Background
Frailty assessment is recommended for patients with heart failure. Despite the availability
of instruments to assess frailty, there are no clear recommendations regarding the
optimal instrument to use in a heart failure context. This ambiguity combined with
a lack of education and resources, often leads clinicians to rely on subjective estimates
of frailty, such as ‘the end-of-the-bed’ or ‘eyeball’ test.
Aim
To examine the association between clinician-estimated frailty and formal frailty
assessment in adults with heart failure.
Methods
Cross-sectional analysis of the FRAilty MEasurement in Heart Failure (FRAME-HF) study.
Participants: (1) Adults aged ≥18 years in the outpatient heart failure clinic and
cardiology ward; (2) and cardiovascular clinicians (nurses, physicians, and allied-health
professionals). Following participant recruitment, cardiovascular clinicians were
asked to rate the participant’s frailty status based on their routine clinical assessment
as either: frail, pre-frail, or non-frail, which was then compared to a formal frailty
assessment using a modified version of the Frailty Phenotype. The association between
clinician-estimated frailty and formal frailty assessment were examined using a weighted
Kappa statistic and Spearman’s correlation coefficient.
Results
A total of 75 patients and 39 clinicians were recruited, producing 194 paired frailty
assessments. Mean age of the patients was 54 (±13) years. Correlation of pooled clinician-estimated
frailty to formal frailty was fair (0.52, p=0.00). Correlation was highest between
allied-health estimated frailty and formal frailty (0.70, p=0.00). Agreement between
pooled clinician-estimated frailty and formal frailty was fair (0.33) and was highest
between allied health-estimated frailty and formal frailty (0.45).
Conclusion
Subjective clinician-estimated frailty is not a reliable replacement for formal frailty
assessment in adults with heart failure, underscoring the need for assessment using
a valid and reliable instrument.
Keywords
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Article info
Publication history
Published online: April 29, 2022
Accepted:
April 6,
2022
Received in revised form:
November 2,
2021
Received:
February 16,
2021
Identification
Copyright
© 2022 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.
