Abstract
Background: Heart failure (HF) is a major global public health issue, affecting over 64 million people worldwide and predominantly older adults, with high mortality and rehospitalization rates despite guideline directed medical therapy. Frailty is a geriatric syndrome characterized by reduced physiological reserve and increased vulnerability to stressors and has emerged as a strong, independent prognostic factor in patients with HF. However, data on frailty assessed by the Clinical Frailty Scale (CFS) in older patients hospitalized with acute HF in Vietnam remain scarce. Objectives: (1) To describe the prevalence and severity of frailty according to the CFS in older patients (≥ 60 years) hospitalized for acute HF at the Vietnam National Heart Institute, Bach Mai Hospital; (2) To identify clinical, laboratory and treatment-related factors associated with frailty (CFS ≥ 5). Methods: We conducted a prospective cross sectional study including 240 consecutive patients aged ≥ 60 years admitted with acute HF between August 2024 and March 2025. Acute HF was diagnosed according to the latest ESC guidelines. Frailty was assessed using the 9 point Clinical Frailty Scale (CFS) based on baseline functional status 2–4 weeks prior to admission and categorized as: non frail (CFS 1–3), pre frail (CFS 4), mildly–moderately frail (CFS 5–6), severely–very severely frail (CFS 7–8); patients with CFS 9 were excluded. Patients were grouped as non frail (CFS 1–4) and frail (CFS ≥ 5). Demographic characteristics, comorbidities, clinical and laboratory findings at admission, echocardiography and in hospital treatments were compared between groups. Results: Mean age was 72.9 ± 8.8 (range 60–97) years, and 57.5% were male. Hypertension, type 2 diabetes, coronary artery disease, atrial fibrillation and chronic kidney disease were present in 60.8%, 47.5%, 44.6%, 30.8% and 63.7% of the cohort, respectively. Most patients were in NYHA class III–IV at admission. The distribution of CFS categories was as follows: CFS 1–3 (non frail) 17.9%, CFS 4 (pre frail) 28.7%, CFS 5–6 (mild–moderate frailty) 47.9%, and CFS 7–8 (severe–very severe frailty) 5.4%, yielding an overall frailty prevalence (CFS ≥ 5) of 53.3% (128/240 patients). Compared with non frail patients (CFS 1–4, n = 112), frail patients (CFS ≥ 5, n = 128) were older (76.9 ± 8.8 vs. 68.5 ± 6.3 years; p < 0.001), and more frequently had chronic kidney disease (48.4% vs. 22.3%; p < 0.001) and prior stroke (9.4% vs. 1.8%; p = 0.012). NYHA III–IV at admission was also more prevalent in frail patients (80.5% vs. 57.1%; p < 0.001). Regarding in hospital treatment, frail patients were less likely to receive ARNI (32.0% vs. 47.3%; p = 0.015), beta blockers (18.8% vs. 33.9%; p = 0.007) and mineralocorticoid receptor antagonists (45.3% vs. 65.2%; p = 0.002), but more frequently received intravenous furosemide (97.7% vs. 89.3%; p = 0.008) and vasopressors (39.8% vs. 23.2%; p = 0.006). Conclusions: Frailty according to the CFS is highly prevalent in older patients hospitalized with acute HF at a tertiary center in Vietnam, with more than half of patients having CFS ≥ 5, predominantly mild–moderate frailty. Older age, chronic kidney disease, history of stroke and advanced HF symptoms (NYHA III–IV) are strongly associated with frailty. Frail patients appear undertreated with guideline directed medical therapies (ARNI, beta blockers, MRA) and more frequently receive symptom oriented therapies (loop diuretics, vasopressors). Routine frailty screening using the CFS and the development of multidisciplinary, frailty oriented care pathways are warranted in this high risk population.
