The Clinical-Functional Vulnerability Index-20 (IVCF-20) Predicts Adverse Outcomes in Older Adults Admitted through the Emergency Department

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.

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.

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.

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. Competing Interest Statement The authors have declared no competing interest. Funding Statement This work was supported by the grants of the Brazilian Official Agencies: Conselho Nacional de Desenvolvimento Cientifico e Tecnologico (CNPq, 315133/2021-0) and Coordenacao de Aperfeicoamento de Pessoal de Nivel Superior (CAPES, 88887.971058/2024-00). Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The Research Ethics Committee of the Federal University of Minas Gerais (UFMG) (CAAE 23649519.0.0000.5149 and the Research Ethics Committee of University of Sao Paulo (USP) gave ethical approval (56802322.9.1001.0068) gave ethical approval for this work. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Data Availability All data produced in the present study are available upon reasonable request to the authors