{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T17:41:38Z","timestamp":1791567698060,"version":"4.3.4"},"reference-count":102,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2023,8,16]],"date-time":"2023-08-16T00:00:00Z","timestamp":1692144000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J cachexia sarcopenia muscle"],"published-print":{"date-parts":[[2023,10]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>At least half of all patients with heart failure (HF) are affected by frailty, a syndrome that limits an individual ability to recover from acute stressors. While frailty affects up to 90% of patients with HF with preserved ejection fraction, it is also seen in ~30\u201360% of patients with HF with reduced ejection fraction, with ~26% higher prevalence in women compared with men. The relationship between frailty and HF is bidirectional, with both conditions exacerbating the other. Frailty is further complicated by a higher prevalence of sarcopenia (by ~20%) in HF patients compared with patients without HF, which negatively affects outcomes. Several frailty assessment methods have been employed historically including the Fried frailty phenotype and Rockwood Clinical Frailty Scale to classify HF patients based on the severity of frailty; however, a validated HF\u2010specific frailty assessment tool does not currently exist. Frailty in HF is associated with a poor prognosis with a 1.5\u2010fold to 2\u2010fold higher risk of all\u2010cause death and hospitalizations compared to non\u2010frail patients. Frailty is also highly prevalent in patients with worsening HF, affecting &gt;50% of patients hospitalized for HF. Such patients with multiple readmissions for decompensated HF have markedly poor outcomes compared to younger, non\u2010frail cohorts, and it is hypothesized that it may be due to major physical and functional limitations that limit recovery from an acute episode of worsening HF, a care aspect that has not been addressed in HF guidelines. Frail patients are thought to confer less benefit from therapeutic interventions due to an increased risk of perceived harm, resulting in lower adherence to HF interventions, which may worsen outcomes. Multiple studies report that &lt;40% of frail patients are on guideline\u2010directed medical therapy for HF, of which most are on suboptimal doses of these medications. There is a lack of evidence generated from randomized trials in this incredibly vulnerable population, and most current practice is governed by post hoc analyses of trials, observational registry\u2010based data and providers' clinical judgement. The current body of evidence suggests that the treatment effect of most guideline\u2010based interventions, including medications, cardiac rehabilitation and device therapy, is consistent across all age groups and frailty subgroups and, in some cases, may be amplified in the older, more frail population. In this review, we discuss the characteristics, assessment tools, impact on prognosis and impact on therapeutic interventions of frailty in patients with HF.<\/jats:p>","DOI":"10.1002\/jcsm.13306","type":"journal-article","created":{"date-parts":[[2023,8,20]],"date-time":"2023-08-20T17:07:50Z","timestamp":1692551270000},"page":"1959-1972","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":151,"title":["Frailty and heart failure: State\u2010of\u2010the\u2010art review"],"prefix":"10.1002","volume":"14","author":[{"given":"Khawaja M.","family":"Talha","sequence":"first","affiliation":[{"name":"Department of Medicine University of Mississippi Medical Center  Jackson MS USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ambarish","family":"Pandey","sequence":"additional","affiliation":[{"name":"Division of Cardiology University of Texas Southwestern Medical Center  Dallas TX 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