Using the VES-13 score for risk stratification in outpatient heart failure management to predict mortality

Abstract Background We have previously demonstrated the efficacy of the Vulnerable Elders Survey-13 (VES-13) as a valuable tool for identifying frailty and predicting outcomes, such as mortality and hospitalisations, in heart failure (HF) outpatients when frailty is detected using a cut-off value of ≥3. Purpose This study aims to assess whether scores obtained from the VES-13, beyond its initial use with a frailty diagnosis threshold, enable a more precise categorization of mortality risk among heart failure outpatients. Methods Nurses administered the VES-13 during patients' initial consultations. We examined a sample of 331 patients, analyzing their main characteristics and individual VES-13 scores. VES-13 scores were categorized into quintiles for risk assessment. Results A total of 331 outpatients were prospectively included in the study. Patient characteristics were as follows: mean age of 69.85±11.96 years, 68% males, 67.6% in NYHA class II, and 25.7% in class III; ischemic aetiology was the most common (42%), and the mean left ventricular ejection fraction (LVEF) was 38.79±13.58. The VES-13 mean’s score was 2.67±2.81. Quintile 1 corresponded to a VES-13 score of 0, quintile 2 to score of 1, quintile 3 to score of 2, quintile 4 to scores of 3 or 4, and quintile 5 to a VES-13 score of 5 points or higher. During a follow-up period of 17.6±6.6 months (up to 24 months), 41 patients died (12.4%). After adjusting for sex, LVEF and ischemic aetiology stratifying VES-13 scores into quintiles allowed us to observe an accurate stratification of the risk of death with a statistically significant relationship between higher VES-13 quintiles and higher mortality (p=0.001) (Figure 1). Indeed, quintiles 4 and 5 were showed a very high hazard of risk of death compared to quintile 1 group (HR 6.97 [1.53, 31.65], p=0.012 for quintile 4; and HR 12.17 [2.77, 53.54], p=0.001 for quintile 5). Conclusions The VES-13, a standard screening tool in our heart failure clinic for identifying frailty, demonstrated the ability, when divided in quintile groups, of accurately stratify the risk of death over a follow-up period of up to two years.