VES-13 identified frailty in 40.2% of HF outpatients and showed stronger prediction of mortality (HR 3.70) and composite endpoint (HR 3.13) than multimodal assessment.
Does the VES-13 frailty screening tool predict adverse prognosis better than a multimodal assessment in heart failure outpatients?
The VES-13 is a simple frailty tool that outperforms comprehensive multimodal assessments in predicting mortality and heart failure hospitalizations in HF outpatients.
Background Frailty is common and significantly impacts prognosis in heart failure (HF). The Vulnerable Elders Survey-13 (VES-13), widely used in oncogeriatrics and public health, remains unexplored as a frailty screening tool in HF outpatients. In this study, we prospectively evaluated VES-13 against a multimodal screening assessment in detecting frailty and predicting individual risk of adverse prognosis. Methods Frailty was assessed at the initial visit using both a multimodal approach, incorporating Barthel Index, Older American Resources and Services scale, Pfeiffer Test, abbreviated Geriatric Depression Scale, age > 85 years, lacking support systems, and VES-13. Patients scoring ≥ 3 on VES-13 or meeting at least one multimodal criterion were classified as frail. Endpoints included all-cause mortality, a composite of death or HF hospitalization, and recurrent HF hospitalizations. Results A total of 301 patients were evaluated. VES-13 identified 40.2% as frail and the multimodal assessment 33.2%. In Cox regression analyses, frailty identified by VES-13 showed greater prognostic significance than the multimodal assessment for all-cause mortality (HR = 3.70 2.15–6.33, P vs. 2.40 1.46–4.0, P = 0.001) and the composite endpoint (HR = 3.13 2.02–4.84, P vs. 1.96 1.28–2.99, P = 0.002). Recurrent HF hospitalizations were four times more frequent in VES-13 frail patients while two times in those identified as frail by the multimodal assessment. Additionally, stratifying patients by VES-13 tertiles provided robust risk differentiation. Conclusions VES-13, a simple frailty tool, outperformed a comprehensive multimodal assessment and could be easily integrated into routine HF care, highlighting its clinical utility in identifying patients at risk for poor outcomes.
Roig et al. (2026) studied this question. VES-13 identified frailty in 40.2% of HF outpatients and showed stronger prediction of mortality (HR 3.70) and composite endpoint (HR 3.13) than multimodal assessment.