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Frailty and Heart Failure: An Integrated Review of a Bidirectional Relationship
Izabella Uchmanowicz1,2, Ercole Vellone3,1, Christopher S Lee4,5
1Division of Research Methodology, Department of Nursing, Faculty of Nursing and Midwifery, Wroclaw Medical University, Wroclaw, Poland.
ESC Heart Failure
|June 27, 2026
Summary
Heart failure (HF) and frailty are closely linked in older adults, worsening outcomes. Addressing frailty through interventions like exercise and nutrition can improve quality of life and reduce mortality in HF patients.
Area of Science:
- Geriatrics
- Cardiology
- Internal Medicine
Background:
- Heart failure (HF) and frailty are prevalent in older adults, leading to adverse clinical outcomes.
- Frailty impacts 15-76% of chronic HF patients, with prevalence nearing 90% in hospitalized HF with preserved ejection fraction (HFpEF).
Purpose of the Study:
- To synthesize evidence on the bidirectional relationship between frailty and HF.
- To explore shared pathophysiological mechanisms, epidemiology, prognostication, assessment, and management strategies.
Main Methods:
- Integrated review of current evidence.
- Analysis of shared pathophysiological mechanisms, epidemiology, prognostic implications, assessment strategies, and management approaches.
Main Results:
- Frailty independently predicts incident HF and cardiac deterioration.
- HF accelerates frailty via inflammation, hypoperfusion, sarcopenia, neurohormonal activation, malnutrition, and deconditioning.
- Frailty worsens quality of life, self-care, hospital stays, treatment tolerance, and increases mortality.
Conclusions:
- Frailty assessment tools like the Heart Failure Frailty Score (HFFS) are crucial.
- Management includes exercise, nutrition, medication review, and integrating frailty into advanced HF care.
- Future research needs prospective validation of HF-specific frailty tools and trials for frailty-targeted interventions.
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