{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T13:58:13Z","timestamp":1785506293038,"version":"3.56.0"},"reference-count":109,"publisher":"Radcliffe Medical Media Ltd","license":[{"start":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T00:00:00Z","timestamp":1785715200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/legalcode"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Card Fail Rev"],"abstract":"<jats:p>This paper discusses the considerations for multidimensional and multidisciplinary management of heart failure (HF) patients with frailty. Frailty is a multidimensional, dynamic and potentially reversible state, defined by clinical, functional, psycho-cognitive and social domains. Frailty is seldom systematically assessed in clinical practice in HF patients. Paradoxically, although the absolute benefit of HF guideline-directed medical treatment in frail HF patients seems greater, it is under-prescribed. This therapeutic gap could be related to different reasons, such as concerns about safety, polypharmacy and the lack of specific evidence-based data. Frail HF patients require a comprehensive, multidimensional therapeutic strategy that integrates available evidence-based pharmacological interventions with targeted non-pharmacological modalities across multiple clinical disciplines to optimise patient outcomes. The four domains of frailty should be objectively and routinely assessed with a multidimensional approach to facilitate a more individualised and comprehensive care plan delivered by a multidisciplinary team. In the future, we need more dedicated studies and randomised clinical trials that include frail HF patients.<\/jats:p>","DOI":"10.15420\/cfr.2025.48","type":"journal-article","created":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T13:00:14Z","timestamp":1785502814000},"source":"Crossref","is-referenced-by-count":0,"title":["Multidimensional and Multidisciplinary Management of Heart Failure Patients with Frailty"],"prefix":"10.15420","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1111-9894","authenticated-orcid":false,"given":"Cristiana","family":"Vitale","sequence":"first","affiliation":[{"id":[{"id":"https:\/\/ror.org\/02rwycx38","id-type":"ROR","asserted-by":"publisher"}],"name":"San Raffaele University of Rome"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2022-774X","authenticated-orcid":false,"given":"Gabriele","family":"Fragasso","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/039zxt351","id-type":"ROR","asserted-by":"publisher"}],"name":"IRCCS Ospedale San Raffaele"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5452-0210","authenticated-orcid":false,"given":"Izabella","family":"Uchmanowicz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1674-5317","authenticated-orcid":false,"given":"Angela","family":"Sciacqua","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/0530bdk91","id-type":"ROR","asserted-by":"publisher"}],"name":"Magna Graecia University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7661-651X","authenticated-orcid":false,"given":"Pablo","family":"D\u00edez-Villanueva","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/03cg5md32","id-type":"ROR","asserted-by":"publisher"}],"name":"Hospital Universitario de La Princesa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0226-5083","authenticated-orcid":false,"given":"Shirley","family":"Sze","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/04h699437","id-type":"ROR","asserted-by":"publisher"}],"name":"University of Leicester"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7568-9568","authenticated-orcid":false,"given":"Quin E","family":"Denfeld","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/009avj582","id-type":"ROR","asserted-by":"publisher"}],"name":"Oregon Health & Science University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4406-8555","authenticated-orcid":false,"given":"Markus S","family":"Anker","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/001w7jn25","id-type":"ROR","asserted-by":"publisher"}],"name":"Charit\u00e9 - Universit\u00e4tsmedizin Berlin"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elena","family":"Marques-Sule","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/043nxc105","id-type":"ROR","asserted-by":"publisher"}],"name":"Universitat de Val\u00e8ncia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Str\u00f6mberg","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/05ynxx418","id-type":"ROR","asserted-by":"publisher"}],"name":"Link\u00f6ping University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emanuelle","family":"Berthelot","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/05c9p1x46","id-type":"ROR","asserted-by":"publisher"}],"name":"Bic\u00eatre Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephan","family":"von Haehling","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/021ft0n22","id-type":"ROR","asserted-by":"publisher"}],"name":"Universit\u00e4tsmedizin G\u00f6ttingen"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giuseppe","family":"Rosano","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/02rwycx38","id-type":"ROR","asserted-by":"publisher"}],"name":"San Raffaele University of Rome"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7598-708X","authenticated-orcid":false,"given":"Wolfram","family":"Doehner","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/001w7jn25","id-type":"ROR","asserted-by":"publisher"}],"name":"Charit\u00e9 - Universit\u00e4tsmedizin Berlin"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuhui","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Camilla","family":"Hage","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/056d84691","id-type":"ROR","asserted-by":"publisher"}],"name":"Karolinska Institutet"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"6096","published-online":{"date-parts":[[2026,8,3]]},"reference":[{"key":"ref0","unstructured":"Vitale C, Berthelot E, Coats AJS, et al. Assessment of frailty in patients with heart failure: a new Heart Failure Frailty Score developed by Delphi consensus. ESC Heart Fail 2025;12:1818\u201331. https:\/\/doi.org\/10.1002\/ehf2.15187; PMID:\u00a039904922."},{"key":"ref1","doi-asserted-by":"crossref","unstructured":"Denfeld QE, Winters-Stone K, Mudd JO, et al. The prevalence of frailty in heart failure: a systematic review and meta-analysis. Int J Cardiol 2017;236:283\u20139. https:\/\/doi.org\/10.1016\/j.ijcard.2017.01.153; PMID:\u00a028215466.","DOI":"10.1016\/j.ijcard.2017.01.153"},{"key":"ref2","doi-asserted-by":"crossref","unstructured":"Uchmanowicz I, Lee CS, Vitale C, et al. Frailty and the risk of all-cause mortality and hospitalization in chronic heart failure: a meta-analysis. ESC Heart Fail 2020;7:3427\u201337. https:\/\/doi.org\/10.1002\/ehf2.12827; PMID:\u00a032955168.","DOI":"10.1002\/ehf2.12827"},{"key":"ref3","doi-asserted-by":"crossref","unstructured":"Zhang Y, Yuan M, Gong M, et al. Frailty and clinical outcomes in heart failure: a systematic review and meta-analysis. J Am Med Dir Assoc 2018;19:1003\u20138. https:\/\/doi.org\/10.1016\/j.jamda.2018.06.009; PMID:\u00a030076123.","DOI":"10.1016\/j.jamda.2018.06.009"},{"key":"ref4","doi-asserted-by":"crossref","unstructured":"Yang X, Lup\u00f3n J, Vid\u00e1n MT, et al. Impact of frailty on mortality and hospitalization in chronic heart failure: a systematic review and meta-analysis. J Am Heart Assoc 2018;7:e008251. https:\/\/doi.org\/10.1161\/JAHA.117.008251; PMID:\u00a030571603.","DOI":"10.1161\/JAHA.117.008251"},{"key":"ref5","doi-asserted-by":"crossref","unstructured":"Jim\u00e9nez-M\u00e9ndez C, D\u00edez-Villanueva P, Bonanad C, et al. Frailty and prognosis of older patients with chronic heart failure. Rev Esp Cardiol (Engl Ed) 2022;75:1011\u20139. https:\/\/doi.org\/10.1016\/j.rec.2022.04.016; PMID:\u00a035718066.","DOI":"10.1016\/j.rec.2022.04.016"},{"key":"ref6","doi-asserted-by":"crossref","unstructured":"Sokoreli I, Pauws SC, Steyerberg EW, et al. Prognostic value of psychosocial factors for first and recurrent hospitalizations and mortality in heart failure patients: insights from the OPERA-HF study. Eur J Heart Fail 2018;20:689\u201396. https:\/\/doi.org\/10.1002\/ejhf.1112; PMID:\u00a029314447.","DOI":"10.1002\/ejhf.1112"},{"key":"ref7","doi-asserted-by":"crossref","unstructured":"Matsue Y, Kamiya K, Saito H, et al. Prevalence and prognostic impact of the coexistence of multiple frailty domains in elderly patients with heart failure: the FRAGILE-HF cohort study. Eur J Heart Fail 2020;22:2112\u20139. https:\/\/doi.org\/10.1002\/ejhf.1926; PMID:\u00a032500539.","DOI":"10.1002\/ejhf.1926"},{"key":"ref8","doi-asserted-by":"crossref","unstructured":"Fried LP, Tangen CM, Walston J, et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci 2001;56:M146\u201356. https:\/\/doi.org\/10.1093\/gerona\/56.3.M146; PMID:\u00a011253156.","DOI":"10.1093\/gerona\/56.3.M146"},{"key":"ref9","doi-asserted-by":"crossref","unstructured":"Guralnik JM, Simonsick EM, Ferrucci L, et al. A short physical performance battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission. J Gerontol 1994;49:M85\u201394. https:\/\/doi.org\/10.1093\/geronj\/49.2.M85; PMID:\u00a08126356.","DOI":"10.1093\/geronj\/49.2.M85"},{"key":"ref10","doi-asserted-by":"crossref","unstructured":"Jones DM, Song X, Rockwood K. Operationalizing a frailty index from a standardized comprehensive geriatric assessment. J Am Geriatr Soc 2004;52:1929\u201333. https:\/\/doi.org\/10.1111\/j.1532-5415.2004.52521.x; PMID:\u00a015507074.","DOI":"10.1111\/j.1532-5415.2004.52521.x"},{"key":"ref11","doi-asserted-by":"crossref","unstructured":"Hwang R, Morris NR, Mandrusiak A, et al. Timed up and go test: a reliable and valid test in patients with chronic heart failure. J Card Fail 2016;22:646\u201350. https:\/\/doi.org\/10.1016\/j.cardfail.2015.09.018; PMID:\u00a026456063.","DOI":"10.1016\/j.cardfail.2015.09.018"},{"key":"ref12","doi-asserted-by":"crossref","unstructured":"Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987;40:373\u201383. https:\/\/doi.org\/10.1016\/0021-9681(87)90171-8; PMID:\u00a03558716.","DOI":"10.1016\/0021-9681(87)90171-8"},{"key":"ref13","doi-asserted-by":"crossref","unstructured":"Guigoz Y, Vellas B, Garry PJ. Assessing the nutritional status of the elderly: the Mini Nutritional Assessment as part of the geriatric evaluation. Nutr Rev 1996;54:S59\u201365. https:\/\/doi.org\/10.1111\/j.1753-4887.1996.tb03793.x; PMID:\u00a08919685.","DOI":"10.1111\/j.1753-4887.1996.tb03793.x"},{"key":"ref14","doi-asserted-by":"crossref","unstructured":"Romero-Ortuno R, Walsh CD, Lawlor BA, Kenny RA. A frailty instrument for primary care: findings from the Survey of Health, Ageing and Retirement in Europe (SHARE). BMC