Predictive value of the clinical frailty scale and the essential frailty toolset versus euroscore ii for 30-day outcomes after mitral valve surgery

Q: What are the key findings of this study?

Clinical Frailty Scale (CFS) predicted 30-day composite outcomes after mitral valve surgery better than EFT and EuroSCORE II (AUC 0.809 vs 0.736 and 0.649; p<0.001 vs EuroSCORE II).

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Severe mitral valve disease undergoing mitral valve repair or replacement (n=184). Intervention: Preoperative frailty assessment using the Clinical Frailty Scale (CFS) and Essential Frailty Toolset (EFT) vs. EuroSCORE II surgical risk score (and non-frail strata). Primary outcome: 30-day composite of all-cause death, major cardiovascular complications, prolonged ventilation (>24 hours) or reintubation, prolonged vasopressor dependence (>24 hours), and rehospitalization for heart failure (AUC 0.809 (CFS) vs AUC 0.736 (EFT) vs AUC 0.649 (EuroSCORE II), 95% CI 0.750-0.868, p=<0.001).

Q: What does this research mean for the field?

Preoperative frailty assessment using the Clinical Frailty Scale predicts 30-day composite outcomes after mitral valve surgery significantly better than the Essential Frailty Toolset and EuroSCORE II. Novelty: ClaimNovelty.CONFIRMATORY. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

To compare the 30-day predictive performance of the Clinical Frailty Scale (CFS) and the Essential Frailty Toolset (EFT) against EuroSCORE II in patients undergoing mitral valve surgery.

Thi Thanh Huong Nguyen; Việt Hà Trịnh; Minh Tuan Pham

doi:10.47972/vjcts.v57i.1897

October 28, 2026Tạp chí Phẫu thuật và Tim mạch và Lồng ngực Việt NamOpen Access

Predictive value of the clinical frailty scale and the essential frailty toolset versus euroscore ii for 30-day outcomes after mitral valve surgery

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Key result

Clinical Frailty Scale predicts 30-day complications after mitral valve surgery better than EuroSCORE II.

AUC 0.809 (CFS) vs AUC 0.736 (EFT) vs AUC 0.649 (EuroSCORE II)
95% CI 0.750-0.868
P<0.001
n=184

Why the study?

Frailty reflects reduced physiological reserve and may add prognostic information beyond conventional surgical risk scores like EuroSCORE II in patients undergoing mitral valve surgery.

Does preoperative frailty assessment using the Clinical Frailty Scale (CFS) or Essential Frailty Toolset (EFT) improve prediction of 30-day composite postoperative outcomes compared to EuroSCORE II in patients undergoing mitral valve surgery?

Key Points

To compare the 30-day predictive performance of the Clinical Frailty Scale (CFS) and the Essential Frailty Toolset (EFT) against EuroSCORE II in patients undergoing mitral valve surgery.
Prospective cohort study of 184 patients undergoing mitral valve repair or replacement at the Vietnam National Heart Institute, Bach Mai Hospital, between September 2025 and July 2026.
Frailty was measured preoperatively using the CFS and EFT, with baseline surgical risk estimated by EuroSCORE II.
The primary endpoint was a 30-day composite of death, major cardiovascular complications, prolonged mechanical ventilation or reintubation, prolonged vasopressor dependence, and heart failure rehospitalization, compared using DeLong's test.
Frailty was identified in 55.4% of patients by CFS and in 8.7% by EFT, with only 16 of 102 patients identified as frail by CFS concordantly classified by EFT.
The 30-day composite endpoint occurred in 107 patients (58.2%), with no deaths, and event rates increased across the three strata for all risk tools (p for trend < 0.001).
The area under the curve for CFS was 0.809 (95% CI 0.750–0.868), which was significantly higher than EFT (0.736; p = 0.031) and EuroSCORE II (0.649; p < 0.001).

Study Design

Type

Cohort (n=184)

Blinding

Unblinded (assessors and ICU team were not blinded)

Multicenter

No

Structured PICO

Does preoperative frailty assessment using the Clinical Frailty Scale (CFS) or Essential Frailty Toolset (EFT) improve prediction of 30-day composite postoperative outcomes compared to EuroSCORE II in patients undergoing mitral valve surgery?

P

Population

184 adults (mean age 56.7 years, 64.1% female) with predominantly rheumatic severe mitral valve disease undergoing mitral valve repair or replacement at a single center in Vietnam, followed for 30 days.

E

Exposure

Preoperative frailty assessment using the 9-point Clinical Frailty Scale (CFS; categorized as non-frail 1-3, pre-frail 4, frail ≥5) and modified Essential Frailty Toolset (EFT; 0-5 points based on 5-chair rises, Mini-Cog, hemoglobin, and serum albumin; categorized as non-frail 0-1, pre-frail 2-3, frail 4-5).

C

Comparator

Preoperative surgical risk stratification using EuroSCORE II (categorized as low risk <2%, intermediate risk 2 to <5%, high risk ≥5%).

