Takeaway
- Frailty commonly accompanies chronic heart failure (CHF).
- Clinical frailty scale (CFS) performed best for frailty assessment.
- Editorial:
- Discusses limitations of sensitivity and specificity, dichotomous outcomes.
- “The optimal approach for [frailty] measurement continues to be a source of debate.”
Why this matters
- In this population, frailty correlates with higher mortality risk and hospitalizations, but there is no standardized approach to frailty assessment.
Study design
- Single-center cross-sectional study of consecutive CHF outpatients (n=467) and controls (n=87) who underwent frailty assessments:
- 3 screening tools: Derby frailty index (DFI), acute frailty network criteria, CFS.
- 3 assessment tools: Fried physical-frailty criteria, Edmonton frailty score (EFS), Deficit Index.
- Gold standard for each was combined results of other 5; if ≥3 tools diagnosed frailty, patient was deemed frail.
- Outcomes: frailty prevalence, classification performance, tools’ agreement.
- Funding: None disclosed.
Key results
- Frailty prevalence was higher in patients with heart failure with normal vs reduced ejection fraction.
- Of screening tools, CFS correlated best with assessment tools:
- Correlation coefficient, 0.86-0.89; all P<.001.
- Sensitivity, 87%; specificity, 89%.
- Of assessment tools:
- Fried had highest sensitivity (93%) and false-positive rate (14%).
- EFS had highest specificity (98%) and false-negative rate (18%).
Limitations
- External validation needed.
- Tool predictive value not assessed.
References
References