Prognostic impact of frailty at admission and in-hospital changes of frailty status in elderly patients with acute heart failure.

Aims: To comprehensively assess the prognostic value of frailty at admission and trajectories of frailty during hospitalization in acute heart failure (AHF).

Methods and results: This retrospective, single-centre study (AHF-COR Registry) includes hospitalized AHF patients ≥65 years, admitted to a tertiary hospital in Vienna between 2012 and 2019. Frailty was assessed at admission and discharge by nursing staff, based on care needs in personal hygiene, nutrition, mobility, bowel and bladder control, categorizing patients into three groups: non-frailty, moderate frailty, and severe frailty. Our study encompassed 2619 patients admitted for AHF (mean age 81 ± 8 years), of whom 31% died within 1 year. A total of 46% of patients were not frail, 42% were moderately frail, and 12% were severely frail. Patients with frailty were more likely to be female and had a higher cardiovascular comorbidity burden. We identified moderate and severe frailty as independent prognostic markers of 1-year mortality (adjusted hazard ratio [HR] 1.89; 95% confidence interval [CI] 1.60-2.23; p < 0.001; adjusted HR 2.91; 2.36-3.59; p < 0.001). Similar results were found for 28-day and 5-year mortality risk. Improvement in frailty status during hospitalization resulted in a significantly lower risk of 1-year mortality (adjusted HR 0.65; 95% CI 0.49-0.88; p < 0.001), while worsening of frailty was associated with higher risk (adjusted HR 3.18; 95% CI 2.07-4.91; p < 0.001). Prescription of guideline-directed medical therapy in patients with heart failure with reduced ejection fraction decreased with increasing frailty but was consistently associated with a reduced risk of mortality, regardless of frailty status, as no significant interaction effect was observed (p_{frailty-interaction} = 0.592).

Conclusions: Frailty is an independent prognostic marker of increased mortality risk in patients with AHF. Improvement of frailty status during hospitalization reduces mortality risk while worsening of frailty increases mortality risk.