O

Outcome

30-day composite endpoint of all-cause mortality (in-hospital or within 30 days), major cardiovascular complications (cardiogenic shock, cardiac arrest, pericardial or pleural hemothorax requiring intervention, severe respiratory failure), prolonged mechanical ventilation (>24 hours) or reintubation, prolonged vasopressor dependence (>24 hours to maintain MAP ≥65 mmHg), and rehospitalization for heart failure within 30 days.composite

Main Result

Effect estimate: AUC 0.809 (CFS) vs AUC 0.736 (EFT) vs AUC 0.649 (EuroSCORE II) (95% CI 0.750-0.868)

Absolute Event Rate: 82.4% vs 17.9%

p-value: p=<0.001

In a relatively young, predominantly rheumatic mitral valve surgery cohort largely classified as low-risk by EuroSCORE II, preoperative frailty assessment with the Clinical Frailty Scale (CFS) demonstrated superior discrimination for 30-day postoperative morbidity compared to EuroSCORE II and EFT.

Limitations

Single-center study with convenience sampling and a short 30-day follow-up period, limiting generalizability and long-term assessment.
The primary composite endpoint was heavily driven by prolonged vasopressor dependence (53.8%), which is influenced by ICU team practices.
Frailty assessors and the ICU care team were not blinded to each other, introducing potential bias in postoperative management decisions.
Used modified EFT thresholds and Mini-Cog instead of MMSE, and did not evaluate model calibration or incremental value added to EuroSCORE II.
Single-center study with convenience sampling and short (30-day) follow-up, limiting generalizability and assessment of medium- to long-term outcomes.
The composite endpoint was heavily driven by prolonged vasopressor dependence (53.8%), which is influenced by ICU team practices, and assessors/ICU staff were not blinded.
Used modified EFT thresholds and substituted Mini-Cog for MMSE, limiting direct comparison with original EFT studies.
Focused only on discrimination without evaluating calibration, incremental value over EuroSCORE II, or the impact of perioperative factors.

Implication

CFS may enhance 30-day risk prediction in mitral valve surgery; leaves open its role in routine assessment pending validation.

Abstract

Background: Frailty reflects reduced physiological reserve and may add prognostic information beyond conventional surgical risk scores. We compared the 30-day predictive performance of the Clinical Frailty Scale (CFS) and the Essential Frailty Toolset (EFT) with EuroSCORE II in patients undergoing mitral valve surgery. Methods: Prospective cohort of 184 patients undergoing mitral valve repair or replacement at the Vietnam National Heart Institute, Bach Mai Hospital (September 2025 to July 2026). The primary endpoint was a 30-day composite of death, major cardiovascular complications, prolonged ventilation or reintubation, prolonged vasopressor dependence, and rehospitalization for heart failure. Discrimination was compared using DeLong's test. Results: Mean age was 56.7 ± 9.8 years and 64.1% were women. Frailty was identified in 55.4% by CFS and 8.7% by EFT; only 16 of 102 patients frail by CFS were concordantly classified by EFT. The composite endpoint occurred in 107 patients (58.2%), with no deaths. Event rates rose across the three strata of all tools (p for trend < 0.001). The area under the curve was 0.809 (95% CI 0.750–0.868) for CFS, higher than EFT (0.736; p = 0.031) and EuroSCORE II (0.649; p < 0.001). Conclusions: In a relatively young mitral valve population largely classified as low risk by EuroSCORE II, frailty assessment by CFS or EFT predicted 30-day outcomes better than EuroSCORE II; CFS showed the highest discriminative ability.

Discussion

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Cite This Study

Nguyen et al. (2026) conducted a cohort in Severe mitral valve disease undergoing mitral valve repair or replacement (n=184). Preoperative frailty assessment using the Clinical Frailty Scale (CFS) and Essential Frailty Toolset (EFT) vs. EuroSCORE II surgical risk score (and non-frail strata) was evaluated on 30-day composite of all-cause death, major cardiovascular complications, prolonged ventilation (>24 hours) or reintubation, prolonged vasopressor dependence (>24 hours), and rehospitalization for heart failure (AUC 0.809 (CFS) vs AUC 0.736 (EFT) vs AUC 0.649 (EuroSCORE II), 95% CI 0.750-0.868, p=<0.001). Clinical Frailty Scale (CFS) predicted 30-day composite outcomes after mitral valve surgery better than EFT and EuroSCORE II (AUC 0.809 vs 0.736 and 0.649; p<0.001 vs EuroSCORE II).

synapsesocial.com/papers/6ae4338fd9418cd7c8f465b3 https://doi.org/10.47972/vjcts.v57i.1897

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Predictive value of the clinical frailty scale and the essential frailty toolset versus euroscore ii for 30-day outcomes after mitral valve surgery

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Predictive value of the clinical frailty scale and the essential frailty toolset versus euroscore ii for 30-day outcomes after mitral valve surgery

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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