article · European Heart Journal
A prospective study evaluated 3,429 adults with heart failure across 27 high-, middle-, and low-income countries over a median follow-up of 3.1 years to assess the prognostic value of frailty. Baseline frailty was measured using the Fried index, classifying 18 percent of participants as robust, 61 percent as pre-frail, and 21 percent as frail. Over the study period, 16 percent of participants died and 14 percent were hospitalised for heart failure. Adjusted analyses revealed that pre-frail and frail individuals experienced significantly higher risks of death and heart failure hospitalisation compared to robust individuals. These associations remained consistent across different national income tiers and key clinical subgroups. Furthermore, incorporating frailty measurements into the existing MAGGIC risk score improved the accuracy of predicting future hospitalisations and death, demonstrating that frailty provides critical prognostic insight beyond standard clinical variables.
Heart failure is a major global health challenge, but risk prediction has traditionally relied on conventional clinical measurements. By demonstrating that frailty assessments improve risk stratification across diverse healthcare environments regardless of national income, this work supports the global adoption of functional assessments to identify vulnerable patients who face elevated risks of death and hospitalisation.
The findings could inform the development or updating of clinical decision-support software and risk-prediction algorithms used by clinicians managing heart failure. Because the study validates the additive value of the Fried index alongside the established MAGGIC score, this applied research could be integrated into digital health tools, though the abstract itself does not outline a specific commercialisation pathway.
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BACKGROUND AND AIMS: There is little information on the incremental prognostic importance of frailty beyond conventional prognostic variables in heart failure (HF) populations from different country income levels. METHODS: A total of 3429 adults with HF (age 61 ± 14 years, 33% women) from 27 high-, middle- and low-income countries were prospectively studied. Baseline frailty was evaluated by the Fried index, incorporating handgrip strength, gait speed, physical activity, unintended weight loss, and self-reported exhaustion. Mean left ventricular ejection fraction was 39 ± 14% and 26% had New York Heart Association Class III/IV symptoms. Participants were followed for a median (25th to 75th percentile) of 3.1 (2.0-4.3) years. Cox proportional hazard models for death and HF hospitalization adjusted for country income level; age; sex; education; HF aetiology; left ventricular ejection fraction; diabetes; tobacco and alcohol use; New York Heart Association functional class; HF medication use; blood pressure; and haemoglobin, sodium, and creatinine concentrations were performed. The incremental discriminatory value of frailty over and above the MAGGIC risk score was evaluated by the area under the receiver-operating characteristic curve. RESULTS: At baseline, 18% of participants were robust, 61% pre-frail, and 21% frail. During follow-up, 565 (16%) participants died and 471 (14%) were hospitalized for HF. Respective adjusted hazard ratios (95% confidence interval) for death among the pre-frail and frail were 1.59 (1.12-2.26) and 2.92 (1.99-4.27). Respective adjusted hazard ratios (95% confidence interval) for HF hospitalization were 1.32 (0.93-1.87) and 1.97 (1.33-2.91). Findings were consistent among different country income levels and by most subgroups. Adding frailty to the MAGGIC risk score improved the discrimination of future death and HF hospitalization. CONCLUSIONS: Frailty confers substantial incremental prognostic information to prognostic variables for predicting death and HF hospitalization. The relationship between frailty and these outcomes is consistent across countries at all income levels.
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DOI: 10.1093/eurheartj/ehad595
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