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The goal of this observational study is to investigate the prevalence and associated factors of frailty in hospitalized elderly patients with heart failure. The main questions it aims to answer are:(1) To clarify differences in demographic characteristics and test results (including CGA, BNP, and echocardiography) among different frail populations (2) What demographic, clinical, and geriatric assessment factors are independently associated with frailty in elderly patients with heart failure?
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Non-frail Group | Participants with a Clinical Frailty Scale (CFS) score ranging from 0 to 4. | ||
| Moderate Frailty Group | Participants with a Clinical Frailty Scale (CFS) score ranging from 5 to 6. | ||
| Severe Frailty Group | Participants with a Clinical Frailty Scale （CFS） score of 7 |
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| Measure | Description | Time Frame |
|---|---|---|
| Clinical Frail Scale (CFS) score | The CFS is assessed through clinical judgment based on a patient's functional status, mobility, activity tolerance, comorbidities, and cognitive function in the preceding two weeks. The scale classifies patients into nine levels based on their degree of frailty: 1 - Very Fit, 2 - Well, 3 - Managing Well, 4 - Vulnerable, 5 - Mildly Frail, 6 - Moderately Frail, 7 - Severely Frail, 8 - Very Severely Frail, and 9 - Terminally Ill. The higher the CFS score, the greater the degree of frailty. Excluding those with scores of 8-9, patients with scores of 0-4 are classified into the non-frail group, while those with scores of 5 or higher are classified into the frail group. Frailty Severity Grading Criteria: Clinical Frailty Scale (CFS) score: non-frail (CFS 0-4), moderate frailty (CFS 5-6), and severe frailty (CFS 7). | Baseline |
| brain natriuretic peptide (BNP) | Assessed using a blood sample analyzed by an immunoassay. This biomarker reflects ventricular wall stress and is widely used for diagnosing and monitoring heart failure. BNP levels are reported in ng/L. According to clinical guidelines, a BNP <100 ng/L is considered normal in untreated patients; levels >400 ng/L are strongly suggestive of heart failure, while values between 100 and 400 ng/L are considered intermediate and should be interpreted in the clinical context. Higher BNP levels indicate greater cardiac stress and correlate with worse outcomes. | Baseline |
| left ventricular ejection fraction (LVEF) value | Assessed using echocardiography (transthoracic echocardiography is the standard method), or alternatively by cardiac magnetic resonance imaging or nuclear imaging. This imaging parameter quantifies the percentage of blood ejected from the left ventricle during systole and is the primary measure of systolic function. LVEF is reported as a percentage (%). According to clinical guidelines, a normal LVEF is ≥50%; a mildly reduced LVEF is 40-49%; a moderately reduced LVEF is 30-39%; and a severely reduced LVEF is <30%. Lower LVEF values indicate worse systolic dysfunction and are associated with increased risk of heart failure and adverse outcomes. | Baseline |
| Measure | Description | Time Frame |
|---|---|---|
| body mass index (BMI) | Calculated from measured height (meters) and weight (kilograms) using the formula: weight (kg) / [height (m)]2. Unit: kg/m2. | Baseline |
| activities of daily living (ADL) score |
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Inclusion Criteria:
Exclusion Criteria:
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The study population consists of hospitalized patients aged ≥60 years with a confirmed diagnosis of heart failure, admitted to the Geriatrics Department of Zhejiang Hospital between January 2023 and December 2023.
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Xiufang Hong | Hangzhou | Zhejiang | China |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 41068970 | Background | Yang X, Zhao ZP, Shi Y, Han GY, Xu Y, Li YC, Zhou MG. The evolving burden of heart failure in China: a 34-year subnational analysis of trends and causes from the Global Burden of Disease Study 2023. Mil Med Res. 2025 Oct 9;12(1):65. doi: 10.1186/s40779-025-00650-y. | |
| Background | Leng X. Concepts and practices of geriatric medicine in the United States[J]. Chinese Journal of Practical Internal Medicine, 2011, 31(1): 31-33. | ||
| 40447042 |
| Label | URL |
|---|---|
| The official website of Zhejiang Hospital | View source |
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De-identified individual participant data (IPD) that underlie the results reported in the primary publication (including baseline characteristics, outcome measures, and analysis data sets) will be made available upon reasonable request to the corresponding author, beginning 9 months after article publication and ending 5 years thereafter. Proposals for data use will be reviewed by the study investigators. Requestors will need to sign a data access agreement specifying the intended use of the data, commitment to using it only for the agreed purpose, and agreement not to attempt to re-identify participants.
De-identified IPD and supporting documents (study protocol, informed consent form) will become available 9 months after the publication of the primary results manuscript and will remain available for 5 years. Access will be provided upon reasonable request to the corresponding author and require a signed data use agreement.
