Frailty (CFS 5-8) was significantly associated with in-hospital death (p=0.021) in patients over 65 admitted with acute heart failure, alongside hemodynamic instability and high qSOFA scores.
Observational (n=113)
Frailty, assessed by the clinical frailty scale, along with hemodynamic instability and systemic hypoperfusion, are strong predictors of in-hospital mortality in older patients with acute heart failure.
p-value: p=0.021
Abstract Introduction Acute heart failure (AHF) remains a major cause of hospitalization and short-term mortality worldwide, particularly among older and multimorbid populations (1). Identifying prognostic factors that predict poor outcomes at admission is therefore critical to guide treatment Purpose The purpose of this study was to identify clinical predictors of in-hospital death among patients admitted with acute heart failure. Methods A retrospective observational study included 113 consecutive patients admitted with a diagnosis of acute heart failure and age above 65. The primary outcome was in-hospital death. The following variables were evaluated for their relationship with in-hospital mortality: hemodynamic indicators, systemic severity measures, cardiac function, major causes of decompensation and frailty status assessed by the clinical frailty scale (CFS) (2). Frailty was classified as non-frail (CFS ≤ 4) and frail (CFS 5–8). Results Of 113 patients, 7(6.2%) died during hospitalization. Males comprised 56.6%(n = 64) and females 44.4%(n=49). The mean age was 79.64 ± 8.89 years. Indicators of hemodynamic instability were strongly associated with death, including the presence of mean arterial pressure below 90 mmHg (p=0.039), and a "cold" profile (p0.001). Systemic severity markers also demonstrated significant associations, with patients presenting qSOFA ≥ 2 (p0.001), or infection as a precipitating factor (p = 0.002) being at substantially higher risk. Additional, NYHA class ≥ III and reduced left ventricular ejection fraction (EF 40%; p = 0.03) were significant predictors of mortality. Finally, frailty status, emerged as a key determinant of outcome: frailty (CFS 5–8; p = 0.021) was significantly associated with in-hospital death (Table1). Continuous variables were compared using one-way ANOVA. As shown in Table 2, mean age did not differ significantly between groups (p = 0.369). In contrast, qSOFA scores (p 0.001), serum lactate levels (p 0.001), and CFS scores (p 0.001) were all markedly higher among non-survivors. Discussion This study highlights the critical prognostic importance of hemodynamic instability, systemic hypoperfusion, and frailty in patients hospitalized with acute heart failure. While age and sex were not significant predictors, clinical frailty status demonstrated a strong and independent relationship with in-hospital death. Conclusion In patients hospitalized with acute heart failure, in-hospital mortality is strongly associated with hemodynamic instability, elevated lactate, high qSOFA scores, and frailty. Age alone was not a significant predictor. Assessment of frailty using CFS provides essential prognostic information and should be integrated into standard acute heart failure evaluations. Incorporating frailty scoring into AHF management enables clinicians to individualize therapy intensity, anticipate complications, and facilitate shared decision-making regarding goals of care.Table 1. Table 2
Kyvetos et al. (Fri,) conducted a observational in Acute heart failure (n=113). Frailty (Clinical Frailty Scale 5-8) vs. Non-frail (Clinical Frailty Scale ≤ 4) was evaluated on In-hospital death (p=0.021). Frailty (CFS 5-8) was significantly associated with in-hospital death (p=0.021) in patients over 65 admitted with acute heart failure, alongside hemodynamic instability and high qSOFA scores.