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

Abstract

Aim To compare the frailty prevalence and predictive performance of six frailty instruments in adults with heart failure and determine feasibility of study methods. Methods and Results Prospective cohort pilot study. Adults aged 18 years or older with a confirmed diagnosis of heart failure in Sydney, New South Wales, Australia. The Frailty Phenotype; the Survey of Health, Ageing and Retirement in Europe Frailty Instrument (SHARE-FI); St Vincent’s Frailty instrument; St Vincent’s Frailty instrument plus cognition and mood; The Fatigue, Resistance, Ambulation, Illnesses, and Loss of Weight (FRAIL) scale; and the Deficit Accumulation Index were compared. Multiple logistic regression was used to develop six frailty instrument models to evaluate the association between each frailty instrument and composite all-cause rehospitalisation and mortality at 12 months One hundred and thirty-one patients were included with a mean age of 54 (± 14[SD]). Frailty prevalence ranged from 33-81%. All instruments except one (the FRAIL scale) appeared to signal an increased odds of rehospitalisation and/or mortality, yet these results were non-significant. The six frailty instrument models displayed sensitivity between 88-92% and C-statistic values of 0.71-0.73, suggesting satisfactory discrimination. Conclusions The prevalence of frailty varied across six frailty instruments yet was in the higher range despite a ‘younger’ heart failure cohort. Further research is required to confirm the psychometric properties of these instruments for routine clinical use in an adequately powered and more diverse heart failure cohort.

Association between natriuretic peptides and C-reactive protein with frailty in heart failure: a systematic review and meta-analysis

“…Of the included studies, 13 studies were considered of having a high risk of bias [ 7 , 31 , 32 , 39 , 41 , 43 , 46 , 52 , 53 , 60 , 61 , 63 , 64 ], 16 as moderate risk of bias [ 18 , 29 , 33 , 36 , 37 , 42 , 44 , 45 , 48 – 50 , 55 , 56 , 58 , 59 , 62 ], and 12 studies had a low risk [ 28 , 30 , 34 , 35 , 38 , 40 , 47 , 51 , 54 , 57 , 65 , 66 ] (Table S2).…”

What is the association of polypharmacy with frailty in heart failure? A systematic review and meta-analysis

“…Seven studies assessed the prevalence of polypharmacy [20][21][22][23][24][25][26] and six studies assessed the number of medications [14][15][16][17][18][19] administered by patients with HF and frailty vs. without frailty. Detailed characteristics of the included studies are presented in Tables 1 and 2.…”

“…Of the final 72 studies identified as eligible for inclusion in our study, 58 articles included only data related to specific medications rather than polypharmacy rates and total number of medications, while one study defined frailty as short physical performance battery score below 6. Overall, 13 studies were included in this systematic review and meta-analysis (Figure 1) [14][15][16][17][18][19][20][21][22][23][24][25][26] .…”

“…Eight studies used Fried's criteria for the definition of frailty [14][15][16][20][21][22][23][24] , one study used the Rockwood score 26 , one study the Korean FRAIL scale (K-FRAIL) 17 , one study the FRAIL scale 19 , one study the frail-VIG index 25 , and one study the clinical frailty scale 18 . Polypharmacy was generally defined as the presence of 5 or more medications, although one study defined it as more than 5 24 .…”

A Narrative Review of the Utilisation of the SHARE Frailty Instruments (SHARE-FI and SHARE-FI75+) in the Literature

“…In adult participants of the FRAilty MEasurement in Heart Failure (FRAME-HF) study, SHARE-FI was able to discriminate between inpatients and outpatients 44 . In a small pilot Australian study with 131 adults with HF (mean age 54), SHARE-FI seemed to have, together with the Deficits Accumulation Index (DAI), the highest C-statistic value (0.73) for the prediction of rehospitalisation and/or mortality at 12 months, followed by the original Frailty Phenotype (FP) (0.72), and the St Vincent's Frailty instrument (0.71) 45 ; however, results for the multiple logistic regression models were not statistically significant. A Polish study proposed a novel model to predict frailty (based on SHARE-FI) in HF patients using the following five variables: age >50 years, systolic blood pressure (SBP) on admission <110 mmHg, total cholesterol <4.85 mmol/L, bilirubin ≥15.5 mmol/L, and ALT ≤34 U/L 46 .…”