caregiver recall
FI-VIG not specifically validated in HF populations
Differences in care processes across hospital wards were not specifically analyzed
Assessors were not blinded to previous frailty assessments
Functional decline was not included as an outcome

Abstract

Frailty is insufficiently captured by conventional mortality risk scores in acute heart failure (AHF), particularly regarding its dynamic changes during hospitalization. We aimed to evaluate the relationship between different frailty assessment tools and in-hospital and 30-day post-discharge mortality in older patients hospitalized for AHF. We conducted a prospective cohort study (HOP-AHF cohort) in a second-level hospital between January 2023 and February 2024. Patients aged ≥ 80 years admitted for AHF to Acute Geriatric, Cardiology and Internal Medicine Wards were included. Frailty was assessed at baseline, within the first 48 h of admission, and at discharge using the Frail Index–VIG (FI-VIG), FRAIL scale, Clinical Frailty Scale (CFS), Tilburg Frailty Indicator (TFI) and Identification of Seniors at Risk (ISAR). The multiple estimation of risk based on the Emergency Department Spanish Score in Patients with Acute Heart Failure (MEESSI-AHF risk score) was recorded. Primary Outcome: in-hospital and within 30-day post-discharge mortality. 457 patients were included (mean age 88.60 ± 4.40 years; women 64.3%). Baseline frailty prevalence was high across all instruments (FI-VIG 84.7%, TFI 64.1%, ISAR 62.93%, CFS 60.8%, FRAIL 40.9%). In-hospital and 30-days post-discharge mortality were 8.8% and 13.0% respectively. All frailty instruments assessed at baseline and admission were associated with in-hospital mortality in univariate analyses. In multivariable models, admission frailty assessed by CFS (OR 2.26, 95% CI 1.21–4.21, p = 0.010) and TFI (OR 1.68, 95% CI 1.23–2.28 p < 0.001), together with the MEESSI-AHF score 1.42, 95% CI 1.02–1.97 p = 0.036), remained independently associated with in-hospital mortality. Frailty assessed at discharge emerged as the strongest predictor of 30-day post-discharge mortality, with FI–VIG (OR 1.75, 95% CI 1.35–2.29 p < 0.001), TFI (OR 1.24, 95% CI 1.01–1.52 p = 0.040), and MEESSI-AHF score (OR 1.22, 95% CI 1.05–1.41 p = 0.008) remaining independently associated. Frailty is highly prevalent and dynamically worsens during AHF hospitalization in older patients. Admission frailty identifies patients at risk of in-hospital death, whereas frailty at discharge captures residual vulnerability associated with early post-discharge mortality. Incorporating dynamic frailty assessment may improve prognostic stratification in AHF.

KI fragen

Bookmark

View Full Paper