Tilburg Frailty Indicator Predicts Death and Rehospitalization after Cardiac Resynchronization Therapy in Patients with Heart Failure

Background Frailty in patients with heart failure (HF) is associated with significantly adverse clinical outcomes. Emerging evidence suggests that the Tilburg Frailty Indicator (TFI) score may help with prognosis stratification following cardiac resynchronization therapy (CRT) implantation. Nonetheless, the specific associations between the TFI score and post-procedural mortality or rehospitalization remain elusive. Methods Patients with HF who underwent CRT at Henan Provincial People’s Hospital, the First Affiliated Hospital of Xinjiang Medical University, and Henan Provincial Chest Hospital, completed the TFI questionnaire preoperatively, and had complete clinical records were retrospectively enrolled between January 2022 and May 2024. Cox proportional hazards regression analyses were used to evaluate the association between the TFI score and both all-cause mortality and HF-related rehospitalization following CRT implantation. This association was visualized using restricted cubic spline (RCS) curves. The predictive value of the TFI score for these outcomes was further assessed using a random survival forest (RSF) approach. Results The TFI score was an independent predictor of all-cause mortality (Hazard Ratio [HR]1.39 [95% Confidence Interval [CI] 1.27–1.52], p  < 0.001) and one-year HF-related rehospitalization (HR 1.28 [95% CI 1.18–1.39], p  < 0.001) following CRT implantation. In the frailty cohort, there was a significantly lower survival probability ( p  < 0.0001), with a near-linear positive relationship between the HR and TFI score ( p for non-linearity = 0.5709), and the TFI score emerged as the most important variable for predicting all-cause mortality. Patients with frailty experienced more HF-related rehospitalizations at the 1-year follow-up ( p  < 0.0001), with a similarly near-linear positive association with TFI scores ( p for non-linearity = 0.1658), which was also the most important predictive variable. Conclusions The TFI score emerged as the most significant independent predictor of mortality and rehospitalization following CRT implantation in patients with HF.