Malnutrition-induced frailty and risk of early rehospitalization in heart failure: A Survival analysis from a prospective cohort study

Abstract

Objective: To evaluate the impact of malnutrition-induced frailty on time to rehospitalization among patients with heart failure (HF) in a tertiary care setting in Pakistan.

Methodology: A prospective cohort study of three hundred participants was conducted at the Karachi Institute of Heart Diseases from November 2024 to April 2025, using non-probability consecutive sampling. Adults aged >40 years with confirmed HF and on a regular oral diet were enrolled at index admission and followed for 90 days. Malnutrition was assessed using the Malnutrition Universal Screening Tool (MUST; score ≥1) and frailty using the Tilburg Frailty Indicator (TFI; score >5). Patients with both conditions comprised the exposed group; those without either formed the unexposed group. Time to first rehospitalization was the primary outcome. Kaplan-Meier analysis compared survival curves, and Cox proportional hazards regression identified independent predictors of rehospitalization.

Results: Kaplan-Meier analysis showed significantly shorter rehospitalization-free survival in the exposed group (log-rank p = 0.008). Although frailty was associated with a higher hazard of rehospitalization (HR = 4.912; 95% CI: 0.752-32.071), it did not reach statistical significance (p = 0.096) in the multivariable Cox model. BMI emerged as the only significant predictor (p = 0.047), with underweight patients at greater risk. No significant interaction was observed between BMI and frailty.

Conclusion: Malnutrition-induced frailty showed a trend towards shorter time to rehospitalization in HF patients, though this association was not found statistically significant. Routine frailty screening and targeted post-discharge interventions may help reduce preventable readmissions, particularly in resource-limited settings.