{
  "abstract": "Background: Frailty is highly prevalent in acute heart failure (AHF), yet whether it is more strongly associated with all-cause mortality or with non-fatal heart-failure events, and whether it adds information beyond cardiac severity, is seldom examined. Methods: In a prospective single-center registry of 530 consecutive patients hospitalized for AHF (February 2023-June 2025), frailty was graded at admission by the Clinical Frailty Scale (CFS; strata 1-3, 4-5, 6-9, and CFS ≥ 5) from patient and collateral history. The primary outcome was 12-month all-cause mortality; first AHF rehospitalization was analyzed with death and renal replacement therapy (RRT) as competing events, using Aalen-Johansen cumulative incidence and cause-specific and Fine-Gray models. Incremental value was tested against a cardiorenal model (age, log NT-proBNP, admission estimated glomerular filtration rate and left ventricular ejection fraction [LVEF]). Results: Frailty was highly prevalent (CFS ≥ 5, 66.4%) and was associated with older age, female sex, renal impairment, right heart failure, multivalvular disease and higher, rather than lower, LVEF. Mortality rose steeply across strata (4.5%, 19.3%, 49.7%; hazard ratio 3.29 per stratum, 95% CI 2.43-4.45), whereas the cumulative incidence of first AHF rehospitalization rose less steeply (4.5%, 29.2%, 33.0%; cause-specific hazard ratio 1.86, 95% CI 1.42-2.45; subdistribution hazard ratio 1.51, 95% CI 1.19-1.92). Frail patients with below-median NT-proBNP had mortality comparable to that of patients with CFS < 5 and above-median NT-proBNP (24.3% vs. 22.0%). Adding CFS to the cardiorenal model improved discrimination (C-index 0.701 → 0.734; optimism-corrected 0.694 → 0.726; apparent ΔC-index 0.033, 95% CI 0.007-0.063) and fit (likelihood-ratio χ² = 27.7, p < 0.001). Discharge prescription of disease-modifying therapy declined with increasing frailty. Conclusions: In elderly patients with AHF, frailty was more strongly associated with all-cause mortality than with documented non-fatal AHF rehospitalization, carried prognostic information complementary to natriuretic peptides, and added discrimination beyond cardiorenal variables, supporting structured frailty assessment alongside heart-failure-directed therapy.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Cardiology, Venizelio General Hospital of Heraklion, 71409 Heraklion, Greece.",
    "School of Medicine, University of Crete, 70013 Heraklion, Greece.",
    "Department of Cardiology, University General Hospital of Heraklion, 71500 Heraklion, Greece.",
    "Second Department of Internal Medicine, Venizelio General Hospital of Heraklion, 71409 Heraklion, Greece.",
    "Department of Biochemistry, Venizelio General Hospital of Heraklion, 71409 Heraklion, Greece.",
    "Institute of Applied and Computational Mathematics, Foundation for Research and Technology-Hellas, 70013 Heraklion, Greece.",
    "Department of Nephrology, University General Hospital of Heraklion, 71500 Heraklion, Greece."
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 9,
  "authors": [
    {
      "affs": [
        0,
        1
      ],
      "name": "Georgios Aletras",
      "orcid": "0009-0004-7238-7117"
    },
    {
      "affs": [
        1,
        2
      ],
      "name": "Maria Marketou",
      "orcid": "0000-0003-1888-3430"
    },
    {
      "affs": [
        3
      ],
      "name": "Maria Bachlitzanaki",
      "orcid": "0009-0004-2432-7988"
    },
    {
      "affs": [
        0
      ],
      "name": "Maria Stratinaki",
      "orcid": "0000-0001-8720-1830"
    },
    {
      "affs": [
        4
      ],
      "name": "Maria Tsigaridaki"
    },
    {
      "affs": [
        5
      ],
      "name": "Yannis Pantazis"
    },
    {
      "affs": [
        0
      ],
      "name": "Emmanuel Foukarakis",
      "orcid": "0000-0002-1340-2282"
    },
    {
      "affs": [
        1,
        2
      ],
      "name": "Michalis Hamilos"
    },
    {
      "affs": [
        1,
        6
      ],
      "name": "Konstantinos Stylianou",
      "orcid": "0000-0003-3678-9421"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/c84dyv87w3x7b.bib",
  "cited_by": 0,
  "doi": "10.3390/medicina62101942",
  "fulltext_url": "https://europepmc.org/articles/PMC13707131",
  "id": "c84dyv87w3x7b",
  "issns": [
    "1010-660X",
    "1648-9144"
  ],
  "landing_url": "https://europepmc.org/article/MED/42942474",
  "language": "eng",
  "licence": "CC-BY",
  "licence_label": "CC BY",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "openalex",
      "2705|Heart Failure Treatment and Management"
    ]
  ],
  "openalex": "W7221032487",
  "pdf_url": "https://europepmc.org/articles/PMC13707131?pdf=render",
  "pmcid": "PMC13707131",
  "pmid": "42942474",
  "published": "2026-10-08",
  "publisher": null,
  "ris": "https://research.draconitic.com/paper/c84dyv87w3x7b.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:22:24Z",
      "native_id": "MED:42942474",
      "source": "europepmc",
      "url": "https://europepmc.org/article/MED/42942474"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2705|Heart Failure Treatment and Management",
      "subfield": "cardiovascular"
    }
  ],
  "title": "Beyond Cardiorenal Risk Factors: The Prognostic Role of Frailty in Acute Heart Failure.",
  "title_text": "Beyond Cardiorenal Risk Factors: The Prognostic Role of Frailty in Acute Heart Failure.",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:22:24Z",
  "url": "https://research.draconitic.com/paper/c84dyv87w3x7b",
  "venue": "Medicina (Kaunas, Lithuania)",
  "versions": []
}