Frailty Matters: Validation of an Automated Electronic Short Physical Performance Battery (eSPPB) for Predicting...

Background: Frailty is a major determinant of adverse outcomes in older adults with cardiovascular disease. Automated digital tools may facilitate routine frailty assessment in hospital settings; however, their validity and prognostic relevance in acutely hospitalized patients remain insufficiently established. Methods: In this prospective cohort study, 113 hospitalized cardiology patients underwent frailty assessment using both manual Short Physical Performance Battery (mSPPB) and an automated electronic SPPB (eSPPB) system. Agreement between methods was evaluated using Pearson correlation, intraclass correlation coefficients (ICCs), and Bland-Altman analysis. Frailty was defined as SPPB < 5. The association between frailty and 30-day mortality was assessed using logistic regression and Kaplan-Meier survival analysis. Results: Seventeen patients (15.0%) were classified as frail. Automated and manual SPPB scores were highly correlated (r = 0.994, p < 0.001) and demonstrated good agreement (ICC = 0.80). Bland-Altman analysis showed a mean difference of -1.63 points (95% limits of agreement -4.41 to 1.16). Frailty was associated with significantly higher 30-day mortality (17.6% vs. 2.1%, p = 0.009), corresponding to a tenfold increase in mortality odds (OR 10.07; 95% CI 1.5-67.5). An exploratory model showed apparent discriminative performance (AUC 0.83; 95% CI 0.71-0.95). Conclusions: Automated eSPPB demonstrated good agreement with manual assessment and was significantly associated with short-term mortality in hospitalized cardiovascular patients. These findings support the validity and potential clinical utility of automated frailty assessment for risk stratification in acute cardiology settings.