Author + information
- Received August 30, 2018
- Revision received November 19, 2018
- Accepted November 20, 2018
- Published online March 25, 2019.
- Shirley Sze, MBBSa,b,∗ (, )
- Pierpaolo Pellicori, MDa,c,
- Jufen Zhang, PhDa,d,
- Joan Westona and
- Andrew L. Clark, MA, MDa
- aDepartment of Cardiology, Castle Hill Hospital, Hull York Medical School (at University of Hull), Kingston upon Hull, United Kingdom
- bCardiovascular Research Centre, University of Leicester, Glenfield Hospital Groby Road, Leicester, United Kingdom
- cRobertson Centre for Biostatistics & Clinical Trials, University of Glasgow & National Heart & Lung Institute, Imperial College, London, United Kingdom
- dFaculty of Medical Science, Anglia Ruskin University, United Kingdom
- ↵∗Address for correspondence:
Dr. Shirley Sze, Department of Cardiology, Hull York Medical School, Hull and East Yorkshire Medical Research and Teaching Centre, Castle Hill Hospital, Cottingham, Kingston upon Hull HU16 5JQ, United Kingdom.
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.
The authors have reported that they have no relationships relevant to the contents of this work to disclose.
- Received August 30, 2018.
- Revision received November 19, 2018.
- Accepted November 20, 2018.
- 2019 American College of Cardiology Foundation
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