BackgroundsThe　optimal　multidimensional　frailty　assessment　approach　in　heart　failure　(HF)　remains　uncertain.　This　study　aimed　to　compare　the　prognostic　value　of　a　multi-domain　approach　versus　the　Tilburg　Frailty　Indicator　(TFI)　in　elderly　HF　patients.MethodsThis　prospective　single-center　cohort　study　consecutively　enrolled　461　elderly　HF　patients　at　Fuzhou　University　Affiliated　Provincial　Hospital,　China.　Frailty　was　assessed　using　both　the　TFI　and　a　multi-domain　approach.　The　primary　outcome　was　the　composite　of　heart　failure　hospitalization　or　all-cause　death　within　six　months.　Clinical　outcomes　were　analyzed　using　Kaplan-Meier　and　Cox　proportional　hazards　regression　models,　with　predictive　performance　compared　by　receiver　operating　characteristic　curves.ResultsAmong　461　participants,　physical,　psychological,　and　social　frailty　prevalence　rates　were　41.0%,　59.9%,　and　56.8%,　respectively.　Multidimensional　frailty,　assessed　by　the　TFI,　was　present　in　77.4%　of　the　cohort.　The　risk　of　composite　outcome　increased　significantly　with　the　number　of　frailty　domains　[2　domains:　adjusted　HR　=　1.74　(95%　CI:　1.08-2.79);　3　domains:　HR　=　2.07　(1.28-3.35)].　TFI-based　analysis　yielded　consistent　results.　Notably,　the　predictive　accuracy　of　frailty　domains　(area　under　the　curve　(AUC)　=　0.63,　95%　CI:　0.58-0.69)　did　not　significantly　differ　from　that　of　the　TFI　(AUC　=　0.64,　95%　CI:　0.59-0.70;　P　=　0.713),　indicating　comparable　discriminative　ability.ConclusionsIn　elderly　HF　patients,　both　the　multi-domain　frailty　assessment　and　the　TFI　demonstrated　comparable　predictive　value　for　heart　failure　hospitalization　or　all-cause　death　within　six　months.