Research Square · Sep 14, 2026
Prevalence of frailty and multidimensional associated factors among hospitalized adults with heart failure: a cross-sectional study
By Dorri S, Khalili A, Zolfaghari F et al.
Background Frailty is common in heart failure and may complicate inpatient management and discharge planning. Evidence integrating clinical, functional, nutritional, psychosocial, sleep-related, and laboratory factors in hospitalized populations remains limited. This study estimated frailty prevalence and examined multidimensional factors associated with frailty among hospitalized adults with heart failure. Methods This analytical cross-sectional study consecutively recruited 500 adults hospitalized with confirmed heart failure at a tertiary cardiovascular referral hospital in Iran between August and November 2024. Frailty was assessed using the validated Persian Tilburg Frailty Indicator (TFI; total score ≥ 5). Sociodemographic, clinical, functional, self-care, nutritional, sleep, psychological, social-support, and laboratory variables were evaluated using bivariate analyses and multivariable binary logistic regression. Results Frailty was identified in 306 participants (61.2%; 95% confidence interval [CI], 56.8–65.5). The mean age was 68.7 years, and 81.7% of participants were aged 60 years or older. In the complete-case model (n = 461), frailty was associated with older age (adjusted odds ratio [aOR], 1.05 per year; 95% CI, 1.03–1.08), insufficient perceived income (aOR, 1.61; 95% CI, 1.03–2.53), an unhealthy lifestyle profile (aOR, 1.89; 95% CI, 1.12–3.18), three or more comorbidities (aOR, 1.74; 95% CI, 1.09–2.78), New York Heart Association class III-IV (aOR, 2.46; 95% CI, 1.50–4.03), nutritional risk (aOR, 2.12; 95% CI, 1.31–3.45), lower serum albumin (aOR, 0.92 per 1 g/L increase; 95% CI, 0.87–0.97), and poor sleep quality (aOR, 1.67; 95% CI, 1.03–2.69). Each 5-percentage-point increase in left ventricular ejection fraction was associated with lower odds of frailty (aOR, 0.90; 95% CI, 0.81-1.00). Model discrimination was good (area under the curve, 0.81; 95% CI, 0.77–0.85). Conclusions Frailty was common and extended across physical, psychological, and social domains. The observed associations do not establish causality, but they support integrating frailty screening with nutritional, functional, sleep, socioeconomic, and clinical assessment to inform individualized care and discharge planning for hospitalized patients with heart failure.