Frailty first: early detection in heart failure

Background

Heart failure in older patients is frequently accompanied by frailty, a multidimensional syndrome associated with poorer prognosis, reduced quality of life, and increased risks of hospitalization, readmission, functional decline, and mortality. Frailty in heart failure is multidimensional, involving not only physical limitations but also cognitive dysfunction and psychosocial vulnerabilities. Early intervention targeting these factors may reduce frailty risk, thereby improving outcomes and quality of life in heart failure patients. Validated assessment tools, such as the Edmonton Frail Scale (EFS), can support timely detection of frailty-related issues. The EFS is a screening tool that assesses multiple domains and can be administered in approximately ten minutes.

Purpose

The aim of this study is to evaluate the added value of early frailty detection using the EFS in patients aged 70 and older with heart failure who have required intravenous diuretics, and to assess how a multidisciplinary geriatrics-cardiology consultation contributes to optimizing treatment decisions.

Method

Between May 2024 and August 2025, a multidisciplinary consultation (MDC) between geriatrics and cardiology was implemented. Patients with heart failure treated in the cardiology lounge were screened by a heart failure nurse practitioner (NP) using the EFS.

Patients with an EFS score >7 were classified as frail and referred to a geriatrician for a comprehensive geriatric assessment (CGA). This outpatient assessment addressed four domains: somatic, psychological, functional, and social. The results were integrated into an MDC, where treatment options were discussed by the cardiologist, geriatrician, and NP.

Results

A total of 31 patients with heart failure and an EFS score >7 were referred to geriatrics for further evaluation. In this study, there were 31 participants with a mean age of 78.1 years (range: 71-96 years). Of the participants, 13 were men and 18 were women. The number of medications used per participant ranged from 3 to 22 medications, with an average of 12.7 medications.

Five patients received a new diagnosis of dementia, and a case manager was involved for further guidance. In four patients, the geriatric evaluation led to medication adjustments for orthostatic hypotension and increased fall risk. In nine patients, due to frailty in multiple domains, advance care planning (ACP) was initiated. Six patients died within six months of screening.

Conclusion

Early identification of frailty facilitated additional geriatric diagnostics, medication optimization, and timely initiation of ACP. The involvement of multiple disciplines provided a broader perspective and better-aligned care. The fact that six patients died within six months of screening highlights the importance of timely recognition. However, given the small study population, further research is necessary to confirm its clinical relevance.