The article by Jong et al1 indicates that the prognosis in patients with heart failure is often poor. In particular, they stated that a complex interaction of biological and clinical factors should be taken into consideration when determining a prognosis and thus the expected outcome.
We present data on a large population of elderly hospitalized patients 65 years and older (995 patients; mean ± SD age, 80.2 ± 7.1; 34% men) consecutively admitted to our Acute Care for the Elderly Medical Unit (ACE-MU) at Poliambulanza Hospital (Brescia, Italy) during a 9-month period with no associated rapidly fatal disease such as advanced cancer or Child C–stage cirrhosis. Our data indicate that frail patients have only minimally increased heart failure–associated mortality, arguing that frailty is a strong modulator of outcome in elderly patients with heart failure.