Abstract
Objectives
We investigated whether the FRAIL scale questionnaire is consistent with the Fried
criteria, predicts all-cause mortality, and reflects physical dysfunction in patients
with heart failure (HF).
Design
Secondary analysis of FRAGILE-HF, a cohort study that enrolled participants from 2016
to 2018 and followed-up for 1-year of discharge.
Setting and Participants
A prospective multicenter cohort study in which 15 hospitals in Japan (8 university
hospitals and 7 nonuniversity teaching hospitals) participated. We prospectively enrolled
1332 consecutive hospitalized patients ≥65 years old with HF and analyzed 1028 patients
after excluding 304 patients with missing data on the FRAIL scale.
Methods
The FRAIL scale, the Fried model, and physical function were measured before discharge.
The endpoint was all-cause mortality.
Results
According to the FRAIL scale, 459 (44.6%) and 491 (47.8%) were classified as frail
and prefrail, respectively. The Kappa coefficient between the FRAIL scale and the
Fried criteria were 0.39 [95% confidence interval (CI) 0.34–0.44; P < .001]. The area under the receiver-operating characteristic curves for frailty
diagnosed by the Fried criteria of the FRAIL scale was 0.74 (95% CI 0.71–0.76; P < .001). A total of 118 deaths occurred during 1 year of follow-up. After adjusting
for the MAGGIC risk score and log-BNP, The FRAIL scale predicted all-cause mortality
(hazard ratio 1.17; 95% CI 1.01–1.36; P = .035). The FRAIL scale was also associated with various physical dysfunctions that
correlated with poor prognosis.
Conclusions and Implications
The FRAIL scale had moderate consistency with the Fried criteria, predicted all-cause
mortality, and reflected clinically important physical dysfunctions.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of the American Medical Directors AssociationAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- 9-year trend in the management of acute heart failure in Japan: A report from the National Consortium of Acute Heart Failure Registries.J Am Heart Assoc. 2018; 7: e008687
- The global health and economic burden of hospitalizations for heart failure: Lessons learned from hospitalized heart failure registries.J Am Coll Cardiol. 2014; 63: 1123-1133
- Heart Disease and Stroke Statistics-2016 update: A report from the American Heart Association.Circulation. 2016; 133: e38-e360
- Frailty and clinical outcomes in heart failure: A systematic review and meta-analysis.J Am Med Dir Assoc. 2018; 19: 1003-1008.e1
- Frailty in older adults: Evidence for a phenotype.J Gerontol A Biol Sci Med Sci. 2001; 56: M146-M156
- The future is now: A call for action for cardiac telerehabilitation in the COVID-19 pandemic from the secondary prevention and rehabilitation section of the European Association of Preventive Cardiology.Eur J Prev Cardiol. 2020; ([Epub ahead of print])https://doi.org/10.1177/2047487320939671
- Musculoskeletal risk stratification tool to inform a discussion about face-to-face assessment during the COVID-19 pandemic.BMJ Open Sport Exerc Med. 2020; 6: e000916
- Recommendations on how to provide cardiac rehabilitation services during the COVID-19 pandemic.Neth Heart J. 2020; 28: 387-390
- A simple frailty questionnaire (FRAIL) predicts outcomes in middle aged African Americans.J Nutr Health Aging. 2012; 16: 601-608
- FRAIL questionnaire screening tool and short-term outcomes in geriatric fracture patients.J Am Med Dir Assoc. 2017; 18: 1082-1086
- Quick and simple FRAIL scale predicts incident activities of daily living (ADL) and instrumental ADL (IADL) disabilities: A systematic review and meta-analysis.J Am Med Dir Assoc. 2018; 19: 1063-1068
- Frailty defined by FRAIL scale as a predictor of mortality: A systematic review and meta-analysis.J Am Med Dir Assoc. 2018; 19: 480-483
- FRAIL scale also predicts long-term outcomes in older patients with acute coronary syndromes.J Am Med Dir Assoc. 2020; 21: 683-687.e1
- Prevalence and prognostic impact of the coexistence of multiple frailty domains in elderly patients with heart failure: The FRAGILE-HF cohort study.Eur J Heart Fail. 2020; 22: 2112-2119
- The natural history of congestive heart failure: The Framingham study.N Engl J Med. 1971; 285: 1441-1446
- Rising time from bed in acute phase after hospitalization predicts frailty at hospital discharge in patients with acute heart failure.J Cardiol. 2020; 75: 587-593
- A short physical performance battery assessing lower extremity function: Association with self-reported disability and prediction of mortality and nursing home admission.J Gerontol. 1994; 49: M85-M94
