The Road to Frailty Is Paved With Good Intentions

Afilalo, Jonathan

doi:10.1161/circoutcomes.116.002852

Cited by 7 publications

(11 citation statements)

References 13 publications

(19 reference statements)

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“…With this unique linked data, we are the first to build a claims-based index which is validated against an accepted reference standard for assessing the frailty syndrome. (8,26)…”

Section: Discussionmentioning

confidence: 99%

Development of a Claims-based Frailty Indicator Anchored to a Well-established Frailty Phenotype

Segal¹,

et al. 2017

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Background Fried et al described a frailty phenotype measured in the Cardiovascular Health Study (CHS). This phenotype is manifest when 3 or more of the following are present: low grip strength, low energy, slowed waking speed, low physical activity, or unintentional weight loss. We sought to approximate frailty phenotype using only administrative claims data in order to enable frailty to be assessed without physical performance measures. Study Design We used the CHS cohort data linked to participants Medicare claims. The reference standard was the frailty phenotype measured at visits 5 and 9. With penalized logistic regression, we developed a parsimonious index for predicting the frailty phenotype using a linear combination of diagnoses, operationalized with claims data. We assessed the predictive validity of frailty index by examining how well it predicted common aging-related outcomes including hospitalization, disability and death. Results There were 4,454 CHS participants from 4 clinical sites. 84% were white, 58% were women and their mean age was 72 years at enrollment. Approximately 11% of the cohort was frail. The model had an area under the ROC curve of 0.75 to concurrently predict a frailty phenotype. This Claims-based Frailty Index (CFI) significantly predicted death [Odds-Ratio 1.84], time to death [Hazard-Ratio 1.71], number of hospital admissions [Incidence Rate-Ratio 1.74], and nursing home admission [OR 1.47] in models adjusted for age and sex. Conclusions Claims data alone can be used to classify individuals as frail and non-frail. The CFI might be used in research with large datasets for confounding adjustment or risk prediction. The indicator might also be used for emergency preparedness for identification of regions enriched with frail individuals.

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“…With this unique linked data, we are the first to build a claims-based index which is validated against an accepted reference standard for assessing the frailty syndrome. (8,26)…”

Section: Discussionmentioning

confidence: 99%

Development of a Claims-based Frailty Indicator Anchored to a Well-established Frailty Phenotype

Segal¹,

et al. 2017

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“…In addition, remote monitoring, now routine for most CIED patients, may support tracking of individual patients' activity trajectories without the need for in‐office assessments. Importantly, frailty itself is not a fixed state but may be dynamic and potentially modifiable, with physical activity itself consistently demonstrated to be the most powerful intervention . The strong and significant independent association between SOF frailty assessment and mobility or mobility limitation we identified appeared to be more consequential and clinically meaningful in magnitude for the complex TUG task than for gait speed itself, which exhibited a statistically significant but modest mean difference of only 0.02 m/s between robust and frail individuals.…”

Section: Discussionmentioning

confidence: 80%

“…Formal measurement of geriatric conditions such as frailty, as well as physiologic measures such as gait speed, have been increasingly embedded in the care of cardiovascular patients . These measures are associated with outcomes among patients undergoing cardiac surgery and transcatheter aortic valve replacement, and in the setting of acute coronary syndromes, and may be superior to traditional covariates included routinely in risk models . However, frailty and mobility testing have not been routinely integrated into studies of electrophysiology patients.…”

Section: Discussionmentioning

confidence: 99%

Frailty, Physical Activity, and Mobility in Patients With Cardiac Implantable Electrical Devices

Kramer

Tsai

Natarajan

et al. 2017

JAHA

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BackgroundThis study aimed to demonstrate the feasibility of measuring frailty in patients with cardiac implantable electrical devices while validating the physiologic significance of device‐detected physical activity by evaluating its association with frailty and mobility.Methods and ResultsOutpatients with cardiac implantable electrical devices compatible with physical activity analysis with at least 7 days of data were eligible. Office testing included frailty status (Study of Osteoporotic Fractures instrument), gait speed (m/s), mobility according to the Timed Up and Go (TUG) test (seconds), and daily physical activity (h/d) as measured by cardiac implantable electrical device. Among 219 patients, Study of Osteoporotic Fractures testing found 39.7% to be robust, 47.5% prefrail, and 12.8% frail. The mean gait speed for the cohort was 0.8±0.3 m/s, mean TUG time was 10.9±4.4 seconds, and mean activity was 2.8±1.9 h/d. Frail patients were markedly more likely to have gait speeds <0.8 m/s (OR 6.25, 95% CI 1.79‐33.3). In unadjusted analyses each 1‐hour increase in mean daily activity was associated with a 46% reduction of frail phenotype (OR 0.54, 95% CI 0.40‐0.74) versus robust and with a 27% reduction in the odds of having the prefrail phenotype (OR 0.73, 95% CI 0.62‐0.86). After adjustment this association per hour of activity persisted, with an adjusted OR for frailty of 0.71 (95% CI 0.51‐0.99) and adjusted OR for prefrailty of 0.81 (95% CI 0.67‐0.99).ConclusionsFrailty and mobility limitation are common among cardiac implantable electrical device patients and are correlated to device‐detected physical activity.

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Section: Introductionmentioning

confidence: 99%

“…Frailty is a syndrome defined as a diminished capacity to recover from a stressor due to minimal physiologic reserve . The assessment of frailty has traditionally taken place in the geriatric population, where a frail phenotype portends increased morbidity and mortality . Previous studies have assessed the role of frailty among elderly patients undergoing cardiac interventions, showing that frailty was associated with an increased risk of incident heart failure, and a higher risk of hospitalizations and mortality …”

Section: Introductionmentioning

confidence: 99%

The prognostic significance of frailty compared to peak oxygen consumption and B‐type natriuretic peptide in patients with advanced heart failure

Moayedi

Posada

Foroutan

et al. 2018

Clinical Transplantation

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Frailty assessment has become an integral part of the evaluation of potential candidates for heart transplantation and ventricular assist device (HTx/VAD). The impact of frailty, as a heart failure risk factor or to identify those who will derive the greatest benefit with HTx/VAD remains unclear. The aim of this study was to evaluate the independent prognostic relevance of frailty assessment from peak oxygen consumption (peak VO ) or B-type natriuretic peptide (BNP) on mortality in patients referred for advanced heart failure therapies. Frailty was measured using modified Fried frailty criteria. In 201 consecutive patients, during a median follow-up of 17.5 months (IQR 11-29.2), there were 25 (12.4%) deaths. One-year survival was 100%, 94%, and 78% in nonfrail, prefrail, and frail patients, respectively (log rank P = .0001). Frailty was associated with a twofold increase risk of death (HR 2.01, P < .0001, 95% CI 1.42-2.84). When adjusted for BNP or peak VO , frailty was not associated with a significant risk of all-cause death. However, when peak VO is stratified into two categories (≥12 mL/kg/min vs <12 mL/kg/min), frailty was associated with increased mortality in patients with a lower peak VO (HR 1.72, P = .006).

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The Road to Frailty Is Paved With Good Intentions

Cited by 7 publications

References 13 publications

Development of a Claims-based Frailty Indicator Anchored to a Well-established Frailty Phenotype

Development of a Claims-based Frailty Indicator Anchored to a Well-established Frailty Phenotype

Frailty, Physical Activity, and Mobility in Patients With Cardiac Implantable Electrical Devices

The prognostic significance of frailty compared to peak oxygen consumption and B‐type natriuretic peptide in patients with advanced heart failure

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