Journal of the American Geriatrics Society · Sep 22, 2025
Clinical and Prognostic Utility of the Essential Frailty Toolset in Older Patients With Heart Failure
By Maeda D, Matsue Y, Kagiyama N et al.
BACKGROUND: Heart failure (HF) is associated with frailty, and most frailty assessment methods are subjective and complex. The Essential Frailty Toolset (EFT) is a simple, objective, and comprehensive frailty assessment tool. This study aimed to investigate the clinical and prognostic values of the EFT in patients with HF. METHODS: Data from a multicenter, observational study on older (≥ 65 years old) patients hospitalized with HF, the FRAGILE-HF cohort, was used. The EFT includes a five-time chair stand test, cognitive function assessment, and hemoglobin and albumin measurements. Patients were divided into three groups based on their EFT points: robust (0 points), pre-frail (1-2 points), and frail (3-5 points). The primary endpoint was 2-year all-cause mortality. RESULTS: Of the total 1237 patients (80.1 ± 7.1 years; 43% females), the robust, pre-frail, and frail groups included 114 (11.6%), 606 (49.0%), and 487 (39.4%) patients, respectively. The prevalence of frailty, evaluated using the Fried phenotype model, increased with increased EFT points (p < 0.001). Within the 2-year follow-up period, 256 deaths occurred. The frail group was significantly associated with a higher risk of the primary endpoint than the robust group (adjusted hazard ratio [aHR], 2.01; 95% confidence interval [CI], 1.12-3.61; p = 0.019). The EFT point, as a continuous variable, was significantly associated with the primary endpoint (aHR, 1.19; 95% CI, 1.08-1.31; p < 0.001). A significant continuous net reclassification improvement was observed when the EFT groups were added to the conventional risk model. CONCLUSION: The EFT demonstrated valuable clinical and prognostic value in older patients with HF.