摘要Background Frailty is common and significantly impacts prognosis in heart failure(HF).The Vulnerable Elders Survey-13(VES-13),widely used in oncogeriatrics and public health,remains unexplored as a frailty screening tool in HF outpatients.In this study,we prospectively evaluated VES-13 against a multimodal screening assessment in detecting frailty and predicting indi-vidual risk of adverse prognosis.Methods Frailty was assessed at the initial visit using both a multimodal approach,incorporating Barthel Index,Older Americ-an Resources and Services scale,Pfeiffer Test,abbreviated Geriatric Depression Scale,age>85 years,lacking support systems,and VES-13.Patients scoring≥3 on VES-13 or meeting at least one multimodal criterion were classified as frail.Endpoints in-cluded all-cause mortality,a composite of death or HF hospitalization,and recurrent HF hospitalizations.Results A total of 301 patients were evaluated.VES-13 identified 40.2%as frail and the multimodal assessment 33.2%.In Cox regression analyses,frailty identified by VES-13 showed greater prognostic significance than the multimodal assessment for all-cause mortality(HR=3.70[2.15-6.33],P<0.001 vs.2.40[1.46-4.0],P=0.001)and the composite endpoint(HR=3.13[2.02-4.84],P<0.001 vs.1.96[1.28-2.99],P=0.002).Recurrent HF hospitalizations were four times more frequent in VES-13 frail patients while two times in those identified as frail by the multimodal assessment.Additionally,stratifying patients by VES-13 tertiles provided robust risk differentiation.Conclusions VES-13,a simple frailty tool,outperformed a comprehensive multimodal assessment and could be easily integ-rated into routine HF care,highlighting its clinical utility in identifying patients at risk for poor outcomes.