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Measuring frailty in heart failure: a community perspective
Sheila M McNallan1, Alanna M Chamberlain, Yariv Gerber
1Department of Health Sciences Research, Mayo Clinic, Rochester, MN.
American Heart Journal
|October 8, 2013
Summary
Frailty assessment in heart failure patients using the biological phenotype or deficit index equally predicts mortality. The deficit index is a practical alternative for clinical use.
Area of Science:
- Gerontology
- Cardiology
- Clinical Medicine
Background:
- Frailty is a key prognostic factor in heart failure (HF).
- Two common frailty measures are the biological phenotype and the accumulation of deficits (deficit index).
- Their comparative utility in a community HF cohort was previously unevaluated.
Purpose of the Study:
- To compare the predictive accuracy of the biological phenotype and deficit index for mortality in a heart failure cohort.
- To assess the feasibility of using the deficit index in clinical practice.
Main Methods:
- A cohort of 223 Southeastern Minnesota residents with HF was recruited.
- Frailty was assessed using the biological phenotype (3+ criteria: weakness, exhaustion, slowness, low activity, weight loss) and the deficit index (proportion of 32 deficits).
- Mortality was tracked over a mean follow-up of 2.4 years.
Main Results:
- 21% of patients were frail and 48% intermediate frail by biological phenotype.
- The deficit index ranged from 0.02-0.75 (mean 0.25).
- Both frailty measures equally predicted mortality (C-statistics ~0.70). Frail patients had a 2-fold increased death risk; a 0.1 increase in deficit index raised death risk by 44%.
Conclusions:
- The deficit index and biological phenotype demonstrate comparable predictive power for mortality in heart failure.
- The deficit index is a feasible alternative for frailty assessment in clinical settings, as it can be derived from medical records.
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