Frailty in acute cardiac care and acute heart failure: prevalence, prognosis, and modifiability

Abstract Background Frailty is increasingly prevalent among elderly patients admitted for acute cardiac conditions and acute decompensated heart failure (ADHF), yet it remains inconsistently assessed in acute care settings despite robust evidence of prognostic relevance. Purpose To systematically quantify the prevalence of frailty in acute cardiac care and ADHF, and to summarize its association with clinical outcomes and response to multidisciplinary interventions. Methods More than 40 studies were screened; 31 original investigations met inclusion criteria, encompassing approximately 30,000–35,000 patients across acute cardiac care and heart failure settings. Mean or median age ranged from 72 to 83 years, with women representing 40–56% of included populations. In ACCU cohorts using physical frailty definitions, 20–30% of patients were classified as frail and 40–45% as pre-frail. In hospitalized heart failure populations, frailty affected ≥50% of patients overall, reaching up to 90% among those with preserved ejection fraction, with a ~25% higher prevalence in women. Frailty was consistently associated with adverse outcomes. In ACCU studies, frail patients showed higher in-hospital complications, including worsening heart failure (≈50% vs