- ATS statement: Guidelines for the six-minute walk test.Am J Respir Crit Care Med. 2002; 166: 111-117
- Use of the short physical performance battery score to predict loss of ability to walk 400 meters: Analysis from the InCHIANTI study.J Gerontol A Biol Sci Med Sci. 2009; 64: 223-229
- Lower extremity function and subsequent disability: Consistency across studies, predictive models, and value of gait speed alone compared with the short physical performance battery.J Gerontol A Biol Sci Med Sci. 2000; 55: M221-M231
- Asian Working Group for Sarcopenia: 2019 consensus update on sarcopenia diagnosis and treatment.J Am Med Dir Assoc. 2020; 21: 300-307.e2
- Impact of gait speed and instrumental activities of daily living on all-cause mortality in adults >/=65 years with heart failure.Am J Cardiol. 2015; 115: 797-801
- Gait speed and operative mortality in older adults following cardiac surgery.JAMA Cardiol. 2016; 1: 314-321
- Prediction of mortality and morbidity with a 6-minute walk test in patients with left ventricular dysfunction. SOLVD Investigators.JAMA. 1993; 270: 1702-1707
- The relationship of walking intensity to total and cause-specific mortality. Results from the National Walkers' Health Study.PLoS One. 2013; 8: e81098
- Performance of the MAGGIC heart failure risk score and its modification with the addition of discharge natriuretic peptides.ESC Heart Fail. 2018; 5: 610-619
- Predicting survival in heart failure: A risk score based on 39 372 patients from 30 studies.Eur Heart J. 2013; 34: 1404-1413
- Comparing the areas under two or more correlated receiver operating characteristic curves: A nonparametric approach.Biometrics. 1988; 44: 837-845
- Multiple imputation of missing blood pressure covariates in survival analysis.Stat Med. 1999; 18: 681-694
- Small-sample degrees of freedom with multiple imputation.Biometrika. 1999; 86: 948-955
- Frailty among older decompensated heart failure patients: Prevalence, association with patient-centered outcomes, and efficient detection methods.JACC Heart Fail. 2019; 7: 1079-1088
- Comparison of frequency of frailty and severely impaired physical function in patients >/=60 years hospitalized with acute decompensated heart failure versus chronic stable heart failure with reduced and preserved left ventricular ejection fraction.Am J Cardiol. 2016; 117: 1953-1958
- Compliance behaviors of elderly patients with advanced heart failure.J Cardiovasc Nurs. 2003; 18 (quiz 07–8): 197-206
- Limitations of the New York Heart Association functional classification system and self-reported walking distances in chronic heart failure.Heart. 2007; 93: 476-482
- Gait speed has comparable prognostic capability to six-minute walk distance in older patients with cardiovascular disease.Eur J Prev Cardiol. 2018; 25: 212-219
- Short-term change in gait speed and clinical outcomes in older patients with acute heart failure.Circ J. 2019; 83: 1860-1867
- Validation of the FRAIL scale in Mexican elderly: Results from the Mexican Health and Aging Study.Aging Clin Exp Res. 2016; 28: 901-908
- Cross-cultural adaptation and validation of the FRAIL scale in Chinese community-dwelling older adults.J Am Med Dir Assoc. 2018; 19: 12-17
- Usefulness of FRAIL scale in heart valve diseases.Clin Interv Aging. 2020; 15: 1071-1075
- Utility of the FRAIL questionnaire in detecting heart failure with preserved ejection fraction.J Nutr Health Aging. 2019; 23: 373-377
- 2017 AHA/ACC focused update of the 2014 AHA/ACC guideline for the management of patients with valvular heart disease: A report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines.J Am Coll Cardiol. 2017; 70: 252-289
Article info
Publication history
Published online: March 27, 2021
Footnotes
KK has received research funds from Eiken Chemical Co. YM is affiliated with a department endowed by Philips Respironics, ResMed, Teijin Home Healthcare, and Fukuda Denshi, and received an honorarium from Novartis Japan and Otsuka Pharmaceutical Co. NK is affiliated with and receives salary from a department funded by Philips Healthcare, Asahi KASEI Corporation, Inter Reha Co., Ltd, and Toho Holdings Co., Ltd based on collaborative research agreements. TK is affiliated with a department endowed by Philips Respironics, ResMed, Teijin Home Healthcare, and Fukuda Denshi. The other authors declare no conflicts of interest.
The FRAGILE-HF study was supported by Novartis Pharma Research Grants, a Japan Heart Foundation Research Grant, and the Japan Society for the Promotion of Science Grant-in-Aid (JSPS KAKENHI, Grant Number 19K19884).
Identification
Copyright
© 2021 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
