Frailty Test Battery Development including Physical, Socio-Psychological and Cognitive Domains for Cardiovascular Disease Patients: A Preliminary Study

Abstract

Frailty is an age-related decline in physical, socio-psychological and cognitive function that results in extreme vulnerability to stressors. Therefore, this study aimed to elucidate which tests have to be selected to detect frailty in a comprehensive and feasible manner in cardiovascular disease (CVD) patients based on multivariate regression and sensitivity/specificity analyses. Patients (n = 133, mean age 78 ± 7 years) hospitalised for coronary revascularisation or heart failure (HF) were examined using the Fried and Vigorito criteria, together with some additional measurements. Moreover, to examine the association of frailty with 6-month clinical outcomes, hospitalisations and mortality up to 6 months after the initial hospital admission were examined. Some level of frailty was detected in 44% of the patients according to the Vigorito criteria and in 65% of the patients according to the Fried criteria. Frailty could best be detected by a score based on: sex, Mini Nutritional Assessment (MNA), Katz scale, timed up-and-go test (TUG), handgrip strength, Mini-Mental State Examination (MMSE), Geriatric Depression Scale (GDS-15) and total number of medications. Frailty and specific markers of frailty were significantly associated with mortality and six-month hospitalisations. We thus can conclude that, in patients with CVD, sex, MNA, Katz scale, TUG, handgrip strength, MMSE, GDS-15 and total number of medications play a key role in detecting frailty, assessed by a new time- and cost-efficient test battery.

Keywords: cardiovascular disease; frailty; frailty assessment; older adults.

Figure 1

Distribution of the different levels of frailty (%) according to Fried and Vigorito for male and female CORO (a), PCI (b), CABG (c) and HF (d) patients. The different levels of frailty are represented as no frailty (horizontal lines), pre-frailty (Fried) or mild frailty (Vigorito) (vertical lines) and frailty (Fried) or moderate frailty (Vigorito) (diagonal lines). Note: Severe frailty (Vigorito) was not detected in the subjects and, thus, are not represented in the figure. Results are expressed as % within males and within females per CVD for each subcategory of frailty (in CORO, PCI, CABG and HF patients) or as % within CVD for total results (in CORO, PCI, CABG and HF patients) or as % within total population (for total results in last graph) (e). CABG, coronary artery bypass grafting; CORO, coronarography; F, females; HF, heart failure; M, males; PCI, percutaneous coronary intervention.

Figure 2

ROC curve (a) and plot (b) of the new regression formula vs. the total frailty score of Vigorito et al.