TOKYO — Is frailty associated with increased admission and mortality risk in heart failure patients?

Keio University School of Medicine in Japan worked with the VA Palo Alto, CA, Healthcare System and Stanford University School of Medicine to try and answer that question. Results were published in the Journal of the American Heart Association.1

This retrospective cohort analysis included VA heart failure patients. Of 388,785 patients with coding of heart failure between 2015 and 2018, 163,085 patients (41.9%) with ejection fraction (EF) measurement were included in the present analysis—38.3% with reduced EF and 61.7% with preserved EF.

The data included 16,660 patients (10.2%) identified as frail, 9.1% in heart failure with reduced EF and 10.9% in heart failure with preserved EF. The study found frail patients to be older, more often depressed and more likely to have been admitted in the previous year.

Common indicators for frailty include weakness, fatigue, weight loss, low physical activity, poor balance, low gait speed, visual impairment and cognitive impairment.

Results indicated that one‐year all‐cause mortality rate was 9.7% and 28.1%, and admission rate was 58.1% and 79.5% for non-frail and frail patients, respectively. Researchers determined that frailty was associated with mortality and admission risk compared with the non-frail group (adjusted odds ratio [OR], 1.71; 95% CI, 1.65-1.77 for mortality; adjusted OR, 1.29; 95% CI, 1.24-1.34 for admission) independent of EF.

“Frailty based on diagnostic coding was associated with particularly higher risk of mortality despite adjustment for known clinical variables,” the authors wrote. “Our findings underscore the importance of nontraditional parameters in the prognostic assessment.”

Researchers pointed out that, in the absence of prospectively collected data, the ability to identify frailty in diagnostic‐coding records might enable enhanced mortality prediction. They added that the VA has attempted to measure and improve healthcare quality of HF, but outcome measures evaluating HF mortality have not included makers of frailty.


  1. Kohsaka S, Sandhu AT, Parizo JT, Shoji S, Kumamamru H, Heidenreich PA. Association of Diagnostic Coding-Based Frailty and Outcomes in Patients With Heart Failure: A Report From the Veterans Affairs Health System. J Am Heart Assoc. 2020 Dec 15;9(24):e016502. doi: 10.1161/JAHA.120.016502. Epub 2020 Dec 7. PMID: 33283587.