Key result
Higher Clinical Frailty Scale scores linked to ~2.4-fold higher all-cause mortality in elderly HF.
Why the study?
Risk stratification in elderly patients with heart failure remains challenging as conventional models often fail to capture physiologic vulnerability, and the Clinical Frailty Scale has not been systematically evaluated for prognostic value in this population.
Does a higher Clinical Frailty Scale (CFS) score predict increased mortality and heart failure hospitalization in elderly patients with heart failure?
Meta-Analysis (n=2,682)
Does a higher Clinical Frailty Scale (CFS) score predict increased mortality and heart failure hospitalization in elderly patients with heart failure?
Hazard Ratio: 2.39 (95% CI 1.72–3.32)
p-value: p=<0.001
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“Fears of harming by 'commission' are understandable but represent only one side of the risk calculus related to frailty. A frail older person is inherently at greater risk from medication side effects but may also have far more to lose from undertreatment.”
“Many clinicians presume frailty is just a marker of biological age and/or comorbidities, and is therefore already captured by standard prognostic scores based on those variables.”
“Although conventional assessments-such as grip strength, gait speed, chair stand, the short physical performance battery, and the 6-minute walk test-have well-established prognostic value, they often require specialized equipment, time, and trained personnel, limiting their use in practical settings. Conversely, the CFS offers a rapid, visually assessed, bedside evaluation that requires no equipment or specialized training.”
Frailty assessed by the bedside Clinical Frailty Scale is a strong, independent predictor of all-cause mortality and heart failure hospitalization in elderly patients with heart failure.
BACKGROUND Risk stratification in elderly patients with heart failure (HF) remains challenging. Conventional risk models often fail to capture physiologic vulnerability, limiting personalized care. The Clinical Frailty Scale (CFS), a simple bedside measure of frailty, has not been systematically evaluated for its prognostic value in elderly HF populations. METHODS We performed a systematic review of MEDLINE, Scopus, ScienceDirect, and Cochrane databases through June 2026, including studies evaluating the prognostic value of the CFS in patients with HF. Multivariable-adjusted hazard ratios (HRs) for allcause mortality, HF hospitalization, and the composite outcome of all-cause mortality/HF hospitalization were pooled using a random-effects inverse-variance model in RevMan 5.4. RESULTS Five studies including 2,682 elderly HF patients were included in the quantitative synthesis (mean age 81.2 years; 45.4% male; mean LVEF 53.7%). Among studies reporting phenotype, approximately 75% had preserved or mildly reduced EF. Higher CFS scores were associated with statistically significant increases in the risk of all-cause mortality (HR 2.39; 95% CI 1.72-3.32; p<0.001; I²=45%), HF hospitalization (HR 1.52; 95% CI 1.18-1.95; p=0.001; I²=0%), and composite outcome (HR 1.75; 95% CI 1.41-2.16; <;0.001; I²=0%). Leave-one-out sensitivity analysis confirmed robust allcause mortality associations; exclusion of one study reduced heterogeneity to 0% (HR 2.02; 95% CI 1.56-2.63; p<0.001; I²=0%). These associations were derived from multivariable-adjusted models accounting for age, sex, LVEF, and comorbidities. CONCLUSIONS Frailty assessed by the Clinical Frailty Scale is associated with increased mortality and HF rehospitalization, with more than a two-fold increase in all-cause mortality independent of conventional risk factors.
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Sebastian et al. (2026) conducted a meta-analysis in Heart failure (n=2,682). Higher Clinical Frailty Scale (CFS) scores was evaluated on All-cause mortality (HR 2.39, 95% CI 1.72-3.32, p=<0.001). Higher Clinical Frailty Scale scores in elderly heart failure patients were associated with a more than two-fold increased risk of all-cause mortality (HR 2.39; 95% CI 1.72-3.32; p<0.001).
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