Identification of frailty in chronic heart failure

Sze, S., Pellicori, P. , Zhang, J., Weston, J. and Clark, A. L. (2019) Identification of frailty in chronic heart failure. JACC: Heart Failure, 7(4), pp. 291-302. (doi: 10.1016/j.jchf.2018.11.017) (PMID:30738977)

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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.

Item Type:Articles
Glasgow Author(s) Enlighten ID:Pellicori, Dr Pierpaolo
Authors: Sze, S., Pellicori, P., Zhang, J., Weston, J., and Clark, A. L.
College/School:College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > Robertson Centre
Journal Name:JACC: Heart Failure
ISSN (Online):2213-1787
Published Online:06 February 2019
Copyright Holders:Copyright © 2019 Elsevier
First Published:First published in JACC: Heart Failure 7(4):291-302
Publisher Policy:Reproduced in accordance with the copyright policy of the publisher

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