Frailty assessment in people with haemophilia

In the general population, ageing is associated with frailty. Screening is recommended as targeted interventions improve health outcomes. Frailty screening was incorporated within routine clinic appointments for persons with haemophilia (PWH) aged ≥50 years at our large UK Haemophilia Comprehensive Care Centre (HCCC) from 2024.

To determine the prevalence of frailty in PWH aged ≥50 years.

Electronic health records of PWH ≥50 years were reviewed (2024-2025) to collect data on prospective Clinical Frailty Score (CFS), comorbidities, and regular medications.

Of 116 PWH aged ≥50 years, 111 PWH had CFS documented. Frailty (CFS≥4) occurred in 24%. Amongst those aged 50-64 years (n=66), 18% were frail (11 severe and 1 moderate haemophilia); of those aged ≥65 years (n=45), 33% were frail (4 severe, 2 moderate, 9 mild haemophilia). Frailty was associated with high rates of multi-morbidity (100%) and polypharmacy (78%). Haemophilic arthropathy appeared to be a significant contributory factor in some patients. Of those with CFS≥4, falls were reported in 26%, with immobility identified in 11%, cognitive impairment in 4%, and no incontinence documented. Specific clinical actions by the haemophilia team included haemophilia physiotherapy assessment and highlighting CFS to the primary care practitioner.

PWH have higher rates of frailty than reported for the general UK population (33% vs 10% for ≥65 years), and a high incidence in younger PWH. Haemophilic arthropathy appears to be a major contributing factor in some patients. Further studies are needed to clarify the impact of identification of frailty in PWH.