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June 29, 2026ESC Heart FailureOpen Access

Frailty and Heart Failure: An Integrated Review of a Bidirectional Relationship

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Key result

Frailty affects ~90% of hospitalized HFpEF patients and bidirectionally accelerates heart failure progression.

Why the study?

Heart failure and frailty frequently coexist in older adults and are associated with poor clinical outcomes, warranting a synthesis of current evidence on their bidirectional relationship.

Design

Integrated review

Authors

IUIzabella UchmanowiczEdinburgh Napier UniversityEVErcole VelloneHeart Failure & TransplantCLChristopher S. LeeHeart Failure & Transplant

Discussion

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Implication

Supports integrating frailty assessment into HF care; leaves open validation of HF-specific tools and targeted interventions.

Key Points

  • This review aims to synthesize evidence on how frailty and heart failure influence each other in older adults.
  • Integrated review of literature on frailty and heart failure, focusing on epidemiology, mechanisms, and management strategies.
  • Assessment strategies including physical performance measures and multidimensional frailty instruments were discussed.
  • Highlighted the Heart Failure Frailty Score (HFFS) as a new assessment tool for heart failure populations.
  • Frailty is prevalent in 15-76% of chronic heart failure patients and nearly 90% in those with heart failure with preserved ejection fraction (HFpEF).
  • Frailty independently predicts incident heart failure and worsens cardiac health, while heart failure accelerates frailty progression.
  • Management strategies include exercise rehabilitation and nutrition optimization, emphasizing the need for frailty assessment in heart failure care.

Structured PICO

P
Population
Older adults with heart failure and frailty

This review highlights the bidirectional relationship between frailty and heart failure, emphasizing the need for HF-specific frailty assessment tools and targeted management strategies.

Cite This Study

Uchmanowicz et al. (2026) conducted a review in Heart failure and frailty. Frailty was evaluated. Frailty affects 15-76% of patients with chronic heart failure, approaching 90% in hospitalized HFpEF patients, and shares a bidirectional relationship where each condition accelerates the other.

synapsesocial.com/papers/6a420adff91bb43ea919213chttps://doi.org/10.1093/eschf/xvag178

Topics

Cardiac Rehabilitation and Lifestyle Interventions
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Frailty and heart failure: State‐of‐the‐art review2023 · 142 citations
  2. 2Frailty in Heart Failure: Implications for Management2018 · 107 citations
  3. 3Multiprofessional Interventions for Frailty in Patients with Heart Failure: A Comprehensive Review2025 · 8 citations
  4. 4Frailty and prognosis in advanced heart failure2013 · 22 citations
  5. 5Frailty in patients with heart failure2019 · 39 citations