Assessment of frailty in patients with heart failure: A new Heart Failure Frailty Score developed by Delphi consensus
Vitale C. Berthelot E. Coats A.J.S. Loreena H. Albert N.M. Tkaczyszyn M. Adamopoulos S. Anderson L. Anker M.S. Anker S.D. Bell D. Ben-Gal T. Bistola V. Bozkurt B. Brooks P. Camafort M. Carrero J.J. Chioncel O. Choi D.-J. Chung W.-J. Doehner W. Fernández-Bergés D. Ferrari R. Fiuzat M. Gomez-Mesa J.E. Gustafsson F. Jankowska E. Kang S.-M. Kinugawa K. Khunti K. Hobbs F.D.R. Lee C. Lopatin Y. Maddocks M. Maltese G. Marques-Sule E. Matsue Y. Miró Ò. Moura B. Piepoli M. Ponikowski P. Pulignano G. Rakisheva A. Ray R. Sciacqua A. Seferovic P. Sentandreu-Mañó T. Sze S. Sinclair A. Strömberg A. Theou O. Tsutsui H. Uchmanowicz I. Vidan M.T. Volterrani M. von Haehling S. Yoo B. Zhang J. Zhang Y. Metra M. Rosano G.M.C.
June 2025John Wiley and Sons Inc
ESC Heart Failure
2025#12Issue 31818 - 1831 pp.
Aims: The Heart Failure Frailty Score (HFFS) is a novel, multidimensional tool to assess frailty in patients with heart failure (HF). It has been developed to overcome limitations of existing frailty assessment tools while being practical for clinical use. The HFFS reflects the concept of frailty as a multidimensional, dynamic and potentially reversible state, which increases vulnerability to stressors and risk of poor outcomes in patients with HF. Methods and results: The HFFS was developed through a Delphi consensus process involving 54 international experts. This approach involved iterative rounds of questionnaires and interviews, where a panel of experts provided their opinions on specific questions prepared by the Steering Committee. The experts were invited to vote and share their views anonymously, using a 5-point Likert scale over iterative rounds. An 80% threshold was set for agreement or disagreement for each statement. Twenty-two variables from four domains (clinical, functional, psycho-cognitive and social) have been selected for inclusion in the HFFS after the third round of the Delphi process. A shorter version (S-HFFS), including 10 variables, has also been developed for daily clinical use. Conclusions: The HFFS is a new multidimensional tool for the identification of frailty in patients with HF. It should also enables healthcare providers to identify potential ‘red flags’ for frailty in order to develop personalized care plans. The next step will be to validate the new score in patients with HF.
Frailty , Heart failure , Management , Prognosis , Score
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Department of Human Sciences and Promotion of Quality of Life, San Raffaele Open, University of Rome, Rome, Italy
Hospital Bicetre, Le-Kremlin Bicetre, France
Heart Research Institute, Sydney, Australia
School of Nursing & Midwifery, Queens University, Belfast, United Kingdom
Nursing Institute and Linda H. Kaufman Center for Heart Failure Treatment and Recovery, Cleveland Clinic, Cleveland, OH, United States
Division of Translational Cardiology and Clinical Registries, Institute of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland
Heart Failure and Transplant Unit, Onassis Cardiac Surgery Centre, Athens, Greece
Cardiovascular Clinical Academic Group, Molecular and Clinical Sciences Research Institute, University of London and St Georges University Hospitals NHS Foundation Trust, London, United Kingdom
Department of Cardiology CBF German Heart Center Charité, DZHK, BCRT, University Medicine Berlin FU and HU, Berlin, Germany
Department of Cardiology (CVK) of German Heart Center Charité; Berlin Institute of Health Center for Regenerative Therapies (BCRT), German Centre for Cardiovascular Research (DZHK) partner site Berlin, Charité Universitätsmedizin, Berlin, Germany
National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC), London, United Kingdom
Heart Failure Unit, Cardiology Department, Rabin Medical Center, Petah Tikva and Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
Department of Cardiology, Attikon University Hospital, National Kapodistrian University of Athens Medical School, Athens, Greece
Winters Center for Heart Failure, Cardiovascular Research Institute, Baylor College of Medicine and DeBakey VA Medical Center, Houston, TX, United States
Royal Devon University Healthcare NHS Foundation Trust, Barnstaple, United Kingdom
Heart Failure Unit, Internal Medicine Department, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
Emergency Institute for Cardiovascular Diseases ‘Prof. C.C. Iliescu’, University of Medicine Carol Davila, Bucharest, Romania
Seoul National University Bundang Hospital, Seongnam, South Korea
Department of Cardiovascular Medicine, Gachon University Gil Medical Center, Incheon, South Korea
Berlin Institute of Health Center for Regenerative Therapies and Deutsches Herzzentrum der Charité, Department Cardiology (Virchow Klinikum), German Centre for Cardiovascular Research Partner Site Berlin and Center for Stroke Research Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany
Research Unit of Don Benito-Villanueva de la Serena Health Area, SES-Fundesalud, Villanueva de la Serena, Spain, University Institute for Biosanitary Research of Extremadura (INUBE), Badajoz, Spain
Centro Cardiologico Universitario di Ferrara, University of Ferrara, Ferrara, Italy
Division of Cardiology, Duke University, Durham, NC, United States
Cardiology Department, Fundacion Valle del Lili, Health Sciences Department, Universidad Icesi, Cali, Colombia
Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; Institute of Heart Diseases, Wroclaw Medical University, University Hospital, Wroclaw, Poland
Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University, Seoul, South Korea
The Second Department of Internal Medicine, University of Toyama, Toyama, Japan
