Beyond Cardiorenal Risk Factors: The Prognostic Role of Frailty in Acute Heart Failure.
7 affiliations
- 1Department of Cardiology, Venizelio General Hospital of Heraklion, 71409 Heraklion, Greece.
- 2School of Medicine, University of Crete, 70013 Heraklion, Greece.
- 3Department of Cardiology, University General Hospital of Heraklion, 71500 Heraklion, Greece.
- 4Second Department of Internal Medicine, Venizelio General Hospital of Heraklion, 71409 Heraklion, Greece.
- 5Department of Biochemistry, Venizelio General Hospital of Heraklion, 71409 Heraklion, Greece.
- 6Institute of Applied and Computational Mathematics, Foundation for Research and Technology-Hellas, 70013 Heraklion, Greece.
- 7Department of Nephrology, University General Hospital of Heraklion, 71500 Heraklion, Greece.
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.
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BibTeX
@article{aletras2026beyond,
title = {{Beyond Cardiorenal Risk Factors: The Prognostic Role of Frailty in Acute Heart Failure.}},
author = {Georgios Aletras and Maria Marketou and Maria Bachlitzanaki and Maria Stratinaki and Maria Tsigaridaki and Yannis Pantazis and Emmanuel Foukarakis and Michalis Hamilos and Konstantinos Stylianou},
journal = {Medicina (Kaunas, Lithuania)},
year = {2026},
month = oct,
doi = {10.3390/medicina62101942},
url = {https://europepmc.org/article/MED/42942474},
note = {CC BY},
}
RIS
TY - JOUR
TI - Beyond Cardiorenal Risk Factors: The Prognostic Role of Frailty in Acute Heart Failure.
AU - Georgios Aletras
AU - Maria Marketou
AU - Maria Bachlitzanaki
AU - Maria Stratinaki
AU - Maria Tsigaridaki
AU - Yannis Pantazis
AU - Emmanuel Foukarakis
AU - Michalis Hamilos
AU - Konstantinos Stylianou
PY - 2026
DA - 2026/10/08
JO - Medicina (Kaunas, Lithuania)
DO - 10.3390/medicina62101942
UR - https://europepmc.org/article/MED/42942474
AB - 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.
SN - 1010-660X
SN - 1648-9144
ER -