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Prognostic impact of multi-domain approaches and the Tilburg frailty indicator in elderly patients with heart failure

Xiaodan Guo,Minmin Wu,Huazhen Xiao,Jiali Liu,Xiaoqian Zhu,Shuang Jin,Yuhong Liu,Yuanfan Zhu,Xin Lin,Yan Mu

Published 2025 in Aging Clinical and Experimental Research

ABSTRACT

The optimal multidimensional frailty assessment approach in heart failure (HF) remains uncertain. This study aimed to compare the prognostic value of a multi-domain approach versus the Tilburg Frailty Indicator (TFI) in elderly HF patients. This prospective single-center cohort study consecutively enrolled 461 elderly HF patients at Fuzhou University Affiliated Provincial Hospital, China. Frailty was assessed using both the TFI and a multi-domain approach. The primary outcome was the composite of heart failure hospitalization or all-cause death within six months. Clinical outcomes were analyzed using Kaplan-Meier and Cox proportional hazards regression models, with predictive performance compared by receiver operating characteristic curves. Among 461 participants, physical, psychological, and social frailty prevalence rates were 41.0%, 59.9%, and 56.8%, respectively. Multidimensional frailty, assessed by the TFI, was present in 77.4% of the cohort. The risk of composite outcome increased significantly with the number of frailty domains [2 domains: adjusted HR = 1.74 (95% CI: 1.08–2.79); 3 domains: HR = 2.07 (1.28–3.35)]. TFI-based analysis yielded consistent results. Notably, the predictive accuracy of frailty domains (area under the curve (AUC) = 0.63, 95% CI: 0.58–0.69) did not significantly differ from that of the TFI (AUC = 0.64, 95% CI: 0.59–0.70; P = 0.713), indicating comparable discriminative ability. In elderly HF patients, both the multi-domain frailty assessment and the TFI demonstrated comparable predictive value for heart failure hospitalization or all-cause death within six months.

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