Frailty in acute cardiac care and acute heart failure: prevalence, prognosis, and modifiability
F Veneziano, F A Gioia, M M Vicusi, L De LucaAbstract
Background
Frailty is increasingly prevalent among elderly patients admitted for acute cardiac conditions and acute decompensated heart failure (ADHF), yet it remains inconsistently assessed in acute care settings despite robust evidence of prognostic relevance.
Purpose
To systematically quantify the prevalence of frailty in acute cardiac care and ADHF, and to summarize its association with clinical outcomes and response to multidisciplinary interventions.
Methods
More than 40 studies were screened; 31 original investigations met inclusion criteria, encompassing approximately 30,000–35,000 patients across acute cardiac care and heart failure settings. Mean or median age ranged from 72 to 83 years, with women representing 40–56% of included populations. In ACCU cohorts using physical frailty definitions, 20–30% of patients were classified as frail and 40–45% as pre-frail. In hospitalized heart failure populations, frailty affected ≥50% of patients overall, reaching up to 90% among those with preserved ejection fraction, with a ~25% higher prevalence in women. Frailty was consistently associated with adverse outcomes. In ACCU studies, frail patients showed higher in-hospital complications, including worsening heart failure (≈50% vs <5%), acute renal failure (≈25% vs 0%) and in-hospital mortality (≈20% vs 0%). At mid-term follow-up (12–24 months), mortality reached ≈33% in frail, ≈30% in pre-frail, and <6% in robust patients, corresponding to hazard ratios up to 7.4 for frail and 5.9 for pre-frail individuals compared with robust counterparts. In heart failure cohorts, accumulation of frailty domains conferred a ~3-fold higher risk of all-cause mortality and a ~2-fold higher risk of death or rehospitalization versus no frailty. Importantly, frailty demonstrated partial reversibility, with frail ADHF patients showing a 2.6-fold greater improvement in physical function following early, tailored, multidomain rehabilitation compared with pre-frail patients.
Results
owed a 2.6-fold greater improvement in physical function following early, tailored, multidomain rehabilitation compared with pre-frail patients.
Conclusions
Across more than 30,000 patients, frailty and pre-frailty are highly prevalent in acute cardiac care and ADHF and confer a steep, graded increase in complications and mortality. Evidence supports frailty as a measurable and modifiable risk state rather than a static descriptor. Integrating systematic frailty assessment with multidisciplinary and rehabilitative pathways may represent a key strategy to improve outcomes in acute heart failure care.