Multidimensional Assessments Better Gauge Frailty in Patients With Heart Failure

As more patients with heart disease live longer, physicians need better tools to assess frailty in those with heart failure. New study results suggest a multidimensional assessment approach is preferable to one that focuses only on physical metrics.

Multidimensional frailty assessments are better predictors of mortality, disability, and hospitalizations compared with physical frailty assessments, according to new research.

The study, published in the ESC Heart Failure, was intended to help physicians understand the best ways to assess patients with heart failure (HF); however the superiority of the multidisciplinary measure held true for both study cohorts: the heart failure group and the control group.

Corresponding author Pasquale Abete, MD, PhD, of the University of Naples, Italy, wrote that HF is likely to become a bigger problem in the coming years, as medical advances make it possible for people with heart disease to live longer.

“However, in HF patients, the prognosis is worse in the elderly, with higher mortality, both in-hospital and long term,” Abete and colleagues wrote.

Elderly individuals now make up 70% of all HF hospital admissions, and those patients are subject to more serious clinical manifestations of HF due to a high frequency of other cardiac problems and the broader effects of aging.

Frailty can be a significant factor in whether a patient is more at risk of when exposed to a stressor like HF, Abete and colleagues note. However, it has been difficult to fully understand the relationship between HF and frailty because there is a lack of agreement on how best to assess the condition.

Abete and colleagues write that one measure, a physical phenotype (phy-Fi), is based on factors like unintentional weight loss, muscle weakness, slow walking speed, low physical activity, and exhaustion. There is a newer approach, however, that accounts for a series of multidimensional factors, such as comorbidity, disability, and social and psychological components.

The question for Abete and colleagues was: which measure should predominate?

The team constructed a study of 1077 patients, all 65 years or older. Patients were categorized based on the presence or lack of HF, and they were assessed on both phy-Fi frailty scale and a modified version of the multidimensional scale (m-Fi), with nutritional and socio-economic factors to the evaluation. The study enrollees were assessed for mortality, disability, and hospitalizations at baseline and after 24 months.

The m-Fi measure outperformed the phy-Fi scale in all 3 categories, and the superiority of m-Fi was even more pronounced among patients with a history of HF.

Abete and colleagues said their study supports other research that found the phy-Fi tends to overestimate frailty in patients with HF. One reason, they note, is that some of the physical symptoms of HF can also appear to be physical symptoms of frailty.

“Accordingly, when considering ‘physical’ frailty in HF patients, frailty might be often blurred by HF‐related signs and symptoms,” they write. “In contrast, a multidimensional approach involving not only physical but also mental, nutritional, and psychosocial components could be a more appropriate tool for frailty identification.”

“The m-Fi score is the result of a multidomain assessment, and it is able not only to identify multidimensional frailty but also to determine its degree,” Abete and colleagues conclude.


Testa G, Curcio F, Liguori I, et al. Physical vs multidimensional frailty in older adults with and without heart failure [published online April 3, 2020]. ESC Heart Failure. doi: 10.1002/ehf2.12688.