Comprehensive geriatric assessment identifies multidimensional vulnerabilities in older adults with heart failure

Heart failure (HF) in older adults is frequently accompanied by geriatric syndromes that remain unrecognized in conventional cardiac evaluations. The vulnerabilities of older adults with and without HF in terms of muscle strength, physical performance, functional capacity, frailty, nutritional status, cognition, mood, anxiety, polypharmacy, and comorbidity were investigated using comprehensive geriatric assessment (CGA).

A cross-sectional study was conducted in two academic outpatient clinics, enrolling 420 adults aged ≥60 years, including 92 (21.9%) with HF. Data included sociodemographic characteristics, anthropometric measurements, and CGA parameters: handgrip strength, the Five-Times Sit-to-Stand Test (FTSST), the Short Physical Performance Battery (SPPB), activities of daily living (ADL), instrumental ADL (IADL), the FRAIL scale, the Mini Nutritional Assessment-Short Form, the Mini-Cog, the Geriatric Depression Scale-Short Form, and the Generalized Anxiety Disorder-7. Univariate and multivariate regression analyses were performed.

HF participants had slower FTSST (12.7 s versus 11.7 s; p = 0.002), and lower SPPB scores (10.0 versus 11.0; p = 0.016). IADL scores were significantly lower in the HF group (median, 7.0 versus 8.0; p < 0.001), indicating a higher prevalence of IADL impairment. Frailty (31.5% versus 18.9%; p = 0.009), malnutrition (6.5% versus 2.1%; p = 0.043), cognitive impairment (29.3% versus 14.3%; p = 0.001), and polypharmacy (88.0% versus 57.9%; p < 0.001) were significantly more prevalent in the HF group. Low lower extremity muscle strength (OR = 3.713), impaired IADL (OR = 4.974), and higher comorbidity burden (OR = 1.603) were identified as independent factors associated with HF in multivariate analysis.

Older adults with HF showed substantial deficits across multiple CGA domains, including functional capacity, frailty, nutrition, and cognition. Integration of CGA into HF management may facilitate the identification of previously unrecognized vulnerabilities and support multidisciplinary care planning.