Geriatr 2010;10:57. https:\/\/doi.org\/10.1186\/1471-2318-10-57; PMID:\u00a020731877.","DOI":"10.1186\/1471-2318-10-57"},{"key":"ref15","doi-asserted-by":"crossref","unstructured":"Studenski S, Perera S, Patel K, et al. Gait speed and survival in older adults. JAMA 2011;305:50\u20138. https:\/\/doi.org\/10.1001\/jama.2010.1923; PMID:\u00a021205966.","DOI":"10.1001\/jama.2010.1923"},{"key":"ref16","doi-asserted-by":"crossref","unstructured":"Izawa KP, Watanabe S, Osada N, et al. Handgrip strength as a predictor of prognosis in Japanese patients with congestive heart failure. Eur J Cardiovasc Prev Rehabil 2009;16:21\u20137. https:\/\/doi.org\/10.1097\/HJR.0b013e32831269a3; PMID:\u00a019237993.","DOI":"10.1097\/HJR.0b013e32831269a3"},{"key":"ref17","doi-asserted-by":"crossref","unstructured":"Folstein MF, Folstein SE, McHugh PR. \u201cMini-mental state\u201d: a practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975;12:189\u201398. https:\/\/doi.org\/10.1016\/0022-3956(75)90026-6; PMID:\u00a01202204.","DOI":"10.1016\/0022-3956(75)90026-6"},{"key":"ref18","doi-asserted-by":"crossref","unstructured":"Nasreddine ZS, Phillips NA, B\u00e9dirian V, et al. The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment. J Am Geriatr Soc 2005;53:695\u20139. https:\/\/doi.org\/10.1111\/j.1532-5415.2005.53221.x; PMID:\u00a015817019.","DOI":"10.1111\/j.1532-5415.2005.53221.x"},{"key":"ref19","doi-asserted-by":"crossref","unstructured":"Borson S, Scanlan J, Brush M, et al. The Mini-Cog: a cognitive \u201cvital signs\u201d measure for dementia screening in multi-lingual elderly. Int J Geriatr Psychiatry 2000;15:1021\u20137. https:\/\/doi.org\/10.1002\/1099-1166(200011)15:11<1021::AID-GPS234>3.0.CO;2-6; PMID:\u00a011113982.","DOI":"10.1002\/1099-1166(200011)15:11<1021::AID-GPS234>3.0.CO;2-6"},{"key":"ref20","doi-asserted-by":"crossref","unstructured":"Whooley MA, Avins AL, Miranda J, Browner WS. Case-finding instruments for depression. Two questions are as good as many. J Gen Intern Med 1997;12:439\u201345. https:\/\/doi.org\/10.1046\/j.1525-1497.1997.00076.x; PMID:\u00a09229283.","DOI":"10.1046\/j.1525-1497.1997.00076.x"},{"key":"ref21","doi-asserted-by":"crossref","unstructured":"Kroenke K, Spitzer RL, Williams JBW. The Patient Health Questionnaire-2: validity of a two-item depression screener. Med Care 2003;41:1284\u201392. https:\/\/doi.org\/10.1097\/01.MLR.0000093487.78664.3C; PMID:\u00a014583691.","DOI":"10.1097\/01.MLR.0000093487.78664.3C"},{"key":"ref22","doi-asserted-by":"crossref","unstructured":"Yesavage JA, Brink TL, Rose TL, et al. Development and validation of a geriatric depression screening scale: a preliminary report. J Psychiatr Res 1982;17:37\u201349. https:\/\/doi.org\/10.1016\/0022-3956(82)90033-4; PMID:\u00a07183759.","DOI":"10.1016\/0022-3956(82)90033-4"},{"key":"ref23","doi-asserted-by":"crossref","unstructured":"Yesavage JA, Sheikh JI. 9\/Geriatric Depression Scale (GDS). Clin Gerontol 1986;5:165\u201373. https:\/\/doi.org\/10.1300\/J018v05n01_09.","DOI":"10.1300\/J018v05n01_09"},{"key":"ref24","doi-asserted-by":"crossref","unstructured":"Kroenke K, Spitzer RL, Williams JBW, et al. Anxiety disorders in primary care: prevalence, impairment, comorbidity, and detection. Ann Intern Med 2007;146:317\u201325. https:\/\/doi.org\/10.7326\/0003-4819-146-5-200703060-00004; PMID:\u00a017339617.","DOI":"10.7326\/0003-4819-146-5-200703060-00004"},{"key":"ref25","doi-asserted-by":"crossref","unstructured":"Spitzer RL, Kroenke K, Williams JBW, L\u00f6we B. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med 2006;166:1092\u20137. https:\/\/doi.org\/10.1001\/archinte.166.10.1092; PMID:\u00a016717171.","DOI":"10.1001\/archinte.166.10.1092"},{"key":"ref26","doi-asserted-by":"crossref","unstructured":"Makizako H, Shimada H, Tsutsumimoto K, et al. Social frailty in community-dwelling older adults as a risk factor for disability. J Am Med Dir Assoc 2015;16:1003.e7\u201311. https:\/\/doi.org\/10.1016\/j.jamda.2015.08.023; PMID:\u00a026482055.","DOI":"10.1016\/j.jamda.2015.08.023"},{"key":"ref27","doi-asserted-by":"crossref","unstructured":"Lubben JE. Assessing social networks among elderly populations. Fam Community Health 1988;11:42\u201352. https:\/\/doi.org\/10.1097\/00003727-198811000-00008.","DOI":"10.1097\/00003727-198811000-00008"},{"key":"ref28","doi-asserted-by":"crossref","unstructured":"Lubben J, Blozik E, Gillmann G, et al. Performance of an abbreviated version of the Lubben Social Network Scale among three European Community-dwelling older adult populations. Gerontologist 2006;46:503\u201313. https:\/\/doi.org\/10.1093\/geront\/46.4.503; PMID:\u00a016921004.","DOI":"10.1093\/geront\/46.4.503"},{"key":"ref29","doi-asserted-by":"crossref","unstructured":"Russell D, Peplau LA, Ferguson ML. Developing a measure of loneliness. J Pers Assess 1978;42:290\u20134. https:\/\/doi.org\/10.1207\/s15327752jpa4203_11; PMID:\u00a0660402.","DOI":"10.1207\/s15327752jpa4203_11"},{"key":"ref30","doi-asserted-by":"crossref","unstructured":"Takabayashi K, Kitaguchi S, Nohara R. Living alone combined with physical frailty or cognitive frailty is independent risk factor of outcomes in the patients with acute heart failure after discharge. Eur Heart J 2020;41(Suppl 2):ehaa946.3073. https:\/\/doi.org\/10.1093\/ehjci\/ehaa946.3073.","DOI":"10.1093\/ehjci\/ehaa946.3073"},{"key":"ref31","doi-asserted-by":"crossref","unstructured":"D\u00edez-Villanueva