Frailty assessment instruments in heart failure: A systematic review

Abstract

Background: Frailty is an independent predictor of mortality across many conditions. Reported rates of frailty in heart failure range from 15% to 74%. There are several instruments available to assess frailty; however, to date there has been no consensus on the most appropriate instrument for use in individuals with heart failure. Aims: To identify how frailty is assessed in individuals with heart failure and to elucidate which domains of frailty are most frequently assessed. Methods: Key electronic databases were searched (MEDLINE, COCHRANE Central and CINAHL) to identify studies that assessed frailty in individuals with heart failure using a formal frailty instrument. Results: Twenty studies published in 24 articles were included, for which a total of seven unique frailty instruments were identified. The most commonly used instrument was the Frailty Phenotype (n= 11), with the majority of studies using a modified version of the Frailty Phenotype (n= 8). The second most commonly used instrument identified was the Comprehensive Geriatric Assessment (n= 4). Conclusion:There is an increasing interest in the assessment of frailty, but, to date, there is no frailty instrument validated specifically in the heart failure population.

Comorbidities, Fragility, and Quality of Life in Heart Failure Patients With Midrange Ejection Fraction

“…The term fragility may be used to describe slightly different settings; yet from a strict geriatric perspective, it means an increased risk of disability. Indeed, our approach has been included as the Comprehensive Geriatric Assessment instrument in a recent comprehensive review by McDonagh et al 6 . Most patients were referred from the cardiology department and had ischemic heart disease as the cause of HF, and the study population was relatively young, with a small percentage of women.…”

“…In this context, QOL is related to fragility in the full age spectrum of patients with HF 5 . Notably, there is still no universal definition of fragility; thus, there are no fully standardized methods for measuring it, although several tools are increasingly used in recent times 6 . We started to assess fragility almost 2 decades ago in ambulatory patients with HF using a set of validated geriatric scales as surrogates of fragility,3, 5 and with these scales we have shown that fragility is a key determinant for the prognosis of patients with HF of all ages 7 …”

Heart Failure Association of the European Society of Cardiology position paper on frailty in patients with heart failure

“…In an attempt to overcome these weaknesses, several other instruments have been developed over time, through changing, omitting or adding criteria to one or the other of these two conceptual definitions or using single components of the physical frailty phenotype. [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17] The main characteristics and limitations of the main frailty assessment instruments used in HF patients are shown in Table 1.…”

“…Although the concept of frailty is extensively used, in clinical and research settings, an internationally accepted definition is still lacking and there is no agreement on which is the best method or instrument to assess frailty. Several definitions of frailty and a plethora of different instruments have been used for the identification of frailty within a variety of disease states and settings . This has limited the possibility not only to ‘speak a common language’ and to compare the results from different studies, but has challenged the possibility for correct diagnosis and interventions.…”

“…Several definitions of frailty and a plethora of different instruments have been used for the identification of frailty within a variety of disease states and settings. [2][3][4][5][6][7][8] This has limited the possibility not only to 'speak a common language' and to compare the results from different studies, but has challenged the possibility for correct diagnosis and interventions. In addition, the lack of a gold standard method Gorodeski et al 9 and the inconvenience of using a number of available assessment instruments (due to time, availability of special equipment, patient limitations, etc.)…”