Access will be granted to qualified researchers (affiliated with academic or healthcare institutions) who provide a methodologically sound research proposal approved by the study investigators. Requestors can access de-identified IPD, study protocol, and informed consent form for the purpose of individual participant data meta-analysis, reproducibility checks, or secondary analysis aligned with the original study ethics. Proposals should be submitted to the corresponding author [hongxf_1101@163.com] and require a signed Data Access/Use Agreement that includes commitments to: (1) use data only for the specified purpose; (2) protect data confidentiality; (3) not attempt to re-identify participants; and (4) acknowledge the data source in publications.
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| ID | Term |
|---|---|
| D006333 | Heart Failure |
| ID | Term |
|---|---|
| D006331 | Heart Diseases |
| D002318 | Cardiovascular Diseases |
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Assessed using the Barthel Index. This scale evaluates ten activities: feeding, bathing, grooming, dressing, bowel control, bladder control, toileting, chair/bed transfer, ambulation, and stair climbing. The Activities of Daily Living (ADL) scale based on the Barthel Index score ranges from 0 to 100, with higher scores indicate greater independence.
| Baseline |
| instrumental activities of daily living (IADL) score | This scale evaluates evaluates eight domains of function: ability to use a telephone, shopping, food preparation, housekeeping, laundry, mode of transportation, responsibility for own medications, and ability to handle finances. The total score ranges from 0 (low function, dependent) to 8 (high function, independent) . A higher score on the IADL scale indicates a greater level of independence in performing these instrumental activities of daily living. | Baseline |
| short physical performance battery (SPPB) score | Comprises three components: balance tests (side-by-side, semi-tandem, and tandem stands), 4-meter walk speed test, and five times sit-to-stand test. Each component is scored from 0 to 4, yielding a total score ranging from 0 to 12. The Short Physical Performance Battery (SPPB) score ranges from 0 to 12 and higher scores reflect better lower extremity function. | Baseline |
| performance-oriented mobility assessment (POMA) score | Assessed using the Tinetti Balance and Gait Evaluation. The scale consists of a balance section (9 items, max 16 points) and a gait section (7 items, max 12 points). Total scores range from 0 to 28, with higher scores indicating better balance and gait, and lower fall risk. | Baseline |
| mini nutritional assessment-short form(MNA-SF) score | Assessed using the Mini Nutritional Assessment-Short Form. This 6-item tool screens for malnutrition risk by evaluating weight loss, food intake, mobility, psychological stress, body mass index, and disease. Total scores range from 0 to 14, with scores ≤7 indicating malnutrition, 8-11 indicating at risk of malnutrition, and ≥12 indicating normal nutritional status. The Mini Nutritional Assessment-Short Form (MNA-SF) score ranges from 0 to 14, with higher scores indicating better nutritional status. | Baseline |
| grip strength | Measured using a handheld electronic dynamometer. The participant is seated or standing with the elbow flexed at 90°, forearm and wrist in a neutral position. Maximum force is applied with the dominant hand. The best of two attempts is recorded. Unit: kilograms (kg). | Baseline |
| skeletal muscle mass index (SMI) | Assessed using bioelectrical impedance analysis (BIA) with the InBody device. This method calculates the skeletal muscle mass index (SMI) as appendicular skeletal muscle mass (ASM) divided by height squared (kg/m²). SMI values are sex-specific; according to the Asian Working Group for Sarcopenia (AWGS) 2019 criteria, SMI <7.0 kg/m² for men and <5.4 kg/m² for women indicates low muscle mass. When low muscle mass is accompanied by low muscle strength and/or low physical performance, the diagnosis is sarcopenia or severe sarcopenia. The SMI is reported in kg/m², with lower values reflecting lower relative skeletal muscle mass. | Baseline |
