Comparison of Physical Frailty Assessments in Heart Failure With Preserved Ejection Fraction

Frailty is a known determinant of poor clinical outcomes in heart failure with preserved ejection fraction (HFpEF). However, prevalence estimates and effect sizes vary in part due to multiple tools available to measure frailty. This study aimed to compare the prevalence and prognostic value of 6 commonly used frailty assessments in adults with HFpEF. We examined 203 outpatients with HFpEF seen at Weill Cornell Medicine from June 2018 to August 2022. The following frailty scales were compared: the Clinical Frailty Scale (CFS), the Fatigue, Resistance, Ambulation, Illnesses, and Loss of Weight scale (FRAIL) scale, the 5-m gait speed test, the 5 timed sit-to-stand test, hypoalbuminemia, and the modified body mass index score. The primary endpoint was a 1-year composite of all-cause mortality and hospitalization. Cox proportional hazard models were used to examine the association between frailty and the primary endpoint, adjusting for race and the MAGGIC (Meta-Analysis Global Group in Chronic) heart failure prognostic risk score. The median age was 76.7 years (IQR: 69.7-83.9 years). The prevalence of frailty ranged from 21.2% (hypoalbuminemia) to 77.8% (5 timed sit-to-stand) and increased with advancing HFpEF severity. Of the 6 frailty assessments, the CFS (HR: 2.83; 95% CI: 1.61-4.98, P < 0.001), FRAIL scale (HR: 1.96; 95% CI: 1.25-3.07, P = 0.004), and 5-m gait speed test (HR: 2.80; 95% CI: 1.50-5.25, P = 0.001) were associated with adverse outcomes in the multivariate analysis. Frailty assessments yield a wide range of prevalence estimates and vary in their associations with clinical outcomes. The CFS, FRAIL scale, and the 5-m gait speed tests demonstrated associations with adverse outcomes and may thus be reasonable tools for routine use in patients with HFpEF.