Comparison of six frailty instruments in adults with heart failure: a prospective cohort pilot study

Aims: To compare the frailty prevalence and predictive performance of six frailty instruments in adults with heart failure and determine the feasibility of study methods. Methods and results: Prospective cohort pilot study. Adults aged 18 years or older with a confirmed diagnosis of heart failure in Sydney, New South Wales, Australia. The Frailty Phenotype; the Survey of Health, Ageing, and Retirement in Europe Frailty Instrument (SHARE-FI); St Vincent's Frailty instrument; St Vincent's Frailty instrument plus cognition and mood; The Fatigue, Resistance, Ambulation, Illnesses, and Loss of Weight (FRAIL) scale; and the Deficit Accumulation Index (DAI) were compared. Multiple logistic regression was used to develop six frailty instrument models to evaluate the association between each frailty instrument and composite all-cause rehospitalization and mortality at 12 months. One hundred and thirty-one patients were included with a mean age of 54 [± 14(SD)]. Frailty prevalence ranged from 33 to 81%. All instruments except one (the FRAIL scale) appeared to signal an increased odds of rehospitalization and/or mortality, yet these results were non-significant. The six frailty instrument models displayed sensitivity between 88-92% and C-statistic values of 0.71-0.73, suggesting satisfactory discrimination. Conclusion: The prevalence of frailty varied across six frailty instruments yet was in the higher range despite a 'younger' heart failure cohort. Further research is required to confirm the psychometric properties of these instruments for routine clinical use in an adequately powered and more diverse heart failure cohort.