Comparison of Questionnaire and Performance‐Based Physical Frailty Scales to Predict Survival and Health‐Related Quality of Life in Patients With Heart Failure

BACKGROUND: Frailty is prevalent in older adults with heart failure and is associated with poor outcomes; however, there remains uncertainty on how to measure frailty in clinical practice. METHODS AND RESULTS: A multicentric prospective cohort study was assembled at 4 heart failure clinics to compare the prognostic value of 3 physical frailty scales in ambulatory patients with heart failure. Outcomes were all‐cause death or hospitalization and health‐related quality of life using the 36‐Item Short Form survey questionnaire (SF‐36) at 3 months. Multivariable regression was adjusted for age, sex, Meta‐Analysis Global Group in Chronic Heart Failure score, and baseline SF‐36 score. The cohort included 215 patients (mean age 77.6 years). All 3 frailty scales were independently associated with death or hospitalization at 3 months; the adjusted odds ratios standardized per 1 SD worsening of the Short Physical Performance Battery; Fried, and strength, assistance with walking, rising from a chair, climbing stairs, and falls scales were 1.67 (95% CI, 1.09–2.55), 1.60 (95% CI, 1.04–2.46), and 1.55 (95% CI, 1.03–2.35), respectively, with C statistics of 0.77 to 0.78. All 3 frailty scales were independently associated with worsening SF‐36 scores, especially the Short Physical Performance Battery, for which 1 SD worsening of frailty translated to a decrement of −5.86 (−8.55 to −3.17) and −5.51 (−7.82 to −3.21) points in the Physical Component Score and Mental Component Score. CONCLUSIONS: All 3 physical frailty scales were associated with death, hospitalization, and reduced health‐related quality of life in ambulatory patients with heart failure. Questionnaire or performance‐based physical frailty scales can be used to offer prognostic value and a therapeutic target in this vulnerable population. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03887351.