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

BackgroundFrailty 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. MethodsObservational 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. ResultsA 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. ConclusionsIVCF-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.