P, Ariz\u00e1-Sol\u00e9 A, Vid\u00e1n MT, et al. Recommendations of the geriatric cardiology section of the Spanish Society of Cardiology for the assessment of frailty in elderly patients with heart disease. Rev Esp Cardiol (Engl Ed) 2019;72:63\u201371. https:\/\/doi.org\/10.1016\/j.rec.2018.06.035; PMID:\u00a030269913.","DOI":"10.1016\/j.rec.2018.06.035"},{"key":"ref32","doi-asserted-by":"crossref","unstructured":"Tromp J, Ouwerkerk W, van Veldhuisen DJ, et al. A systematic review and network meta-analysis of pharmacological treatment of heart failure with reduced ejection fraction. JACC Heart Fail 2022;10:73\u201384. https:\/\/doi.org\/10.1016\/j.jchf.2021.09.004; PMID:\u00a034895860.","DOI":"10.1016\/j.jchf.2021.09.004"},{"key":"ref33","unstructured":"McDonagh TA, Metra M, Adamo M, et al. 2021 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J 2021;42:3599\u2013726. https:\/\/doi.org\/10.1093\/eurheartj\/ehab368; PMID:\u00a034447992."},{"key":"ref34","doi-asserted-by":"crossref","unstructured":"Jhund PS, Talebi A, Henderson AD, et al. Mineralocorticoid receptor antagonists in heart failure: an individual patient level meta-analysis. Lancet 2024;404:1119\u201331. https:\/\/doi.org\/10.1016\/S0140-6736(24)01733-1; PMID:\u00a039232490.","DOI":"10.1016\/S0140-6736(24)01733-1"},{"key":"ref35","doi-asserted-by":"crossref","unstructured":"Solomon SD, McMurray JJV, Vaduganathan M, et al. Finerenone in heart failure with mildly reduced or preserved ejection fraction. N Engl J Med 2024;391:1475\u201385. https:\/\/doi.org\/10.1056\/NEJMoa2407107; PMID:\u00a039225278.","DOI":"10.1056\/NEJMe2410904"},{"key":"ref36","doi-asserted-by":"crossref","unstructured":"Karakasis P, Fragakis N, Patoulias D, et al. The emerging role of glucagon-like peptide-1 receptor agonists in the management of obesity-related heart failure with preserved ejection fraction: benefits beyond what scales can measure? Biomedicines 2024;12:2112. https:\/\/doi.org\/10.3390\/biomedicines12092112; PMID:\u00a039335625.","DOI":"10.3390\/biomedicines12092112"},{"key":"ref37","doi-asserted-by":"crossref","unstructured":"Kosiborod MN, Deanfield J, Pratley R, et al. Semaglutide versus placebo in patients with heart failure and mildly reduced or preserved ejection fraction: a pooled analysis of the SELECT, FLOW, STEP-HFpEF, and STEP-HFpEF DM randomised trials. Lancet 2024;404:949\u201361. https:\/\/doi.org\/10.1016\/S0140-6736(24)01643-X; PMID:\u00a039222642.","DOI":"10.1016\/S0140-6736(24)01643-X"},{"key":"ref38","doi-asserted-by":"crossref","unstructured":"Savarese G, Lindberg F, Cannata A, et al. How to tackle therapeutic inertia in heart failure with reduced ejection fraction. A scientific statement of the Heart Failure Association of the ESC. Eur J Heart Fail 2024;26:1278\u201397. https:\/\/doi.org\/10.1002\/ejhf.3295; PMID:\u00a038778738.","DOI":"10.1002\/ejhf.3295"},{"key":"ref39","doi-asserted-by":"crossref","unstructured":"Hamada T, Kubo T, Kawai K, et al. Frailty interferes with the guideline-directed medical therapy in heart failure patients with reduced ejection fraction. ESC Heart Fail 2023;10:223\u201333. https:\/\/doi.org\/10.1002\/ehf2.14163; PMID:\u00a036193578.","DOI":"10.1002\/ehf2.14163"},{"key":"ref40","doi-asserted-by":"crossref","unstructured":"Nijskens CM, Handoko L, Remmelzwaal S, et al. Efficacy and safety of heart failure treatment according to frailty status: a systematic review. J Am Heart Assoc 2025;14:e042367. https:\/\/doi.org\/10.1161\/JAHA.125.042367; PMID:\u00a040878979.","DOI":"10.1161\/JAHA.125.042367"},{"key":"ref41","doi-asserted-by":"crossref","unstructured":"Lai HY, Huang ST, Anker SD, et al. The burden of frailty in heart failure: prevalence, impacts on clinical outcomes and the role of heart failure medications. J Cachexia Sarcopenia Muscle 2024;15:660\u201370. https:\/\/doi.org\/10.1002\/jcsm.13412; PMID:\u00a038291000.","DOI":"10.1002\/jcsm.13412"},{"key":"ref42","doi-asserted-by":"crossref","unstructured":"Abe T, Jujo K, Maeda D, et al. The interaction between physical frailty and prognostic impact of heart failure medication in elderly patients. ESC Heart Fail 2023;10:1698\u2013705. https:\/\/doi.org\/10.1002\/ehf2.14114; PMID:\u00a036824014.","DOI":"10.1002\/ehf2.14114"},{"key":"ref43","unstructured":"Butt JH, Jhund PS, Belohl\u00e1vek J, et al. Efficacy and safety of dapagliflozin according to frailty in patients with heart failure: a prespecified analysis of the DELIVER trial. Circulation 2022;146:1210\u201324. https:\/\/doi.org\/10.1161\/CIRCULATIONAHA.122.061754; PMID:\u00a036029465."},{"key":"ref44","doi-asserted-by":"crossref","unstructured":"Butt JH, Dewan P, Merkely B, et al. Efficacy and safety of dapagliflozin according to frailty in heart failure with reduced ejection fraction: a post hoc analysis of the DAPA-HF trial. Ann Intern Med 2022;175:820\u201330. https:\/\/doi.org\/10.7326\/M21-4776; PMID:\u00a035467935.","DOI":"10.7326\/M21-4776"},{"key":"ref45","doi-asserted-by":"crossref","unstructured":"Sanders NA, Supiano MA, Lewis EF, et al. The frailty syndrome and outcomes in the TOPCAT trial. Eur J Heart Fail 2018;20:1570\u20137. https:\/\/doi.org\/10.1002\/ejhf.1308; PMID:\u00a030225878.","DOI":"10.1002\/ejhf.1308"},{"key":"ref46","unstructured":"Butt JH, Dewan P, Jhund PS, et al. Sacubitril\/Valsartan and frailty in patients with heart failure and preserved ejection fraction. J Am Coll Cardiol 2022;80:1130\u201343. https:\/\/doi.org\/10.1016\/j.jacc.2022.06.037; PMID:\u00a036050227."