Physical vs. multidimensional frailty in older adults with and without heart failure

Aims: The assessment of frailty in older adults with heart failure (HF) is still debated. Here, we compare the predictive role and the diagnostic accuracy of physical vs. multidimensional frailty assessment on mortality, disability, and hospitalization in older adults with and without HF. Methods and results: A total of 1077 elderly (≥65 years) outpatients were evaluated with the physical (phy-Fi) and multidimensional (m-Fi) frailty scores and according to the presence or the absence of HF. Mortality, disability, and hospitalizations were assessed at baseline and after a 24 month follow-up. Cox regression analysis demonstrated that, compared with phy-Fi score, m-Fi score was more predictive of mortality [hazard ratio (HR) = 1.05 vs. 0.66], disability (HR = 1.02 vs. 0.89), and hospitalization (HR = 1.03 vs. 0.96) in the absence and even more in the presence of HF (HR = 1.11 vs. 0.63, 1.06 vs. 0.98, and 1.14 vs. 1.03, respectively). The area under the curve indicated a better diagnostic accuracy with m-Fi score than with phy-Fi score for mortality, disability, and hospitalizations, both in absence (0.782 vs. 0.649, 0.763 vs. 0.695, and 0.732 vs. 0.666, respectively) and in presence of HF (0.824 vs. 0.625, 0.886 vs. 0.793, and 0.812 vs. 0.688, respectively). Conclusions: The m-Fi score is able to predict mortality, disability, and hospitalizations better than the phy-Fi score, not only in absence but also in presence of HF. Our data also demonstrate that the m-Fi score has better diagnostic accuracy than the phy-Fi score. Thus, the use of the m-FI score should be considered for the assessment of frailty in older HF adults.