Independent contributions of functional class, comorbidity, and frailty to health status in elderly adults with heart failure

Aims This study identified and quantified independent predictors of health status among older ambulatory adults with chronic heart failure in an Asian population, hypothesizing that systemic burden indicators would predict health status independently of ejection fraction. Methods This cross-sectional observational study enrolled 150 consecutive Vietnamese patients aged 60 years or older with chronic heart failure attending a cardiology clinic between August 2024 and March 2025. Health status was assessed using the validated Vietnamese Kansas City Cardiomyopathy Questionnaire-12. Multivariable linear regression models examined associations between KCCQ-12 scores and clinical variables including left ventricular ejection fraction, New York Heart Association functional class, Clinical Frailty Scale scores, Charlson Comorbidity Index, and demographics. Secondary analyses evaluated domain-specific scores and phenotype-stratified associations. Results The median age was 75 years, and median KCCQ-12 summary score was 68. Multivariable regression explained 77% of variance in health status. Advanced NYHA functional class, higher comorbidity burden, and frailty independently predicted lower KCCQ-12 scores, while male sex was associated with higher scores. Left ventricular ejection fraction and N-terminal pro-B-type natriuretic peptide showed no significant association with health status. These patterns remained consistent across all KCCQ-12 domains and heart failure phenotypes. Nutritional status correlated with health status univariately but was subsumed by frailty in multivariable models. Conclusions Geriatric syndromes, including frailty, multimorbidity, and functional limitation, determine patient-reported health status in older Asian adults with heart failure independent of cardiac-specific indices. These findings support integrating systematic frailty assessment and functional preservation into routine cardiovascular care for aging Asian populations.