Frailty and Comorbidity Burden as Predictors of Recurrent Hospitalization in Older Vietnamese Adults with Heart Failure: A Prospective Cohort Study.

Abstract

Background Frailty predicts mortality in older adults with heart failure, but its association with recurrent hospitalization, and its value relative to left ventricular ejection fraction (LVEF), remain poorly characterized in Asian populations. Methods We followed 150 consecutive Vietnamese outpatients aged 60 years or older with chronic heart failure for 12 months for recurrent all-cause hospitalization. Frailty was defined as a Clinical Frailty Scale (CFS) score of 5 or higher. The primary analysis used the Andersen-Gill recurrent-event model; a four-level frailty-comorbidity composite was derived from the Charlson Comorbidity Index, and discrimination was compared by Harrell's C-statistic. Results Of 150 participants (median age 75 years; 59.3% male), 54 (36.0%) were frail and 79 (52.7%) were hospitalized at least once. Frailty was associated with recurrent hospitalization after adjustment for age and sex (adjusted HR 1.73, 95% CI 1.06-2.83; p = 0.028). The frailty-comorbidity composite showed a graded increase in hospitalization burden that did not persist after adjustment. Discrimination was modest across all models (C-statistics near 0.60) and did not differ significantly between frailty (0.581) and LVEF (0.568); combining both gave 0.610 (95% CI 0.560-0.661). Conclusion In older Vietnamese adults with chronic heart failure, frailty was associated with recurrent all-cause hospitalization after adjustment for age and sex, with modest discrimination similar to LVEF-based stratification. Baseline frailty assessment may help identify higher-risk patients and warrants prospective evaluation.