TY - JOUR
T1 - Clinician estimates of frailty compared to formal frailty assessment in adults with heart failure : a cross-sectional analysis
AU - McDonagh, Julee
AU - Prichard, Roslyn
AU - Ferguson, Caleb
AU - Phillips, Jane L.
AU - Davidson, Patricia M.
AU - Macdonald, Peter S.
AU - Newton, Phillip J.
PY - 2022
Y1 - 2022
N2 - Background: Frailty assessment is recommended for patients with heart failure. Despite the availability of instruments to assess frailty, there are no clear recommendations regarding the optimal instrument to use in a heart failure context. This ambiguity combined with a lack of education and resources, often leads clinicians to rely on subjective estimates of frailty, such as ‘the end-of-the-bed’ or ‘eyeball’ test. Aim: To examine the association between clinician-estimated frailty and formal frailty assessment in adults with heart failure. Methods: Cross-sectional analysis of the FRAilty MEasurement in Heart Failure (FRAME-HF) study. Participants: (1) Adults aged ≥18 years in the outpatient heart failure clinic and cardiology ward; (2) and cardiovascular clinicians (nurses, physicians, and allied-health professionals). Following participant recruitment, cardiovascular clinicians were asked to rate the participant's frailty status based on their routine clinical assessment as either: frail, pre-frail, or non-frail, which was then compared to a formal frailty assessment using a modified version of the Frailty Phenotype. The association between clinician-estimated frailty and formal frailty assessment were examined using a weighted Kappa statistic and Spearman's correlation coefficient. Results: A total of 75 patients and 39 clinicians were recruited, producing 194 paired frailty assessments. Mean age of the patients was 54 (ñ13) years. Correlation of pooled clinician-estimated frailty to formal frailty was fair (0.52, p=0.00). Correlation was highest between allied-health estimated frailty and formal frailty (0.70, p=0.00). Agreement between pooled clinician-estimated frailty and formal frailty was fair (0.33) and was highest between allied health-estimated frailty and formal frailty (0.45). Conclusion: Subjective clinician-estimated frailty is not a reliable replacement for formal frailty assessment in adults with heart failure, underscoring the need for assessment using a valid and reliable instrument.
AB - Background: Frailty assessment is recommended for patients with heart failure. Despite the availability of instruments to assess frailty, there are no clear recommendations regarding the optimal instrument to use in a heart failure context. This ambiguity combined with a lack of education and resources, often leads clinicians to rely on subjective estimates of frailty, such as ‘the end-of-the-bed’ or ‘eyeball’ test. Aim: To examine the association between clinician-estimated frailty and formal frailty assessment in adults with heart failure. Methods: Cross-sectional analysis of the FRAilty MEasurement in Heart Failure (FRAME-HF) study. Participants: (1) Adults aged ≥18 years in the outpatient heart failure clinic and cardiology ward; (2) and cardiovascular clinicians (nurses, physicians, and allied-health professionals). Following participant recruitment, cardiovascular clinicians were asked to rate the participant's frailty status based on their routine clinical assessment as either: frail, pre-frail, or non-frail, which was then compared to a formal frailty assessment using a modified version of the Frailty Phenotype. The association between clinician-estimated frailty and formal frailty assessment were examined using a weighted Kappa statistic and Spearman's correlation coefficient. Results: A total of 75 patients and 39 clinicians were recruited, producing 194 paired frailty assessments. Mean age of the patients was 54 (ñ13) years. Correlation of pooled clinician-estimated frailty to formal frailty was fair (0.52, p=0.00). Correlation was highest between allied-health estimated frailty and formal frailty (0.70, p=0.00). Agreement between pooled clinician-estimated frailty and formal frailty was fair (0.33) and was highest between allied health-estimated frailty and formal frailty (0.45). Conclusion: Subjective clinician-estimated frailty is not a reliable replacement for formal frailty assessment in adults with heart failure, underscoring the need for assessment using a valid and reliable instrument.
UR - https://hdl.handle.net/1959.7/uws:77055
U2 - 10.1016/j.hlc.2022.04.003
DO - 10.1016/j.hlc.2022.04.003
M3 - Article
SN - 1443-9506
VL - 31
SP - 1241
EP - 1246
JO - Heart Lung and Circulation
JF - Heart Lung and Circulation
IS - 9
ER -