},{"key":"ref47","doi-asserted-by":"crossref","unstructured":"Butt JH, Jhund PS, Henderson AD, et al. Finerenone according to frailty in heart failure: a prespecified analysis of the FINEARTS-HF randomized clinical trial. JAMA Cardiol 2025;10:829\u201340. https:\/\/doi.org\/10.1001\/jamacardio.2025.1775; PMID:\u00a040531488.","DOI":"10.1001\/jamacardio.2025.1775"},{"key":"ref48","doi-asserted-by":"crossref","unstructured":"Ladage D, Schwinger RHG, Brixius K. Cardio-selective beta-blocker: pharmacological evidence and their influence on exercise capacity. Cardiovasc Ther 2013;31:76\u201383. https:\/\/doi.org\/10.1111\/j.1755-5922.2011.00306.x; PMID:\u00a022279967.","DOI":"10.1111\/j.1755-5922.2011.00306.x"},{"key":"ref49","unstructured":"Hikoso S, Kida H, Sunaga A, et al. \u03b2-blockers may be detrimental in frail patients with heart failure with preserved ejection fraction. Clin Res Cardiol 2024;113:842\u201355. https:\/\/doi.org\/10.1007\/s00392-023-02301-5; PMID:\u00a038019285."},{"key":"ref50","doi-asserted-by":"crossref","unstructured":"Nakano I, Tsuda M, Kinugawa S, et al. Loop diuretic use is associated with skeletal muscle wasting in patients with heart failure. J Cardiol 2020;76:109\u201314. https:\/\/doi.org\/10.1016\/j.jjcc.2020.01.003; PMID:\u00a032001074.","DOI":"10.1016\/j.jjcc.2020.01.003"},{"key":"ref51","doi-asserted-by":"crossref","unstructured":"Bai X, Han B, Zhang M, et al. The association between diuretics and falls in older adults: a systematic review and meta-analysis. Geriatr Nurs 2023;52:106\u201314. https:\/\/doi.org\/10.1016\/j.gerinurse.2023.05.009; PMID:\u00a037290215.","DOI":"10.1016\/j.gerinurse.2023.05.009"},{"key":"ref52","doi-asserted-by":"crossref","unstructured":"2019 American Geriatrics Society Beers Criteria\u00ae Update Expert Panel. American Geriatrics Society 2019 Updated AGS beers Criteria\u00ae for potentially inappropriate medication use in older adults. J Am Geriatr Soc 2019;67:674\u201394. https:\/\/doi.org\/10.1111\/jgs.15767; PMID:\u00a030693946.","DOI":"10.1111\/jgs.15767"},{"key":"ref53","doi-asserted-by":"crossref","unstructured":"O\u2019Mahony D, O\u2019Sullivan D, Byrne S, et al. STOPP\/START criteria for potentially inappropriate prescribing in older people: version 2. Age Ageing 2015;44:213\u20138. https:\/\/doi.org\/10.1093\/ageing\/afu145; PMID:\u00a025324330.","DOI":"10.1093\/ageing\/afu145"},{"key":"ref54","doi-asserted-by":"crossref","unstructured":"Segar MW, Keshvani N, Singh S, et al. Frailty status modifies the efficacy of ICD therapy for primary prevention among patients with HF. JACC Heart Fail 2024;12:757\u201367. https:\/\/doi.org\/10.1016\/j.jchf.2023.06.009; PMID:\u00a037565972.","DOI":"10.1016\/j.jchf.2023.06.009"},{"key":"ref55","doi-asserted-by":"crossref","unstructured":"Wilson DG, Sharma-Oates A, Sheldon J, et al. Predictors of death without prior appropriate therapy in ICD recipients: the comorbidities, frailty and functional status (COMFFORT study). Open Heart 2024;11:e002574. https:\/\/doi.org\/10.1136\/openhrt-2023-002574; PMID:\u00a039401956.","DOI":"10.1136\/openhrt-2023-002574"},{"key":"ref56","unstructured":"Slaughter MS, Rogers JG, Milano CA, et al. Advanced heart failure treated with continuous-flow left ventricular assist device. N Engl J Med 2009;361:2241\u201351. https:\/\/doi.org\/10.1056\/NEJMoa0909938; PMID:\u00a019920051."},{"key":"ref57","doi-asserted-by":"crossref","unstructured":"Aili SR, Lo P, Villanueva JE, et al. Prevention and reversal of frailty in heart failure: a systematic review. Circ J 2021;86:14\u201322. https:\/\/doi.org\/10.1253\/circj.CJ-21-0819; PMID:\u00a034707071.","DOI":"10.1253\/circj.CJ-21-0819"},{"key":"ref58","doi-asserted-by":"crossref","unstructured":"Flint KM, Matlock DD, Lindenfeld J, Allen LA. Frailty and the selection of patients for destination therapy left ventricular assist device. Circ Heart Fail 2012;5:286\u201393. https:\/\/doi.org\/10.1161\/CIRCHEARTFAILURE.111.963215; PMID:\u00a022438521.","DOI":"10.1161\/CIRCHEARTFAILURE.111.963215"},{"key":"ref59","doi-asserted-by":"crossref","unstructured":"Soysal P, Veronese N, Arik F, et al. Mini Nutritional Assessment Scale-Short Form can be useful for frailty screening in older adults. Clin Interv Aging 2019;14:693\u20139. https:\/\/doi.org\/10.2147\/CIA.S196770; PMID:\u00a031118593.","DOI":"10.2147\/CIA.S196770"},{"key":"ref60","doi-asserted-by":"crossref","unstructured":"Prado CM, Landi F, Chew STH, et al. Advances in muscle health and nutrition: a toolkit for healthcare professionals. Clin Nutr 2022;41:2244\u201363. https:\/\/doi.org\/10.1016\/j.clnu.2022.07.041; PMID:\u00a036081299.","DOI":"10.1016\/j.clnu.2022.07.041"},{"key":"ref61","doi-asserted-by":"crossref","unstructured":"Koliaki C, Spinos T, Spinou \u039c, et al. Defining the optimal dietary approach for safe, effective and sustainable weight loss in overweight and obese adults. Healthcare (Basel) 2018;6:73. https:\/\/doi.org\/10.3390\/healthcare6030073; PMID:\u00a029958395.","DOI":"10.3390\/healthcare6030073"},{"key":"ref62","doi-asserted-by":"crossref","unstructured":"Rhee CM, Ahmadi SF, Kovesdy CP, Kalantar-Zadeh K. Low-protein diet for conservative management of chronic kidney disease: a systematic review and meta-analysis of controlled