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Subjective Assessment Underestimates Fraility in Patients With Heart Failure Referred for Advanced Therapies
Cassandra Heaney1, Alexis Knisel1, Ravi Vuthoori2
1From the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell is in Manhasset, New York, USA.
ASAIO Journal (American Society for Artificial Internal Organs : 1992)
|February 22, 2023
Summary
Subjective provider assessment (SPA) significantly underestimates frailty compared to the objective modified five-item Fried Frailty Index (mFFI). While providers correctly identify frail patients 84% of the time, they are less accurate when identifying non-frail patients.
Area of Science:
- Cardiology
- Geriatrics
- Clinical Assessment
Background:
- Frailty assessment is crucial for evaluating patients for advanced therapies (ATs).
- Current clinical practice often relies on subjective provider assessment (SPA), or the "eye-ball" test.
- Objective measures, such as the modified five-item Fried Frailty Index (mFFI), offer a validated alternative.
Purpose of the Study:
- To compare the accuracy of SPA against the mFFI in patients referred for AT.
- To investigate the association between frailty status and macrophage migration inhibitory factor (MIF) levels.
- To evaluate the inter-rater reliability of SPA among clinicians.
Main Methods:
- Seventy-eight patients undergoing evaluation for AT were assessed using both SPA by three independent cardiac surgeons and the mFFI.
- Plasma MIF levels were measured and compared between frail and non-frail groups.
- Statistical analysis included kappa statistics for agreement and t-tests for MIF level comparison.
Main Results:
- SPA significantly underestimated frailty compared to mFFI (κ = 0.02-0.14).
- Providers correctly identified frail patients 84% of the time but only 40% of the time for non-frail patients.
- No significant difference in plasma MIF levels was observed between frail and non-frail subjects (p = 0.6).
Conclusions:
- Clinicians tend to underestimate frailty when using subjective assessments.
- While SPA is reliable in identifying frail patients, its accuracy decreases for non-frail individuals.
- The mFFI provides a more objective and potentially more accurate measure of frailty in this population.
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