Prevalence of Frailty in Heart Failure Patients in 1.1 million sized adult population of Mid & South Essex. Findings support recommending a “Frailty First” approach to managing Heart failure

Prevalence of Frailty in Heart Failure Patients in 1.1 million sized adult population of Mid & South Essex. Findings support recommending a “Frailty First” approach to managing Heart failure

S Zaidi; R Thakkar                                 

Background: Heart failure (HF) and frailty have a bidirectional relationship. 

Although people with HF experience high rates of unplanned hospitalisation, most admissions in those with co-existing frailty are due to non-cardiac causes, including falls, acute kidney injury/electrolyte disturbance and bleeding events, rather than HF itself. These events are frequently related to adverse effects of cardiovascular medications.

 Similarly, 84% of deaths are not directly attributable to HF. Frailty independently increases the risk of adverse drug events and mortality, yet patients with moderate-to-severe frailty were largely excluded from trials informing HF guidelines.

 Consequently, applying guideline-directed medical therapy without considering frailty may increase iatrogenic harm, emergency hospitalisation and premature mortality.

Purpose: To determine prevalence of frailty and end-of-life (EOL) risk indicators among adults with HF in Mid and South Essex (MSE) Integrated Care System (ICS) and inform a "frailty first" approach to HF management.

Methods: Linked population health data from MSE (June 2026) were analysed using the Athena Population Health Management segmentation model. Heart failure, frailty and end-of-life prognostic indicators were identified using validated data filters.

Results: Of all 1,063,332 adults in the ICS population 

• 20,072 had diagnosed HF (1.89% prevalence).
• 82% were aged ≥65 years; 45% were aged >80 years.
• Overall, 14,059 patients (70%) had frailty, including those with end-of-life prognostic indicators. 
• 41% had end-of-life prognostic indicators, including all patients with severe or very severe frailty. 
• Among older people aged ≥65 years with HF, 76% had frailty and/or end-of-life indicators.
• Among 3,691 younger adults aged 18–64 years with HF, 43% had frailty and/or end-of-life indicators.

Conclusions: Frailty and EOL indicators are highly prevalent across the HF population, including younger adults.

 Routine frailty identification should underpin personalised HF management to support shared decision-making, optimise safer prescribing, reduce avoidable iatrogenic harm, facilitate timely access to palliative and end-of-life care to improve outcomes and reduce inequalities