Identification of Frailty in Chronic Heart Failure

JACC Heart Fail. 2019 Apr;7(4):291-302. doi: 10.1016/j.jchf.2018.11.017. Epub 2019 Feb 6.

Abstract

Objectives: This study sought to report the prevalence of frailty, classification performance, and agreement among 3 frailty assessment tools and 3 screening tools in chronic heart failure (CHF) patients.

Background: Frailty is common in patients with CHF. There are many available frailty tools, but no standard method for evaluating frailty.

Methods: We used the following frailty screening tools: the clinical frailty scale (CFS); the Derby frailty index; and the acute frailty network frailty criteria. We used the following frailty assessment tools: the Fried criteria; the Edmonton frailty score; and the Deficit Index.

Results: A total of 467 consecutive ambulatory CHF patients (67% male; median age: 76 years; interquartile range [IQR]: 69 to 82 years; median N-terminal pro-B-type natriuretic peptide: 1,156 ng/l [IQR: 469 to 2,463 ng/l]) and 87 control patients (79% male; median age: 73 years; IQR: 69 to 77 years) were studied. The prevalence of frailty using the different tools was higher in CHF patients than in control patients (30% to 52% vs. 2% to 15%, respectively). Frail patients tended to be older, have worse symptoms, higher N-terminal pro-B-type natriuretic peptide levels, and more comorbidities. Of the screening tools, CFS had the strongest correlation and agreement with the assessment tools (correlation coefficient: 0.86 to 0.89, kappa coefficient: 0.65 to 0.72, depending on the frailty assessment tools, all p < 0.001). CFS had the highest sensitivity (87%) and specificity (89%) among screening tools and the lowest misclassification rate (12%) among all 6 frailty tools in identifying frailty according to the standard combined frailty index.

Conclusions: Frailty is common in CHF patients and is associated with increasing age, comorbidities, and severity of heart failure. CFS is a simple screening tool that identifies a similar group using more lengthy assessment tools.

Keywords: assessment; frailty screening; heart failure.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Comorbidity
  • Female
  • Follow-Up Studies
  • Frail Elderly / statistics & numerical data*
  • Frailty / epidemiology*
  • Frailty / physiopathology
  • Heart Failure / epidemiology*
  • Heart Failure / physiopathology
  • Humans
  • Male
  • Motor Activity / physiology*
  • Prevalence
  • Prospective Studies
  • Risk Assessment / methods*
  • Risk Factors
  • Stroke Volume / physiology*
  • United Kingdom / epidemiology