Journal of the American Heart Association · Dec 11, 2025

Prognostic Value of Frailty Assessment Combining the Frailty Index Based on Laboratory Tests With the Clinical Frailty Scale in Patients With Acute Heart Failure

By Mizuno C, Hiraiwa H, Kondo T et al.

BACKGROUND: Heart failure (HF) is often complicated by frailty. We evaluated the prognostic value of the Frailty Index based on laboratory tests (FI-lab) and the Clinical Frailty Scale, as well as their combined use, for adults with acute HF. METHODS: This study was a post hoc analysis of the POPEYE-AHF (Prospective Observational Study on Acute Pharmacotherapy and Prognosis in Management of Acute Heart Failure) registry, a prospective observational study evaluating the treatment and characteristics of patients with acute HF. At discharge, 975 patients had available FI-lab data, while 637 patients had available Clinical Frailty Scale data. The FI-lab was determined at discharge by the proportion of 21 laboratory items with abnormal results. The outcomes were all-cause death, HF hospitalization, and the composite of both. RESULTS: At baseline, the median age was 80 years, and 45.0% of the patients with FI-lab data were women. Multivariable Cox proportional hazards regression revealed that the measured FI-lab was associated with all outcomes (all-cause death: hazard ratio [HR], 1.38 [95% CI, 1.15-1.67], P=0.001; HF hospitalization: HR, 1.15 [95% CI, 1.00-1.32], P=0.044; composite outcome: HR, 1.21 [95% CI, 1.08-1.37], P=0.002) after full adjustment. When dividing patients into the high and low FI-lab subgroups (median cutoff, 0.48), high FI-lab was associated with all-cause death (HR, 2.11 [95% CI, 1.31-3.41], P=0.002) and the composite outcome (HR, 1.40 [95% CI, 1.05-1.88], P=0.023). High FI-lab/high Clinical Frailty Scale was associated with all-cause death after adjustment (HR, 2.62 [95% CI, 1.38-4.99], P=0.003). CONCLUSIONS: FI-lab identified high-risk adults with acute HF. The combined use of the Clinical Frailty Scale and FI-lab identified adults at high risk of all-cause death.

doi.org/10.1161/jaha.125.042719 Open access PubMed 41378490 Biomarkers