Clinical and Prognostic Utility of the Essential Frailty Toolset in Older Patients With Heart Failure

Heart failure (HF) is associated with frailty, and most frailty assessment methods are subjective and complex. The Essential Frailty Toolset (EFT) is a simple, objective, and comprehensive frailty assessment tool. This study aimed to investigate the clinical and prognostic values of the EFT in patients with HF.

Data from a multicenter, observational study on older (≥ 65 years old) patients hospitalized with HF, the FRAGILE-HF cohort, was used. The EFT includes a five-time chair stand test, cognitive function assessment, and hemoglobin and albumin measurements. Patients were divided into three groups based on their EFT points: robust (0 points), pre-frail (1-2 points), and frail (3-5 points). The primary endpoint was 2-year all-cause mortality.

Of the total 1237 patients (80.1 ± 7.1 years; 43% females), the robust, pre-frail, and frail groups included 114 (11.6%), 606 (49.0%), and 487 (39.4%) patients, respectively. The prevalence of frailty, evaluated using the Fried phenotype model, increased with increased EFT points (p < 0.001). Within the 2-year follow-up period, 256 deaths occurred. The frail group was significantly associated with a higher risk of the primary endpoint than the robust group (adjusted hazard ratio [aHR], 2.01; 95% confidence interval [CI], 1.12-3.61; p = 0.019). The EFT point, as a continuous variable, was significantly associated with the primary endpoint (aHR, 1.19; 95% CI, 1.08-1.31; p < 0.001). A significant continuous net reclassification improvement was observed when the EFT groups were added to the conventional risk model.

The EFT demonstrated valuable clinical and prognostic value in older patients with HF.