trials. J Cachexia Sarcopenia Muscle 2018;9:235\u201345. https:\/\/doi.org\/10.1002\/jcsm.12264; PMID:\u00a029094800.","DOI":"10.1002\/jcsm.12264"},{"key":"ref63","doi-asserted-by":"crossref","unstructured":"Heidenreich PA, Bozkurt B, Aguilar D, et al. 2022 AHA\/ACC\/HFSA guideline for the management of heart failure: a report of the American College of Cardiology\/American Heart Association joint committee on clinical practice guidelines. Circulation 2022;145:e895\u2013e1032. https:\/\/doi.org\/10.1161\/CIR.0000000000001063; PMID:\u00a035363499.","DOI":"10.1161\/CIR.0000000000001073"},{"key":"ref64","unstructured":"Cruz-Jentoft AJ, Bahat G, Bauer J, et al. Sarcopenia: revised European consensus on definition and diagnosis. Age Ageing 2019;48:16\u201331. https:\/\/doi.org\/10.1093\/ageing\/afy169; PMID:\u00a030312372."},{"key":"ref65","doi-asserted-by":"crossref","unstructured":"Herrmann JJ, Brunner-La Rocca HP, Baltussen LEHJM, et al. Liberal fluid intake versus fluid restriction in chronic heart failure: a randomized clinical trial. Nat Med 2025;31:2062\u20138. https:\/\/doi.org\/10.1038\/s41591-025-03628-4; PMID:\u00a040159556.","DOI":"10.1038\/s41591-025-03628-4"},{"key":"ref66","doi-asserted-by":"crossref","unstructured":"Ezekowitz JA, Colin-Ramirez E, Ross H, et al. Reduction of dietary sodium to less than 100\u00a0mmol in heart failure (SODIUM-HF): an international, open-label, randomised, controlled trial. Lancet 2022;399:1391\u2013400. https:\/\/doi.org\/10.1016\/S0140-6736(22)00369-5; PMID:\u00a035381194.","DOI":"10.1016\/S0140-6736(22)00369-5"},{"key":"ref67","doi-asserted-by":"crossref","unstructured":"Mullens W, Damman K, Dhont S, et al. Dietary sodium and fluid intake in heart failure. A clinical consensus statement of the Heart Failure Association of the ESC. Eur J Heart Fail 2024;26:730\u201341. https:\/\/doi.org\/10.1002\/ejhf.3244; PMID:\u00a038606657.","DOI":"10.1002\/ejhf.3244"},{"key":"ref68","doi-asserted-by":"crossref","unstructured":"Wu XS, Miles A, Braakhuis AJ. Texture-modified diets, nutritional status and mealtime satisfaction: a systematic review. Healthcare (Basel) 2021;9:624. https:\/\/doi.org\/10.3390\/healthcare9060624; PMID:\u00a034073835.","DOI":"10.3390\/healthcare9060624"},{"key":"ref69","doi-asserted-by":"crossref","unstructured":"von Haehling S, Arzt M, Doehner W, et al. Improving exercise capacity and quality of life using non-invasive heart failure treatments: evidence from clinical trials. Eur J Heart Fail 2021;23:92\u2013113. https:\/\/doi.org\/10.1002\/ejhf.1838; PMID:\u00a032392403.","DOI":"10.1002\/ejhf.1838"},{"key":"ref70","unstructured":"D\u00edez-Villanueva P, Jim\u00e9nez-M\u00e9ndez C, Pardo HG, et al. The role of cardiovascular rehabilitation in the elderly patient. Cardiology 2024;149:561\u201370. https:\/\/doi.org\/10.1159\/000539766; PMID:\u00a038865979."},{"key":"ref71","doi-asserted-by":"crossref","unstructured":"Kitzman DW, Whellan DJ, Duncan P, et al. Physical rehabilitation for older patients hospitalized for heart failure. N Engl J Med 2021;385:203\u201316. https:\/\/doi.org\/10.1056\/NEJMoa2026141; PMID:\u00a033999544.","DOI":"10.1056\/NEJMoa2026141"},{"key":"ref72","doi-asserted-by":"crossref","unstructured":"Pandey A, Segar MW, Singh S, et al. Frailty status modifies the efficacy of exercise training among patients with chronic heart failure and reduced ejection fraction: an analysis from the HF-ACTION trial. Circulation 2022;146:80\u201390. https:\/\/doi.org\/10.1161\/CIRCULATIONAHA.122.059983; PMID:\u00a035616018.","DOI":"10.1161\/CIRCULATIONAHA.122.059983"},{"key":"ref73","doi-asserted-by":"crossref","unstructured":"Angulo J, El Assar M, \u00c1lvarez-Bustos A, Rodr\u00edguez-Ma\u00f1as L. Physical activity and exercise: strategies to manage frailty. Redox Biol 2020;35:101513. https:\/\/doi.org\/10.1016\/j.redox.2020.101513; PMID:\u00a032234291.","DOI":"10.1016\/j.redox.2020.101513"},{"key":"ref74","doi-asserted-by":"crossref","unstructured":"Taylor JL, Myers J, Bonikowske AR. Practical guidelines for exercise prescription in patients with chronic heart failure. Heart Fail Rev 2023;28:1285\u201396. https:\/\/doi.org\/10.1007\/s10741-023-10310-9; PMID:\u00a037071253.","DOI":"10.1007\/s10741-023-10310-9"},{"key":"ref75","doi-asserted-by":"crossref","unstructured":"Kitzman DW, Brubaker PH, Morgan TM, et al. Exercise training in older patients with heart failure and preserved ejection fraction: a randomized, controlled, single-blind trial. Circ Heart Fail 2010;3:659\u201367. https:\/\/doi.org\/10.1161\/CIRCHEARTFAILURE.110.958785; PMID:\u00a020852060.","DOI":"10.1161\/CIRCHEARTFAILURE.110.958785"},{"key":"ref76","doi-asserted-by":"crossref","unstructured":"Bray NW, Smart RR, Jakobi JM, Jones GR. Exercise prescription to reverse frailty. Appl Physiol Nutr Metab 2016;41:1112\u20136. https:\/\/doi.org\/10.1139\/apnm-2016-0226; PMID:\u00a027649859.","DOI":"10.1139\/apnm-2016-0226"},{"key":"ref77","doi-asserted-by":"crossref","unstructured":"Dent E, Daly RM, Hoogendijk EO, Scott D. Exercise to prevent and manage frailty and fragility fractures. Curr Osteoporos Rep 2023;21:205\u201315. https:\/\/doi.org\/10.1007\/s11914-023-00777-8; PMID:\u00a036976491.","DOI":"10.1007\/s11914-023-00777-8"},{"key":"ref78","doi-asserted-by":"crossref","unstructured":"Afilalo J. Evaluating and treating frailty in cardiac rehabilitation. Clin Geriatr Med 