Clinician Estimates of Frailty Compared to Formal Frailty Assessment in Adults With Heart Failure: A Cross-Sectional Analysis

Differences in preoperative frailty assessment of surgical candidates by sex, age, and race

“…However, this trend was reversed where “frail” female Black standardized patients received stronger support for surgery versus the “frail” male standardized Black patients [ 24 ]. In contrast, McDonagh et al [ 19 ] found no sex-based difference in clinician-estimated frailty among a cohort of adults with heart failure. Although reports vary in the role sex or gender influences the perception of frailty, consistent disparities are observed in treatment decision-making between male and female patients.…”

“…In a study of advanced chronic kidney disease patients, Fried criteria identified 34 % to be frail, whereas 44 % of patients were qualified as frail by physician impression, with a weak agreement between assessments [ 32 ]. Among patients with heart failure, two separate studies reported fair agreement between formal and subjective provider assessment of frailty, yet overall, physicians tended to significantly overestimate non-frail patients and underestimate the true prevalence of frailty [ 19 , 20 ]. These results have encouraged the inclusion of self-rated indices in frailty measurements to improve detection rates, particularly in younger patients in which fitness status may not be visibly apparent [ 37 ].…”

“…Although most surgeons view frailty screening favorably, only one-third of practices include formal assessments due to concerns regarding clinical feasibility, doubt regarding its impact on decision-making, and belief that frailty is identified without questionnaires or physical testing [ [14] , [15] , [16] ]. Notably, subjective frailty assessments have demonstrated poor-to-fair agreement with objective frailty measures and often underestimate the prevalence of pre- to intermediately frail patients [ [17] , [18] , [19] , [20] , [21] ].…”

Frailty and oral anticoagulant prescription in adults with atrial fibrillation: A systematic review

“…There are numerous frailty assessment instruments available, including the Fried Frailty Phenotype, 29 Cumulative Deficit Model of Frailty (CDM), 30 Survey of Health, Aging, and Retirement in Europe Frailty Index (SHARE‐FI), 31 and the Clinical Frailty Scale (Rockwood) 32 . Clinician estimated frailty (e.g., the end‐of‐the‐bed, “eye‐ball” test) has been shown to be inaccurate when compared against the use of frailty assessment instruments 33,34 . Therefore, the use of a validated instrument may assist in decision making for anticoagulation for stroke prevention.…”

“… 32 Clinician estimated frailty (e.g., the end‐of‐the‐bed, “eye‐ball” test) has been shown to be inaccurate when compared against the use of frailty assessment instruments. 33 , 34 Therefore, the use of a validated instrument may assist in decision making for anticoagulation for stroke prevention. Despite increasing interest in the assessment of frailty in the context of AF, the impact of frailty on the appropriate use of NOACs for stroke prevention remains unclear.…”