Clinical Frailty Scale Enhances Prognosis for Heart Failure Patients

A recent study led by Dr. Taisuke Nakade from the Department of Cardiovascular Biology and Medicine at Juntendo University Graduate School of Medicine has demonstrated that the Clinical Frailty Scale (CFS) can effectively predict mortality in patients with heart failure. Published on October 15, 2025, in The Journal of the American College of Cardiology, this study highlights the importance of routine frailty assessments in managing older adults with heart conditions.

Frailty is significantly associated with adverse outcomes, particularly in the elderly. Traditional methods of assessing frailty often rely on complex tests that require specialized equipment and trained personnel, making them impractical for everyday use. The CFS offers a streamlined, 9-point tool that can be assessed visually at the bedside in just a few minutes, potentially transforming how healthcare providers evaluate frailty in clinical settings.

Despite the promise of the CFS, questions remain regarding its correlation with objective measures of physical and cognitive function and its independent predictive power for mortality among hospitalized heart failure patients. To address these issues, Dr. Nakade and his team, which included Dr. Yuya Matsue, analyzed anonymized data from the Japanese Registry of Acute Decompensated Heart Failure–Next (JROADHF-NEXT). This comprehensive dataset included information from 87 hospitals across Japan and encompassed 3,905 patients who were monitored for at least two years following heart failure treatment.

At discharge, the research revealed that the majority of patients had CFS scores of 4 or higher, indicating a pre-frail status or worse. Alarmingly, the study found that for each additional point on the CFS, the risk of mortality within two years increased by a factor of 1.42. Specifically, patients with a CFS score greater than 7 were found to have a mortality risk that was 6.59 times greater than those with scores of 2 or less.

Dr. Nakade emphasized the significance of these findings, noting that while conventional assessments like grip strength and gait speed are valuable, their practical application is limited. “The CFS provides a rapid, visually assessed evaluation that requires no equipment or specialized training,” he stated. This efficiency could enable physicians to quickly identify patients needing additional support and monitoring after discharge.

The team also evaluated the predictive capabilities of various models for two-year all-cause mortality. They found that incorporating objective physical and cognitive test scores into a biomarker-based baseline model improved its predictive accuracy. Notably, substituting those objective tests with the CFS score enhanced performance even further, underscoring the CFS’s robust prognostic value.

The implications of this research extend beyond mere mortality predictions. By integrating the CFS into clinical workflows, healthcare providers could prioritize high-risk patients upon admission, tailoring treatments that align with individual frailty levels. This approach could also inform post-discharge plans, rehabilitation services, and ongoing monitoring, ultimately improving patient outcomes.

Dr. Nakade concluded that embedding the CFS into routine assessments could bridge the gap between prognosis and meaningful improvements in patient care. As the healthcare landscape evolves, tools like the CFS may play a crucial role in enhancing the quality of care for patients with heart failure.