2019;35:445\u201357. https:\/\/doi.org\/10.1016\/j.cger.2019.07.002; PMID:\u00a031543177.","DOI":"10.1016\/j.cger.2019.07.002"},{"key":"ref79","doi-asserted-by":"crossref","unstructured":"Goyal P, Didomenico RJ, Pressler SJ, et al. Cognitive impairment in heart failure: a Heart Failure Society of America scientific statement. J Card Fail 2024;30:488\u2013504. https:\/\/doi.org\/10.1016\/j.cardfail.2024.01.003; PMID:\u00a038485295.","DOI":"10.1016\/j.cardfail.2024.01.003"},{"key":"ref80","doi-asserted-by":"crossref","unstructured":"Gary RA, Paul S, Corwin E, et al. Exercise and cognitive training as a strategy to improve neurocognitive outcomes in heart failure: a pilot study. Am J Geriatr Psychiatry 2019;27:809\u201319. https:\/\/doi.org\/10.1016\/j.jagp.2019.01.211; PMID:\u00a030910420.","DOI":"10.1016\/j.jagp.2019.01.211"},{"key":"ref81","doi-asserted-by":"crossref","unstructured":"Dinesh V, Pierce R, Hespe L, et al. The relationship between rehabilitation and frailty in advanced heart or lung disease. Transplant Direct 2024;10:e1606. https:\/\/doi.org\/10.1097\/TXD.0000000000001606; PMID:\u00a038464429.","DOI":"10.1097\/TXD.0000000000001606"},{"key":"ref82","doi-asserted-by":"crossref","unstructured":"Lee C, Lee J, Jeong H, et al. Unsupervised frailty intervention by digitalized exercise coaching: a feasibility study. Sensors (Basel) 2025;25:3674. https:\/\/doi.org\/10.3390\/s25123674; PMID:\u00a040573561.","DOI":"10.3390\/s25123674"},{"key":"ref83","doi-asserted-by":"crossref","unstructured":"Izquierdo M, Merchant RA, Morley JE, et al. International exercise recommendations in older adults (ICFSR): expert consensus guidelines. J Nutr Health Aging 2021;25:824\u201353. https:\/\/doi.org\/10.1007\/s12603-021-1665-8; PMID:\u00a034409961.","DOI":"10.1007\/s12603-021-1665-8"},{"key":"ref84","doi-asserted-by":"crossref","unstructured":"Faulkner KM, Uchmanowicz I, Lisiak M, et al. Cognition and frailty in patients with heart failure: a systematic review of the association between frailty and cognitive impairment. Front Psychiatry 2021;12:713386. https:\/\/doi.org\/10.3389\/fpsyt.2021.713386; PMID:\u00a034276454.","DOI":"10.3389\/fpsyt.2021.713386"},{"key":"ref85","doi-asserted-by":"crossref","unstructured":"Wleklik M, Lee CS, Lewandowski \u0141, et al. Frailty determinants in heart failure: inflammatory markers, cognitive impairment and psychosocial interaction. ESC Heart Fail 2025;12:2010\u201322. https:\/\/doi.org\/10.1002\/ehf2.15208; PMID:\u00a039853613.","DOI":"10.1002\/ehf2.15208"},{"key":"ref86","doi-asserted-by":"crossref","unstructured":"Denfeld QE, Winters-Stone K, Mudd JO, et al. Identifying a relationship between physical frailty and heart failure symptoms. J Cardiovasc Nurs 2018;33:E1\u20137. https:\/\/doi.org\/10.1097\/JCN.0000000000000408; PMID:\u00a028353543.","DOI":"10.1097\/JCN.0000000000000408"},{"key":"ref87","doi-asserted-by":"crossref","unstructured":"Jaarsma T, Hill L, Bayes-Genis A, et al. Self-care of heart failure patients: practical management recommendations from the Heart Failure Association of the European Society of Cardiology. Eur J Heart Fail 2021;23:157\u201374. https:\/\/doi.org\/10.1002\/ejhf.2008; PMID:\u00a032945600.","DOI":"10.1002\/ejhf.2008"},{"key":"ref88","doi-asserted-by":"crossref","unstructured":"Hiriscau EI, Bodolea C. The role of depression and anxiety in frail patients with heart failure. Diseases 2019;7:45. https:\/\/doi.org\/10.3390\/diseases7020045; PMID:\u00a031248108.","DOI":"10.3390\/diseases7020045"},{"key":"ref89","doi-asserted-by":"crossref","unstructured":"Bu N, Leng M, Cao G, et al. Frailty and self-care maintenance mediated by social support and depression in older adults with heart failure. Nurs Res 2025;74:115\u201322. https:\/\/doi.org\/10.1097\/NNR.0000000000000795; PMID:\u00a039616428.","DOI":"10.1097\/NNR.0000000000000795"},{"key":"ref90","doi-asserted-by":"crossref","unstructured":"Vitale C, Spoletini I, Rosano GMC. The dual burden of frailty and heart failure. Int J Heart Fail 2024;6:107\u201316. https:\/\/doi.org\/10.36628\/ijhf.2023.0057; PMID:\u00a039081645.","DOI":"10.36628\/ijhf.2023.0057"},{"key":"ref91","doi-asserted-by":"crossref","unstructured":"Denfeld QE, Hiatt SO, Rosenkranz SJ, et al. Background and design of the Physical Frailty and Symptom Monitoring and Management Behaviors in Heart Failure (PRISM-HF) study: a mixed methods study. Int J Nurs Stud Adv 2025;8:100282. https:\/\/doi.org\/10.1016\/j.ijnsa.2024.100282; PMID:\u00a039811574.","DOI":"10.1016\/j.ijnsa.2024.100282"},{"key":"ref92","doi-asserted-by":"crossref","unstructured":"Rossi LP, Granger BB, Bruckel JT, et al. Person-centered models for cardiovascular care: a review of the evidence: a scientific statement from the American Heart Association. Circulation 2023;148:512\u201342. https:\/\/doi.org\/10.1161\/CIR.0000000000001141; PMID:\u00a037427418.","DOI":"10.1161\/CIR.0000000000001141"},{"key":"ref93","doi-asserted-by":"crossref","unstructured":"Wleklik M, Lisiak M, Nowak B, et al. Bidirectional relationship between depression and frailty syndrome in heart failure patients. Eur J Cardiovasc Nurs 2024;23(Suppl 1):zvae098.098. https:\/\/doi.org\/10.1093\/eurjcn\/zvae098.098.","DOI":"10.1093\/eurjcn\/zvae098.098"},{"key":"ref94","doi-asserted-by":"crossref","unstructured":"Uchmanowicz I, Faulkner KM, Iovino P, et al. Integrating frailty interventions into existing care models: a comprehensive approach to enhancing patient outcomes in chronic disease management. Front Public Health 2024;12:1518774. https:\/\/doi.org\/10.3389\/fpubh.2024.1518774; PMID:\u00a039906402.","DOI":"10.3389\/fpubh.2024.1518774"},{"key":"ref95","unstructured":"Ski CF, Taylor RS, McGuigan K, et al. Psychological interventions for depression and anxiety in patients with coronary heart disease, heart failure or atrial fibrillation. Cochrane Database Syst Rev 2024;4:CD013508. https:\/\/doi.org\/10.1002\/14651858.CD013508.pub3; PMID:\u00a038577875."