Key result
Combined frailty and low 6MWD independently predict increased death or HF rehospitalization regardless of MAGGIC score.
Why the study?
Frailty and exercise capacity are individually associated with outcomes in HFpEF, but it remained uncertain whether their combination provides prognostic value in patients with acute decompensated HFpEF in relation to risk scores such as the MAGGIC score.
Does the combination of frailty and exercise capacity improve risk stratification for all-cause death and worsening heart failure rehospitalization in patients with ADHF-HFpEF across MAGGIC score groups?
Cohort (n=620)
Yes
Does the combination of frailty and exercise capacity improve risk stratification for all-cause death and worsening heart failure rehospitalization in patients with ADHF-HFpEF across MAGGIC score groups?
Combining frailty assessment (Clinical Frailty Scale) and exercise capacity (6-minute walk distance) provides significant independent prognostic value for mortality and heart failure rehospitalization in ADHF-HFpEF patients, regardless of baseline MAGGIC risk score.
May refine risk stratification beyond MAGGIC in ADHF-HFpEF; hypothesis-generating for integrated frailty-exercise models.
Background Frailty and exercise capacity have been reported to be associated with clinical outcome in patients with heart failure and preserved ejection fraction (HFpEF). However, it remains uncertain whether the combination of frailty and exercise capacity has prognostic value in patients with acute decompensated heart failure and preserved ejection fraction (ADHF-HFpEF), in relation to other risk scores such as MAGGIC score. Purpose We investigated whether the combination of frailty and exercise capacity could provide prognostic information in patients with ADHF-HFpEF in relation to MAGGIC score. Methods We prospectively studied 620 patients admitted for ADHF-HFpEF in our multicenter-prospective cohort study (PURSUIT-HFpEF registry). Frailty and exercise capacity are assessed using clinical frailty scale (CFS) and 6-minute walk distance (6MWD), respectively. All study patients were divided into 2 groups according to MAGGIC score. The primary outcome was the composite endpoint of all-cause death and rehospitalization for worsening heart failure. Results During a mean follow-up period of 2.6±1.7 years, 351 patients experienced primary outcome. After multivariable adjustment, CFS and 6MWD were significantly independently associated with primary outcome both high (≥25) and low (<25) MAGGIC score groups. In low MAGGIC group, patients with both frailty (CFS≧4) and low 6MWD (≦211m defined by ROC curve analysis) had a significantly higher risk than those with either frailty or low 6MWD, who had an even higher risk than those with none of them (non-frail patients with preserved 6MWD). In high MAGGIC score group, patients with either both frailty and low 6MWD or only one of these markers had a significantly higher risk compared with those without frailty and with preserved 6MWD. Conclusion(s) The combination of frailty and exercise capacity is useful for risk stratification in patients with acute decompensated heart failure and preserved ejection fraction, regardless of MAGGIC score.
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Kondo et al. (2026) conducted a cohort in Acute decompensated heart failure with preserved ejection fraction (ADHF-HFpEF) (n=620). Combined frailty (Clinical Frailty Scale ≥4) and low exercise capacity (6-minute walk distance ≤211m) vs. Non-frail patients with preserved 6-minute walk distance (>211m) was evaluated on Composite of all-cause death and rehospitalization for worsening heart failure. Combined frailty (CFS ≥4) and low 6MWD (≤211m) independently predicted death or HF rehospitalization (351/620 events over 2.6 years) across high (≥25) and low (<25) MAGGIC score groups.
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