The Clinical-Functional Vulnerability Index-20 (IVCF-20) Predicts Adverse Outcomes in Older Adults Admitted through the Emergency Department
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Background
Frailty assessment in the Emergency Department (ED) is essential for identifying older adults at risk of adverse outcomes. The 20-item Clinical-Functional Vulnerability Index (IVCF-20) is a rapid, multidimensional screening tool widely used in Brazilian primary care, but its predictive validity in the ED has not been established. We aimed to evaluate the ability of the IVCF-20 to predict 180-day mortality and other adverse outcomes in older adults admitted to a public ED.
Methods
Observational cohort study comprising patients aged ≥60 years consecutively admitted through the ED of a University Hospital in Brazil. Baseline frailty was assessed with the IVCF-20 and categorized as robust (0-6), pre-frail (7–14), mild-to-moderate (15–29), and severe frail (30–40). The Clinical Frailty Scale (CFS), a validated frailty tool in the ED, was also applied. The primary outcome was 180-day mortality; secondary outcomes included in-hospital and 90-day mortality, prolonged length of stay, home care referral, and ED revisit or hospital readmission. Logistic regression estimated associations between frailty and 180-day mortality, Kaplan-Meier curves illustrated survival across frailty levels. ROC analyses evaluated secondary outcomes.
Results
A total of 310 patients with a median age of 72 years, 58.1% were male. Frailty prevalence ranged from 53.9% (IVCF-20) to 60.1% (CFS). The IVCF-20 score was independently associated with 180-day mortality (adjusted OR = 1.06; 95% CI = 1.02–1.10; p = 0.002). Severely frail participants had an 8.4-fold higher risk of death than robust individuals (adjusted OR = 8.37; 95% CI = 2.20–31.81). Kaplan-Meier curves showed a graded mortality increase across IVCF-20 categories. Both instruments predicted secondary outcomes, though CFS demonstrated slightly better discrimination for mortality.
Conclusions
IVCF-20 predicted 180-day mortality, home care referral, and ED revisit/readmission. Its rapid, judgment-free format supports its feasibility for frailty screening at the ED.
