Frailty assessment at hospital discharge strongly stratified prognosis in adults hospitalized with acute heart failure (HF). Findings from a post hoc analysis of the Prospective Observational Study on Acute Pharmacotherapy and Prognosis in Management of Acute Heart Failure (POPEYE-AHF) registry, published in the Journal of the American Heart Association, showed that a laboratory-based frailty index independently predicted mortality and HF hospitalization, with the highest risk observed when laboratory and clinical frailty measures were combined.

This post hoc analysis used data from the POPEYE-AHF registry. The Frailty Index based on laboratory tests was calculated at discharge using the proportion of abnormal values across 21 laboratory parameters. Clinical frailty was assessed using the CFS. Outcomes included all-cause death, HF hospitalization, and a composite of both.

The analysis included 975 patients with available FI-lab data and 637 patients with CFS data. Median age was 80 years, and 45.0% were women. After multivariable adjustment, FI-lab was associated with all-cause death (HR 1.38; 95% CI 1.15-1.67; P = 0.001), HF hospitalization (HR 1.15; 95% CI 1.00-1.32; P = 0.044), and the composite outcome (HR 1.21; 95% CI 1.08-1.37; P = 0.002).

When patients were stratified by the median FI-lab cutoff of 0.48, high FI-lab was associated with higher all-cause mortality (HR 2.11; 95% CI 1.31–3.41; P = 0.002) and the composite outcome (HR 1.40; 95% CI 1.05–1.88; P = 0.023). Patients with both high FI-lab and high CFS had the greatest adjusted risk of all-cause death (HR 2.62; 95% CI 1.38–4.99; P = 0.003).

Laboratory-derived frailty identified adults with acute HF at increased risk for adverse outcomes. Combined laboratory and clinical frailty assessment provided the strongest prognostic discrimination at hospital discharge.