Physical Frailty Versus the MECKI Score in Risk Stratification of Patients with Advanced Heart Failure: Simpler...

Area of Science:

• Cardiology
• Geriatrics
• Internal Medicine

Background:

• Frailty, characterized by reduced physiological reserves and increased vulnerability, is a significant predictor of adverse events in heart failure (HF).
• The Metabolic Exercise Cardiac Kidney Index (MECKI) score, utilizing cardiopulmonary exercise testing (CPET) and renal parameters, shows prognostic utility in HF.
• Advanced HF patients face high risks, necessitating accurate prognostic tools to guide management and improve outcomes.

Purpose of the Study:

• To assess the prognostic value of physical frailty in predicting mortality in advanced heart failure (HF) patients.
• To directly compare the predictive performance of physical frailty against the established MECKI score.
• To determine if physical frailty can serve as a practical alternative prognostic tool in advanced HF.

Main Methods:

• Prospective enrollment of 104 advanced HF patients on guideline-directed medical therapy.
• Baseline assessments included clinical, echocardiographic, laboratory data, and CPET for MECKI score calculation.
• Physical frailty was evaluated using a modified Fried phenotype adapted for HF; composite endpoint included mortality, urgent transplant, or LVAD.

Main Results:

• Over 30 months, patients with adverse outcomes showed significantly higher frailty and MECKI scores, worse NYHA class, and elevated NT-proBNP.
• Both physical frailty (HR=1.89) and MECKI score (HR=1.04) independently predicted the composite endpoint.
• Receiver operating characteristic (ROC) analysis revealed comparable discriminative performance: AUC 0.86 for frailty vs. 0.88 for MECKI.

Conclusions:

• Physical frailty and MECKI scores are independent predictors of mortality and adverse events in advanced HF.
• Physical frailty demonstrates prognostic accuracy comparable to the MECKI score.
• Physical frailty presents a simple, low-cost, and practical alternative for risk stratification when CPET is unavailable.