Launching: The Frailty-First and End of Life Practical Management Pathway for Heart Failure

Health Innovation Kent Surrey Sussex and partners have launched an innovative frailty-focused pathway to improve the quality of person-centred care for heart failure patients with frailty who require tailored treatment.

The Frailty-First pathway helps clinicians and patients develop a management plan that results in strongly evidenced improved outcomes. These include preventing unplanned hospitalisations, reducing premature long-term 24-hour care dependency, and ensuring the patient’s wishes are at the heart of their treatment.

Developed by multi-disciplinary experts

The pathway aligns to the Health Innovation Network National Heart Failure Programme and follows the success of the 2024 NHS Sussex Heart Failure Pathway. Facilitated by Health Innovation KSS, the pathway was co-designed by experts from –

• NHS Sussex
• NHS Mid and South Essex
• NHS County Durham and Darlington
• The Primary Care Cardiovascular Society (PCCS)

What is a Frailty-First approach?

Frailty Pathway – Step One infographic

The Frailty-First approach is designed to help clinicians improve quality of care. Given such a high prevalence of frailty in heart failure (in all adult age groups), early identification and staging of frailty should become a routine part of any heart failure assessment.

The pathway is broken into three detailed steps, each containing tools and resources for clinicians –

1. Determining the presence and level of frailty.
2. Tailoring heart failure treatment for patients identified as in need.
3. Advance/parallel planning to manage much greater prognostic uncertainty.

This approach supports tailored management, honest, balanced discussions with patients and their loved ones, person-driven shared decision-making, timelier anticipatory palliative care and advance care planning.

Ginny Common, Health Innovation Kent Surrey Sussex Project Manager –
“By focusing on frailty as a key determinant of outcomes, this pathway shifts from disease-focused to a more comprehensive and holistic model to optimise frailty and end of life care for patients with heart failure. It has been great to work with this expert group to develop the pathway, and I would like to thank them all for their contributions.”

Recognising the relevance of frailty to heart failure treatment

Frailty is a clinical state of increased vulnerability due to dysregulation across multiple bodily systems, leading to impaired physical and cognitive functioning with a higher risk of suffering adverse outcomes. It is the strongest independent predictor of increased hospitalisation and reduced survival.

Its prevalence is rising, driven by both an ageing population and increasing multimorbidity, including in younger adults, posing major challenges for clinicians managing long-term conditions.

This is especially relevant in heart failure (HF), where co-existing frailty is extremely common, even independent of age and other co-morbidities. Heart failure is a complex, often progressive condition that disproportionately affects older adults and those with frailty.

Frailty increases vulnerability to treatment side effects and reduces the likelihood of favourable outcomes.  Frequent or lengthy inpatient hospitalisations in patients with co-existing frailty may also accelerate frailty progression, impacting longer-term survival.

Where and when can clinicians find out more about the Frailty-First pathway?

Visit our CVD Central page to access the pathway and resources

In 2026, Health Innovation KSS will bring the pathway to our local, regional and national meetings on Heart Failure and CVD for healthcare professionals. We will also share it with our local cardiac network leads, our wider South-East regional colleagues, the National Health Innovation Network team and beyond.

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