| dominant calf circumference | Assessed using the dominant calf circumference measured with a non-elastic tape. This simple anthropometric indicator screens for low muscle mass by measuring the maximum circumference of the calf, typically on the dominant leg (or the leg with the larger circumference). Values are reported in centimeters. According to the Asian Working Group for Sarcopenia (AWGS) criteria, calf circumference <34 cm in men and <33 cm in women indicates low muscle mass, which is suggestive of sarcopenia when combined with low muscle strength or poor physical performance. Higher calf circumference values reflect greater skeletal muscle mass relative to the lower limb. | Baseline |
| Background |
| Uchida S, Kamiya K, Yamashita M, Noda T, Kagiyama N, Matsue Y. Current findings and challenges on frailty, sarcopenia, and cachexia in older patients with heart failure: insights from the FRAGILE-HF study. J Cardiol. 2026 Jan;87(1):10-16. doi: 10.1016/j.jjcc.2025.05.013. Epub 2025 May 28. |
| 38099896 | Background | Denfeld QE, Jha SR, Fung E, Jaarsma T, Maurer MS, Reeves GR, Afilalo J, Beerli N, Bellumkonda L, De Geest S, Gorodeski EZ, Joyce E, Kobashigawa J, Mauthner O, McDonagh J, Uchmanowicz I, Dickson VV, Lindenfeld J, Macdonald P. Assessing and managing frailty in advanced heart failure: An International Society for Heart and Lung Transplantation consensus statement. J Heart Lung Transplant. 2023 Nov 29:S1053-2498(23)02028-4. doi: 10.1016/j.healun.2023.09.013. Online ahead of print. |
| 40159241 | Background | Kitai T, Kohsaka S, Kato T, Kato E, Sato K, Teramoto K, Yaku H, Akiyama E, Ando M, Izumi C, Ide T, Iwasaki YK, Ohno Y, Okumura T, Ozasa N, Kaji S, Kashimura T, Kitaoka H, Kinugasa Y, Kinugawa S, Toda K, Nagai T, Nakamura M, Hikoso S, Minamisawa M, Wakasa S, Anchi Y, Oishi S, Okada A, Obokata M, Kagiyama N, Kato NP, Kohno T, Sato T, Shiraishi Y, Tamaki Y, Tamura Y, Nagao K, Nagatomo Y, Nakamura N, Nochioka K, Nomura A, Nomura S, Horiuchi Y, Mizuno A, Murai R, Inomata T, Kuwahara K, Sakata Y, Tsutsui H, Kinugawa K; Japanese Circulation Society and the Japanese Heart Failure Society Joint Working Group. JCS/JHFS 2025 Guideline on Diagnosis and Treatment of Heart Failure. Circ J. 2025 Jul 25;89(8):1278-1444. doi: 10.1253/circj.CJ-25-0002. Epub 2025 Jun 25. No abstract available. |
| 38291000 | Background | Lai HY, Huang ST, Anker SD, von Haehling S, Akishita M, Arai H, Chen LK, Hsiao FY. The burden of frailty in heart failure: Prevalence, impacts on clinical outcomes and the role of heart failure medications. J Cachexia Sarcopenia Muscle. 2024 Apr;15(2):660-670. doi: 10.1002/jcsm.13412. Epub 2024 Jan 30. |
| 40711891 | Background | Kaufmann CC, Ahmed A, Harbich PF, Auer L, Propst L, Weltler P, Burger AL, Zweiker D, Geppert A, Huber K, Jager B. Prognostic impact of frailty at admission and in-hospital changes of frailty status in elderly patients with acute heart failure. Eur J Heart Fail. 2025 Nov;27(11):2501-2511. doi: 10.1002/ejhf.3779. Epub 2025 Jul 25. |
| 40155186 | Background | Goyal P, Zainul O, Sharma Y, Reich A, Osma P, Lau JD, Massou E, Turchioe M, Russell D, Creber RM, Deaton C. Geriatric Vulnerabilities Among Adults With Heart Failure With Preserved Ejection Fraction: A Cross-Continent Evaluation. JACC Adv. 2025 Mar;4(3):101602. doi: 10.1016/j.jacadv.2025.101602. |
| 40977495 | Background | Galati G, Germanova O, Dacquino G, Bravo FF, Genovese L, Pedretti RFE. Cardiovascular Diseases Epidemiology and Management in the Elderly and very Elderly. Eur J Prev Cardiol. 2025 Sep 22:zwaf470. doi: 10.1093/eurjpc/zwaf470. Online ahead of print. |
| 38767446 | Background | Maeda D, Fujimoto Y, Nakade T, Abe T, Ishihara S, Jujo K, Matsue Y. Frailty, Sarcopenia, Cachexia, and Malnutrition in Heart Failure. Korean Circ J. 2024 Jul;54(7):363-381. doi: 10.4070/kcj.2024.0089. Epub 2024 Apr 26. |
| 11253156 | Background | Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, Seeman T, Tracy R, Kop WJ, Burke G, McBurnie MA; Cardiovascular Health Study Collaborative Research Group. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001 Mar;56(3):M146-56. doi: 10.1093/gerona/56.3.m146. |
| 38514328 | Background | Chinese Society of Cardiology, Chinese Medical Association; Chinese College of Cardiovascular Physician; Chinese Heart Failure Association of Chinese Medical Doctor Association; Editorial Board of Chinese Journal of Cardiology. [Chinese guidelines for the diagnosis and treatment of heart failure 2024]. Zhonghua Xin Xue Guan Bing Za Zhi. 2024 Mar 24;52(3):235-275. doi: 10.3760/cma.j.cn112148-20231101-00405. Chinese. |