Background: Most patients diagnosed with heart failure (HF) are older adults with multiple comorbidities. Multipathological patients constitute a population with common characteristics: greater clinical complexity and vulnerability, frailty, mortality, functional deterioration, polypharmacy, and poorer health-related quality of life with more dependency. Objectives: To evaluate the clinical characteristics of hospitalized patients with acute heart failure and to determine the prognosis of patients with acute heart failure according to the Short Physical Performance Battery (SPPB) scale. Methods: Observational, prospective, and multicenter cohort study conducted from September 2020 to May 2022 in patients with acute heart failure as the main diagnosis and NT-ProBNP > 300 pg. The cohort included patients admitted to internal medicine departments in 18 hospitals in Spain. Epidemiological variables, comorbidities, cardiovascular risk factors, cardiovascular history, analytical parameters, and treatment during admission and discharge of the patients were collected. Level of frailty was assessed by the SPPB scale, and dependence, through the Barthel index. A descriptive analysis of all the variables was carried out, expressed as frequencies and percentages. A bivariate analysis of the SPPB was performed based on the score obtained (SPPB ≤ 5 and SPPB > 5). For the overall analysis of mortality, HF mortality, and readmission of patients at 30 days, 6 months, and 1 year, Kaplan–Meier survival curves were used, in which the survival experience among patients with an SPPB > 5 and SPPB ≤ 5 was compared. Results: A total of 482 patients were divided into two groups according to the SPPB with a cut-off point of an SPPB < 5. In the sample, 349 patients (77.7%) had an SPPB ≤ 5 and 100 patients (22.30%) had an SPPB > 5. Females (61%) predominated in the group with an SPPB ≤ 5 and males (61%) in those with an SPPB > 5. The mean age was higher in patients with an SPPB ≤ 5 (85.63 years). Anemia was more frequent in patients with an SPPB ≤ 5 (39.5%) than in patients with an SPPB ≥ 5 (29%). This was also seen with osteoarthritis (32.7%, p = 0.000), diabetes (49.6%, p = 0.001), and dyslipidemia (69.6%, p = 0.011). Patients with an SPPB score > 5 had a Barthel index < 60 in only 4% (n = 4) of cases; the remainder of the patients (96%, n = 96) had a Barthel index > 60. Patients with an SPPB > 5 showed a higher probability of survival at 30 days (p = 0.029), 6 months (p = 0.031), and 1 year (p = 0.007) with (OR = 7.07; 95%CI (1.60–29.80); OR: 3.9; 95%CI (1.30–11.60); OR: 6.01; 95%CI (1.90–18.30)), respectively. No statistically significant differences were obtained in the probability of readmission at 30 days, 6 months, and 1 year (p > 0.05). Conclusions: Patients admitted with acute heart failure showed a high frequency of frailty as assessed by the SPPB. Patients with an SPPB ≤ 5 had greater comorbidities and greater functional limitations than patients with an SPPB > 5. Patients with heart failure and a Barthel index > 60 frequently presented an SPPB < 5. In daily clinical practice, priority should be given to performing the SPPB in patients with a Barthel index > 60 to assess frailty. Patients with an SPPB ≤ 5 had a higher risk of mortality at 30 days, 6 months, and 1 year than patients with an SPPB ≤ 5. The SPPB is a valid tool for identifying frailty in acute heart failure patients and predicting 30-day, 6-month, and 1-year mortality.

Background: Older adults hospitalized with acute heart failure frequently present with multimorbidity, frailty, and reduced physiological reserve. This makes accurate prognostic assessment particularly challenging in internal medicine. Traditional heart failure risk models often fail to capture this multidimensional vulnerability. The PROFUND index, developed to estimate medium-term mortality in multimorbid patients, and serum albumin, an established biomarker of nutritional and inflammatory status, may provide complementary prognostic information. This formed the aim of the present study. This study’s objective is to evaluate the individual and combined prognostic value of the PROFUND index and serum albumin for one-year mortality in patients admitted with AHF. Methods: We conducted a prospective, multicenter cohort study within the PROFUNDIC registry. We included consecutive adults hospitalized with AHF or decompensated chronic heart failure who met European Society of Cardiology diagnostic criteria and had NT-proBNP levels > 1500 pg/mL. PROFUND scores were obtained at admission, and hypoalbuminaemia was dichotomized as ≤3.5 g/dL. The primary outcome was one-year mortality, analyzed using Kaplan–Meier survival estimates, Cox proportional hazards models, and time-dependent ROC curves. Results: Among 544 included patients (mean age 85 years; 60% women), high PROFUND scores (>7) were present in 39% and hypoalbuminaemia in 55%. Both variables independently predicted one-year mortality, with the highest risk observed in patients presenting both high PROFUND scores (HR 2.26; 95% CI 1.66–3.09; p < 0.001) and hypoalbuminaemia (HR 1.70; 95% CI 1.18–2.46; p = 0.0046). The combined use of these markers modestly improved discriminatory performance compared with the PROFUND index alone (HR 2.83; 95% CI 1.72–4.64; p < 0.000). Conclusions: These findings suggest that integrating clinical complexity, assessed by the PROFUND index, with serum albumin provides a simple and clinically meaningful approach to early risk stratification in very elderly multimorbid patients treated in internal medicine wards.

Background/Objectives: Acute heart failure (AHF) is the leading cause of hospitalization among patients over 65 years and is frequently associated with frailty. Sodium-glucose cotransporter type 2 inhibitors (SGLT2i) currently represent the only drug class recommended across the entire ejection fraction spectrum, although evidence regarding their effectiveness according to frailty status remains limited. Aims: To determine whether functional frailty, measured by the Short Physical Performance Battery (SPPB) test, influences the effectiveness of SGLT2i in reducing hospital readmission and mortality in elderly patients with AHF. Methods: Observational study of 794 polypathological patients admitted to Internal Medicine with AHF. An interaction analysis assessed whether SPPB, as a continuous variable, modified the association between SGLT2i and the composite outcome (hospital readmission or death), using a Cox model. The sample was further divided by SPPB test score (below 4 (N = 477) or ≥4 (N = 317)) for exploratory analyses. Descriptive and comparative analyses were performed according to SGLT2i administration, using the chi-squared test for qualitative variables and Student’s t-test for quantitative ones (Fisher’s and Mann–Whitney U test as appropriate). Survival analysis was done using Kaplan–Meier curves and Cox regression, with multivariable adjustment for confounders. Results: No significant interaction was found between SPPB score and SGLT2i (p = 0.506). When SPPB was dichotomised, SGLT2i treatment was associated with significantly lower all-cause mortality (3.7% vs. 12.0%; p = 0.018) and readmission (30.3% vs. 45.2%; p = 0.021) in SPPB ≥ 4, with mortality and readmission also numerically lower, without reaching statistical significance, in SPPB < 4 (mortality 12.9% vs. 16.9%, p = 0.410; readmission 34.5% vs. 42.0%, p = 0.220). After adjustment, SGLT2i treatment in the SPPB ≥ 4 group remained associated with a numerically lower hazard for the composite outcome (HR 0.652; 95% CI 0.418–1.018; p = 0.060). Conclusions: No evidence was found that functional frailty modifies the effectiveness of SGLT2i in elderly polypathological patients with AHF. An exploratory analysis suggested a possible gradient of greater association with SPPB ≥ 4, although this should be interpreted as hypothesis-generating.