Clinical Frailty Scale for Risk Stratification in Elderly Patients with Heart Failure: A Meta-Analysis

Risk stratification in elderly patients with heart failure (HF) remains challenging. Conventional risk models often fail to capture physiologic vulnerability, limiting personalized care. The Clinical Frailty Scale (CFS), a simple bedside measure of frailty, has not been systematically evaluated for its prognostic value in elderly HF populations.

We performed a systematic review of MEDLINE, Scopus, ScienceDirect, and Cochrane databases through June 2026, including studies evaluating the prognostic value of the CFS in patients with HF. Multivariable-adjusted hazard ratios (HRs) for allcause mortality, HF hospitalization, and the composite outcome of all-cause mortality/HF hospitalization were pooled using a random-effects inverse-variance model in RevMan 5.4.

Five studies including 2,682 elderly HF patients were included in the quantitative synthesis (mean age 81.2 years; 45.4% male; mean LVEF 53.7%). Among studies reporting phenotype, approximately 75% had preserved or mildly reduced EF. Higher CFS scores were associated with statistically significant increases in the risk of all-cause mortality (HR 2.39; 95% CI 1.72-3.32; p<0.001; I²=45%), HF hospitalization (HR 1.52; 95% CI 1.18-1.95; p=0.001; I²=0%), and composite outcome (HR 1.75; 95% CI 1.41-2.16; <;0.001; I²=0%). Leave-one-out sensitivity analysis confirmed robust allcause mortality associations; exclusion of one study reduced heterogeneity to 0% (HR 2.02; 95% CI 1.56-2.63; p<0.001; I²=0%). These associations were derived from multivariable-adjusted models accounting for age, sex, LVEF, and comorbidities.

Frailty assessed by the Clinical Frailty Scale is associated with increased mortality and HF rehospitalization, with more than a two-fold increase in all-cause mortality independent of conventional risk factors.