Background: Heart failure (HF) is a leading cause of cardiovascular morbidity and mortality, with a global prevalence that increases significantly with age. In India, HF is primarily associated with coronary heart disease, hypertension, obesity, diabetes mellitus (DM), and rheumatic heart disease. HF is categorized into three phenotypes based on left ventricular ejection fraction (LVEF): HF with reduced ejection fraction (HFREF), HF with preserved ejection fraction (HFPEF), and HF with mid-range ejection fraction (HFmrEF). Frailty, a syndrome characterized by decreased physiological reserves, commonly coexists with HF, exacerbating its clinical outcomes.

Objectives: This study aimed to estimate the prevalence of frailty syndrome in patients with HFPEF and HFREF and to compare the prevalence between these two groups.

Methods: A hospital-based comparative study was conducted over 18 months at Guru Gobind Singh Medical College & Hospital, Faridkot, involving 100 HF patients aged 40-65 years. Participants were divided equally into HFPEF and HFREF groups. Frailty was assessed using the Fried Frailty Index, which evaluates five criteria: weight loss, exhaustion, low physical activity, weak hand grip strength, and slow walking speed.  The sum score of these five criteria classifies people into one of three frailty stages (or groups): not frail (score 0), pre frail (score 1–2) and frail (score 3-5).Statistical analysis was performed using SPSS version 26, with significance set at p <0.05.

Results: The study found that 42% of patients were pre-frail, and 36% were frail, indicating that the majority (78%) exhibited some degree of frailty. Frailty was significantly more prevalent in HFREF patients (46%) compared to HFPEF patients (26%) (p=0.037). Females in the HFREF group were more likely to be frail than males (p=0.008). DM was significantly associated with frailty in the HFPEF group (p=0.024), but not in the HFREF group. Factors such as BMI, hypertension, HF etiology, symptomatology, and echocardiographic findings showed no significant association with frailty. However, significant associations were found between frailty and individual components of the Fried Frailty Index, such as weight loss, slow walking speed, exhaustion, weak hand grip strength, and low physical activity, but they did not differ significantly between the two groups of heart failure. However, the composite score of all these components contributing to the Fried Frailty Index significantly differed between the two groups.

Conclusion: Frailty is highly prevalent among HF patients, particularly in those with HFREF. The study highlights the importance of assessing frailty using simple bedside parameters to guide targeted interventions, which may improve clinical outcomes. Further research is required to explore the interplay between frailty and HF to optimize management strategies.