The hospital frailty risk score in patients with heart failure is strongly associated with outcomes but less so with pharmacotherapy

Background Although frailty is known to be an important prognostic factor in heart failure (HF), HF risk‐adjustment models do not incorporate frailty measures and the interplay between frailty, age and pharmacotherapy is unclear. Objectives To explore the relationships between frailty, pharmacotherapy and outcomes in heart failure (HF). Methods Retrospective cohort study of all adults in Alberta, Canada hospitalized for the first time for HF between 2004 and 2016. Frailty was defined using the Hospital Frailty Risk Score (HFRS). Results In 26 626 patients (mean age 77.4 years), the 8887 (33.4%) defined as frail (HFRS ≥ 5) were older, had higher Charlson scores and more prior emergency department visits or hospitalizations. The HFRS and the Charlson Score were only weakly correlated ( r  = 0.35). Whilst more common in older patients (41.4% of patients 80 or older), frailty was present in 22.4% of patients younger than 65. Frail patients had longer lengths of stay and worse outcomes postdischarge, but adding the HFRS to age, sex and Charlson score did not improve prediction of events (c‐statistics 0.69 for 30‐day mortality after admission, and 0.54 for 30‐day readmission/ED visit/or death after discharge). Frail patients younger than 65 were significantly more likely than nonfrail patients 80 or older to be prescribed high‐dose evidence‐based HF therapies (27.1% vs. 22.2%, P  = 0.003). Conclusion Although the HFRS reflects aspects of frailty that patient age and Charlson scores do not, the addition of the HFRS to standard risk prediction equations provides little additional information. Prescribing practices correlate more with patient age than frailty status.