The Fried frailty model independently predicted 2-year all-cause mortality (HR 1.35) and provided the highest incremental prognostic value in older heart failure patients.
Does the choice of frailty assessment tool (FSI, FRAIL scale, or Fried phenotype) affect prognostic stratification for 2-year all-cause mortality in older hospitalized heart failure patients?
The Fried phenotype and FRAIL scale provide significant prognostic value for 2-year all-cause mortality in older heart failure patients, whereas the Frailty Screening Index does not.
Abstract Background In older patients with heart failure, frailty assessment tools potentially have different prognostic value for all-cause mortality. Objective To compare the Frailty Screening Index (FSI), FRAIL scale and Fried phenotype. Design Post hoc analysis of the FRAGILE-HF study. Subjects Hospitalised patients (age ≥ 65 years) with heart failure. Methods We assessed frailty status at discharge, considered preadmission conditions of patients, using the FSI, FRAIL scale and Fried phenotype models and evaluated the primary outcome (2-year all-cause mortality), prognostic performance using Cox regression analysis (adjusted for the Meta-analysis Global Group in Chronic Heart Failure risk score and log-transformed B-type natriuretic peptide) and discriminative and reclassification abilities (area under the receiver-operating characteristic curve and continuous net reclassification improvement, respectively). Results Among 961 patients median age: 80 (IQR, 74–85) years; 41.5% women, frailty was identified in 48.5%, 44.5% and 55.8% by the FSI, FRAIL scale and Fried models, respectively. During the 2-year follow-up, 187 (19.5%) patients died. On Kaplan–Meier analysis, frailty defined by the FRAIL and Fried was associated with significantly lower survival; FSI showed no significant difference. Adjusted Cox models showed that frailty was independently associated HR (95% CI) with mortality in FRAIL 1.31 (1.01–1.71) and Fried 1.35 (1.04–1.75) but not FSI 1.11 (0.84–1.37). The Fried model, incorporated into the baseline model, yielded the highest incremental prognostic value for 2-year all-cause mortality. Conclusions Frailty assessment using different tools yields varying results, with notable differences in their prognostic value for 2-year all-cause mortality. The frailty assessment tool influences both frailty classification and risk stratification and warrants careful clinical selection.
Nakade et al. (2026) studied this question. The Fried frailty model independently predicted 2-year all-cause mortality (HR 1.35) and provided the highest incremental prognostic value in older heart failure patients.