Frailty instruments in patients with heart failure: a comparison of predictive performance

Article: Comparison of six frailty instruments in adults with heart failure: a prospective cohort pilot study

Frailty is characterised by increased vulnerability to acute stressors. As it is common in adults with heart failure (HF), frailty has been used as a predictor of mortality and morbidity for HF patients.

Frailty Phenotype, the most commonly used frailty instrument in HF, is used for the physical examination of frailty. While physical frailty instruments are commonly used in clinical practice, a proportion of studies have expressed issues with such tools. As HF may have detrimental effects on physical function, the use of physical instruments may lead to an under- or over-estimation of frailty.

This study aims to compare the predictive ability of three physical frailty instruments (the Frailty Phenotype, the St Vincent’s Frailty instrument and the SHARE-FI); and three multi-domain instruments (the FRAIL scale, the Deficit Accumulation Index, and St Vincent’s Frailty plus cognition 7 and mood) in adults with HF.

Key learnings:

Frailty prevalence predicted by the six instruments was heterogeneous, but in the higher range despite a younger HF cohort. Furthermore, all frailty models exhibited satisfactory sensitivity, but relatively low specificity, with the FRAIL scale model displaying the highest specificity of all instruments (46%). Despite this, the balance between sensitivity and specificity remained adequate, and all instruments appeared to successfully assess frailty in adults with HF. Excluding the multi-domain FRAIL scale, all instruments displayed predictive ability regarding hospitalisation and/or mortality. However, these results were not statistically significant. Deficit Accumulation Index and SHARE-FI were the best-performing instruments, exhibiting the most statistical significance between ‘frail’ and ‘non-frail’ groups.

Reviewed by: S. Duarte

Authors: Mcdonagh J., Ferguson C., Prichard R. et al.

Published in: European Journal of Cardiovascular Nursing 2022

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