Frailty in heart failure patients and the use of the heart failure frailty score

Background

Frailty is highly prevalent among patients with heart failure (HF) and is increasingly recognized as an important determinant of clinical outcomes, care needs, and follow-up intensity. Frail HF patients are at higher risk for adverse events such as hospitalizations, functional decline, reduced quality of life, and mortality. Early identification of frailty is therefore essential to enable timely, tailored interventions.

Various screening tools have been used to assess frailty in clinical practice. In the Netherlands, the VMS score is widely applied as a general frailty screening instrument; however, it is not disease-specific and may insufficiently capture heart failure–related vulnerabilities. Recently, a heart failure–specific frailty screening tool has been developed: the Heart Failure Frailty Score (HFFS) and its short version, the HFFS-S. This tool incorporates clinical, functional, psychosocial, and cognitive domains that are particularly relevant to the HF population.

Purpose

The aim of this study was to evaluate the applicability of the HFFS-S in assessing frailty among heart failure patients attending our outpatient clinic and to compare its performance with the nonspecific VMS score.

Methods

A total of 43 heart failure patients were assessed using both the HFFS-S and the VMS score. Assessments were performed by two experienced heart failure nurses. Patient characteristics and scoring data were collected retrospectively from the electronic patient record. A score greater than 2 on the HFFS-S was considered indicative of at least moderate frailty.

Results

The study population consisted of elderly heart failure patients aged 71–93 years (mean age 81 years), of whom 25 were male. Heart failure phenotypes included HFrEF in 46% of patients, HFpEF in 21%, and HFmrEF in 33%. The HFFS-S proved easy to administer and could be completed within a limited time frame of approximately five minutes. Using the HFFS-S, 32 patients were identified as at least moderately frail, compared with 20 patients identified by the nonspecific VMS score. Only two patients scored positive for frailty on the VMS score while scoring negative on the HFFS-S.

Conclusion

The HFFS-S is a recently developed, heart failure–specific frailty assessment tool that is feasible and practical for use in routine clinical practice, even when applied retrospectively. In this cohort, the HFFS-S identified a higher number of frail patients compared with the nonspecific VMS score. This may be explained by the inclusion of HF-relevant comorbidities and social and physical factors, which appear to be more predictive of frailty in this population. Further prospective studies are warranted to assess the predictive value of the HFFS-S for morbidity and mortality and to determine its role in supporting tailored, patient-centered care in heart failure management.