A new registry analysis out of Japan suggests we may be able to simplify how we classify heart failure frailty without losing accuracy, allowing us to screen for HF mortality risk in faster and more practical ways.
- In the context of HF, frailty is defined as increased vulnerability due to physical and cognitive decline, muscle loss, and inflammation.
- One option for determining frailty is the Clinical Frailty Scale (CFS), a 9-point (1 = very fit, 9 = terminally ill) tool that summarizes the level of fitness or frailty in adults over 65.
- Physicians use the CFS as a simple visual tool, but whether it adequately captures physical and cognitive decline was unproven till now.
To see how CFS stacks up against comprehensive physical testing, researchers categorized 3.9k patients hospitalized with HF into six CFS categories (1-2, 3, 4, 5, 6, 7-9) and compared their results against function metrics (gait speed, SPPB, grip strength, etc) and cognitive assessment (Mini-Cog test) and found that CFS could more than stand on its own.
- Physical function metrics and Mini-Cog scores progressively worsened with increasing CFS severity, demonstrating the scale captures both physical and cognitive vulnerability.
- Over 2-year follow-up, 18.6% of patients died, with mortality increasing across higher CFS scores.
- Adding CFS to prognostic models significantly improved predictions compared to models based on SPPB and Mini-Cog test alone.
- The CFS was also able to independently predict a patient’s mortality beyond conventional functional testing, meaning it could capture something other tests don’t.
Even with comprehensive performance-based frailty assessments available, the simple visual CFS demonstrated much more accurate prognostic value, challenging assumptions that formal testing provides better risk stratification.
The real kicker comes in how much easier the tool makes physicians’ lives, since CFS offers a more practical option that goes hand in hand with performance-based frailty assessments while not requiring specialized equipment.
The Takeaway
Sometimes it seems like more is better, but in the case of HF’s impact on a patient’s body, keeping it simple might be the best way to quantify risk. If nothing else, this study could encourage physicians to assess their patients in a more pragmatic way.
