Trajectory of Multidimensional Frailty Across Recurrent Heart Failure Hospitalizations　― A Single-Center Longitudinal Cohort Study ―

BACKGROUND: Heart failure (HF) is characterized by recurrent clinical deterioration, and multidimensional frailty (i.e., functional status, nutritional status, sarcopenia-related phenotypes, and cognitive impairment) is a key determinant of prognosis. We explored longitudinal changes in these multidimensional domains across recurrent hospitalizations for HF. METHODS AND RESULTS: This single-center retrospective cohort study analyzed 337 patients initially hospitalized for HF between 2016 and 2024 who subsequently experienced ≥1 rehospitalization (total 780 admissions). Longitudinal changes across repeated hospitalizations were evaluated using age- and sex-adjusted linear mixed-effects models. The median age was 83 years, and 47.2% were women. Across repeated hospitalizations, frailty and functional status worsened (Clinical Frailty Scale, β=0.40, P<0.001; Barthel Index, β=-4.21, P<0.001; Short Physical Performance Battery score, β=-0.56, P=0.043). Gait speed also declined, although this trend did not reach statistical significance (β=-0.03, P=0.089). Nutritional status deteriorated (Controlling Nutritional Status score, β=0.56, P<0.001; Geriatric Nutritional Risk Index, β=-2.37, P<0.001). Sarcopenia-related indices deteriorated (appendicular skeletal muscle index, β=-2.79, P=0.006; grip strength, β=-4.64%, P<0.001). Cognitive function assessed by the Mini-Mental State Examination showed no significant longitudinal change (β=0.11, P=0.501). CONCLUSIONS: Many domains of frailty deteriorated across recurrent hospitalizations for HF, suggesting cumulative frailty progression.