Diabetes Research Centre, University of Leicester, Leicester, United Kingdom
Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
William F. Conell School of Nursing, Boston College, Newton, MA, United States
Regional Cardiology Centre, Volgograd State Medical University, Volgograd, Russian Federation
Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, Kings College London, London, United Kingdom
Department of Diabetes and Endocrinology, Epsom & St Helier University Hospitals, Surrey, United Kingdom
School of Cardiovascular Medicine & Sciences, Kings College London, London, United Kingdom
Department of Physiotherapy, University of Valencia, Valencia, Spain
Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
Emergency Department, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain
Faculty of Medicine of Porto, Armed Forces Hospital, Porto, Portugal
Clinical Cardiology, IRCCS Policlinico San Donato, Milano, Italy
Dipartimento Scienze Biomediche per la Salute, Università Degli Studi di Milano, Milano, Italy
Institute of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland
Institute of Heart Diseases, University Hospital, Wroclaw, Poland
Heart Failure Clinic, Division of Cardiology/Coronary Care Unit, San Camillo Hospital, Rome, Italy
Cardiology Department, City Cardiology Center, Almaty, Kazakhstan
Internal Medicine, Cardiovascular and Metabolic Diseases, Geriatrics Division, University Hospital R. Dulbecco, University Magna Graecia of Catanzaro, Catanzaro, Italy
University Medical Center, Medical Faculty University of Belgrade, Serbian Academy of Sciences and Arts, Belgrade, Serbia
Department of Physiotherapy, Advanced Research Methods Applied to Quality of Life Promotion (ARMAQoL), University of Valencia, Valencia, Spain
NIHR Leicester Biomedical Research Centre, University of Leicester, Glenfield Hospital, Leicester, United Kingdom
Kings College, London, and Foundation for Diabetes Research in Older People (fDROP), Droitwich Spa, United Kingdom
Department of Health, Medicine and Caring Sciences and Department of Cardiology, Linköping University, Linköping, Sweden
School of Physiotherapy and Department of Medicine, Dalhousie University, Halifax, Canada
International University of Health and Welfare, Fukuoka, Japan
Faculty of Nursing and Midwives, Wroclaw Medical University, Wrocław, Poland
Geriatric Department, Hospital General Universitario Gregorio Maranón, Madrid, Spain; Biomedical Research Networking Center on Frailty and Healthy Aging, CIBERFES, Madrid, Spain
Department of Cardiology and Pneumology, University of Göttingen Medical Center, DZHK (German Center for Cardiovascular Research) (DZHK), Partner Site Lower Saxony Göttingen, Göttingen, Germany
Division of Cardiology, Wonju College of Medicine, Yonsei University, Yonsei, South Korea
State Key Laboratory of Cardiovascular Disease, Heart Failure Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
Key Laboratory of Clinical Research for Cardiovascular Medications, National Health Committee, Beijing, China
Fuwai Hospital & National Center for Cardiovascular Diseases, Beijing, China
Director Cardiology Unit ASST Spedali Civili and University of Brescia, Brescia, Italy
Department of Cardiology, San Raffaele Cassino Hospital, Cassino, Italy
Department of Human Sciences and Promotion of Quality of Life
Hospital Bicetre
Heart Research Institute
School of Nursing & Midwifery
Nursing Institute and Linda H. Kaufman Center for Heart Failure Treatment and Recovery
Division of Translational Cardiology and Clinical Registries
Heart Failure and Transplant Unit
Cardiovascular Clinical Academic Group
Department of Cardiology CBF German Heart Center Charité
Department of Cardiology (CVK) of German Heart Center Charité; Berlin Institute of Health Center for Regenerative Therapies (BCRT)
National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC)
Heart Failure Unit
Department of Cardiology
Winters Center for Heart Failure
Royal Devon University Healthcare NHS Foundation Trust
Heart Failure Unit
Department of Medical Epidemiology and Biostatistics
Emergency Institute for Cardiovascular Diseases ‘Prof. C.C. Iliescu’
Seoul National University Bundang Hospital
Department of Cardiovascular Medicine
Berlin Institute of Health Center for Regenerative Therapies and Deutsches Herzzentrum der Charité
Research Unit of Don Benito-Villanueva de la Serena Health Area
Centro Cardiologico Universitario di Ferrara
Division of Cardiology
Cardiology Department
Department of Cardiology
Division of Cardiology
The Second Department of Internal Medicine
Diabetes Research Centre
Nuffield Department of Primary Care Health Sciences
William F. Conell School of Nursing
Regional Cardiology Centre
Cicely Saunders Institute of Palliative Care
Department of Diabetes and Endocrinology
School of Cardiovascular Medicine & Sciences
Department of Physiotherapy
Department of Cardiovascular Biology and Medicine
Emergency Department
Faculty of Medicine of Porto
Clinical Cardiology
Dipartimento Scienze Biomediche per la Salute
Institute of Heart Diseases
Institute of Heart Diseases
Heart Failure Clinic
Cardiology Department
Internal Medicine
University Medical Center
Department of Physiotherapy
NIHR Leicester Biomedical Research Centre
Kings College
Department of Health
School of Physiotherapy and Department of Medicine
International University of Health and Welfare
Faculty of Nursing and Midwives
Geriatric Department
Department of Cardiology and Pneumology
Division of Cardiology
State Key Laboratory of Cardiovascular Disease
Key Laboratory of Clinical Research for Cardiovascular Medications
Fuwai Hospital & National Center for Cardiovascular Diseases
Director Cardiology Unit ASST Spedali Civili and University of Brescia
Department of Cardiology
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