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Publications

Journal Article Ahead of print

PubMed: 42364248 DOI: 10.1093/eschf/xvag178

Frailty and Heart Failure: An Integrated Review of a Bidirectional Relationship.

ESC Heart Fail

Authors: Izabella Uchmanowicz, Ercole Vellone, Christopher S Lee, Robbert J J Gobbens, Camilla Hage, Ekaterini Lambrinou, Bartosz Uchmanowicz, Cristiana Vitale, MichaƂ Czapla

Affiliations

  • Division of Research Methodology, Department of Nursing, Faculty of Nursing and Midwifery, Wroclaw Medical University, Wroclaw, Poland.
  • Centre for Cardiovascular Health, Edinburgh Napier University, Sighthill Campus, Edinburgh, UK.
  • Department of Biomedicine and Prevention, Tor Vergata University of Rome, Rome, Italy.
  • Boston College William F. Connell School of Nursing, Chestnut Hill, MA, USA.
  • Department of Emergency Medical Service, Faculty of Nursing and Midwifery, Wroclaw Medical University, Wroclaw, Poland.
  • Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, Amsterdam, The Netherlands.
  • Zonnehuisgroep Amstelland, Amstelveen, The Netherlands.
  • Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands.
  • Cardiology unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden.
  • Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden.
  • Department of Nursing, School of Health Sciences, Cyprus University of Technology, 30 Archbishop Kyprianou, Limassol 3036, Cyprus.
  • Department of Human Sciences and Promotion of Quality of Life, San Raffaele Open, University of Rome, Rome, Italy.
  • IRCCS San Raffaele, Rome, Italy.
  • Group of Research in Care (GRUPAC), Faculty of Health Sciences, University of La Rioja, Logroño, Spain.
  • Nursing Care and Education Research Group (GRIECE), Department of Nursing, University of Valencia, Valencia, Spain.

Abstract

Heart failure (HF) and frailty frequently coexist in older adults and are associated with poor clinical outcomes. Frailty affects 15-76% of patients with chronic HF depending on the clinical setting and assessment tool used, with prevalence approaching 90% in hospitalised patients with heart failure with preserved ejection fraction (HFpEF). This integrated review synthesises current evidence on the bidirectional relationship between frailty and HF, including shared pathophysiological mechanisms, epidemiology, prognostic implications, assessment strategies, and contemporary management approaches. Available evidence indicates that frailty independently predicts incident HF and is associated with progressive deterioration in cardiac structure and function. Conversely, HF accelerates frailty progression through systemic inflammation, skeletal muscle hypoperfusion, sarcopenia, neurohormonal activation, malnutrition, and hospital-associated deconditioning. Frailty contributes to impaired quality of life, reduced self-care capacity, prolonged hospitalisation, poorer tolerance of guideline-directed medical therapy, and higher all-cause mortality risk. Current assessment strategies include physical performance measures, multidimensional frailty instruments, and comprehensive geriatric assessment. The recently developed Heart Failure Frailty Score (HFFS) represents the first HF-specific multidimensional frailty instrument. Management strategies include exercise rehabilitation, nutritional optimisation, structured medication review, and integration of frailty assessment into advanced HF decision-making. Future research should prioritise prospective validation of HF-specific frailty tools and randomised trials evaluating frailty-targeted interventions in HF populations.

MeSH

Heart Failure, Heart, Heart Failure, Diastolic, Frailty