},{"key":"ref96","doi-asserted-by":"crossref","unstructured":"Enard KR, Coleman AM, Yakubu RA, et al. Influence of social determinants of health on heart failure outcomes: a systematic review. J Am Heart Assoc 2023;12:e026590. https:\/\/doi.org\/10.1161\/JAHA.122.026590; PMID:\u00a036695317.","DOI":"10.1161\/JAHA.122.026590"},{"key":"ref97","doi-asserted-by":"crossref","unstructured":"Keshvani N, Pandey A. Beyond physical impairment: the role of social frailty in heart failure. J Am Heart Assoc 2021;10:e022187. https:\/\/doi.org\/10.1161\/JAHA.121.022187; PMID:\u00a034472383.","DOI":"10.1161\/JAHA.121.022187"},{"key":"ref98","doi-asserted-by":"crossref","unstructured":"Jaarsma T, Riegel B, Str\u00f6mberg A. Self-care: a well-known but yet elusive concept. A discussion of theories, concepts, interventions, and measurement. Eur J Cardiovasc Nurs 2025;24:160\u20134. https:\/\/doi.org\/10.1093\/eurjcn\/zvae124; PMID:\u00a039743225.","DOI":"10.1093\/eurjcn\/zvae124"},{"key":"ref99","doi-asserted-by":"crossref","unstructured":"Li J, Han J, Luo N, et al. Frailty affects self-care behavior in congestive heart failure. Clin Nurs Res 2022;31:615\u201323. https:\/\/doi.org\/10.1177\/10547738221075772; PMID:\u00a035168389.","DOI":"10.1177\/10547738221075772"},{"key":"ref100","doi-asserted-by":"crossref","unstructured":"Braun LT, Grady KL, Kutner JS, et al. Palliative care and cardiovascular disease and stroke: a policy statement from the American Heart Association\/American Stroke Association. Circulation 2016;134:e198\u2013225. https:\/\/doi.org\/10.1161\/CIR.0000000000000438; PMID:\u00a027503067.","DOI":"10.1161\/CIR.0000000000000438"},{"key":"ref101","doi-asserted-by":"crossref","unstructured":"Kavalieratos D, Gelfman LP, Tycon LE, et al. Palliative care in heart failure: rationale, evidence, and future priorities. J Am Coll Cardiol 2017;70:1919\u201330. https:\/\/doi.org\/10.1016\/j.jacc.2017.08.036; PMID:\u00a028982506.","DOI":"10.1016\/j.jacc.2017.08.036"},{"key":"ref102","unstructured":"Rogers JG, Patel CB, Mentz RJ, et al. Palliative care in heart failure: the PAL-HF randomized, controlled clinical trial. J Am Coll Cardiol 2017;70:331\u201341. https:\/\/doi.org\/10.1016\/j.jacc.2017.05.030; PMID:\u00a028705314."},{"key":"ref103","doi-asserted-by":"crossref","unstructured":"Kon AA, Davidson JE, Morrison W, et al. Shared decision making in ICUs: an American College of Critical Care Medicine and American Thoracic Society policy statement. Crit Care Med 2016;44:188\u2013201. https:\/\/doi.org\/10.1097\/CCM.0000000000001396; PMID:\u00a026509317.","DOI":"10.1097\/CCM.0000000000001396"},{"key":"ref104","doi-asserted-by":"crossref","unstructured":"Godfrey S, Barnes A, Gao J, et al. Shared decision-making in palliative and end-of-life care in the cardiac intensive care unit. US Cardiol 2024;18:e13. https:\/\/doi.org\/10.15420\/usc.2024.03; PMID:\u00a039494405.","DOI":"10.15420\/usc.2024.03"},{"key":"ref105","doi-asserted-by":"crossref","unstructured":"Pastrana T, Grant M, Andrade PH, et al. Mapping of current practices of palliative care for patients with heart failure throughout Europe: a scoping review. ESC Heart Fail 2025;12:4021\u201332. https:\/\/doi.org\/10.1002\/ehf2.15431; PMID:\u00a041017534.","DOI":"10.1002\/ehf2.15431"},{"key":"ref106","doi-asserted-by":"crossref","unstructured":"Vitale C, Spoletini I, Gianni W, et al. Instruments to measure frailty in patients with heart failure: a narrative review. Curr Heart Fail Rep 2025;22:26. https:\/\/doi.org\/10.1007\/s11897-025-00716-x; PMID:\u00a041042319.","DOI":"10.1007\/s11897-025-00716-x"},{"key":"ref107","doi-asserted-by":"crossref","unstructured":"Tinetti ME, Fried T. The end of the disease era. Am J Med 2004;116:179\u201385. https:\/\/doi.org\/10.1016\/j.amjmed.2003.09.031; PMID:\u00a014749162.","DOI":"10.1016\/j.amjmed.2003.09.031"},{"key":"ref108","unstructured":"Yun S, Enjuanes C, Calero-Molina E, et al. Effectiveness of telemedicine in patients with heart failure according to frailty phenotypes: insights from the iCOR randomised controlled trial. Eur J Intern Med 2022;96:49\u201359. https:\/\/doi.org\/10.1016\/j.ejim.2021.09.021; PMID:\u00a034656406."}],"container-title":["Cardiac Failure Review"],"original-title":[],"link":[{"URL":"https:\/\/www.cfrjournal.com\/articleindex\/cfr.2025.48","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T13:00:24Z","timestamp":1785502824000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.cfrjournal.com\/articleindex\/cfr.2025.48"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,3]]},"references-count":109,"URL":"https:\/\/doi.org\/10.15420\/cfr.2025.48","relation":{},"ISSN":["2057-7540","2057-7559"],"issn-type":[{"value":"2057-7540","type":"print"},{"value":"2057-7559","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,3]]},"article-number":"e19"}}