Frailty may identify patients with heart failure (HF) at higher mortality risk regardless of chronological age, according to a nationwide Danish registry-based cohort study published in the European Journal of Heart Failure. The analysis evaluated 79,193 patients with new-onset HF diagnosed between 2013 and 2022. Patients were stratified by age (<65, 65–79, ≥80 years) and frailty using the Hospital Frailty Risk Score (low, intermediate, high). 

The primary outcomes included all-cause and cardiovascular (CV) mortality at two years, along with GDMT utilization across strata. Logistic regression models were applied to evaluate associations.

A total of 79,193 patients were included, with 24% aged <65 years, 41% aged 65–79 years, and 35% aged ≥80 years. Frailty significantly modified the relationship between age and mortality (interaction p<0.001). Comparable two-year mortality risks were observed across differing age–frailty combinations: low-frailty individuals aged 80 years had a mortality of 22.1% (95% CI, 21.4–22.8), intermediate-frailty individuals aged 70 years had 22.8% (95% CI, 21.9–23.8), and high-frailty individuals aged 47 years had 22.8% (95% CI, 18.0–28.4).

Similar patterns were reported for CV mortality. GDMT use was consistently lower among patients with high frailty compared with low frailty across all age groups. Additionally, within each frailty category, patients aged ≥80 years had lower odds of receiving GDMT than those aged <65 years.

These findings suggest that frailty assessment may complement age-based evaluation when estimating prognosis and treatment patterns in HF.