Translation of the Frailty Paradigm from Older Adults to Children with Cardiac Disease

Area of Science:

• Pediatric Cardiology
• Gerontology
• Clinical Assessment

Background:

• Children and adolescents with cardiac disease (CCD) experience significant morbidity and reduced quality of life.
• Currently, no widely applicable tools exist to assess functional phenotypes, encompassing physical capability and psychosocial well-being, in CCD, unlike the established frailty scores for the elderly.

Purpose of the Study:

• To investigate the specific domains of frailty within the pediatric and adolescent cardiac disease population.
• To establish whether frailty domains can be quantified using developmentally appropriate methods in CCD.
• To compare frailty domain performance between CCD and age- and gender-matched healthy controls.

Main Methods:

• Prospective recruitment of 34 children and adolescents with cardiac disease (ages 8-17.5) and 22 healthy controls.
• Assessment of five frailty domains: slowness (6-min walk test), weakness (handgrip strength), exhaustion (multidimensional fatigue scale), body composition (height, weight, BMI, skinfold thickness), and physical activity (pediatric activity questionnaire).
• Utilized age- and gender-based population norms to derive Z scores and percentiles for each measurement, followed by two-tailed t-tests for group comparisons.

Main Results:

• The CCD group demonstrated significantly worse performance across all five assessed frailty domains compared to healthy controls.
• Specific significant differences were observed in the 6-min walk test (slowness), handgrip strength (weakness), fatigue scale scores (exhaustion), and various body composition and physical activity metrics.
• These findings support the concept that frailty domains can be quantified in children and adolescents with cardiac disease.

Conclusions:

• Frailty domains are quantifiable in children and adolescents with cardiac disease using developmentally appropriate methods.
• Children and adolescents with cardiac disease exhibit significant deficits in all five frailty domains when compared to healthy controls.
• Larger, longitudinal studies are warranted to further investigate frailty in CCD and its potential to predict adverse health outcomes.