A Comparison of Surgeon's Subjective Assessment of Frailty to Formal Frailty Testing in Patients with Heart Failure Being Evaluated for Advanced Therapies

Introduction Most heart failure (HF) programs use a subjective provider assessment (SPA) of frailty, or “eye-ball” test, for patient selection for advanced therapies (AT). The Modified Fried Frailty Index (mFFI) is an objective assessment of frailty and has been validated in elderly HF populations. We compared SPA to mFFI in patients referred for AT. Methods Patients referred to our center for evaluation for AT were studied. Those unable to undergo mFFI testing due to other comorbidities were excluded. mFFI assigns a frailty point in each of five domains (max. possible score 5): weight loss, exhaustion, activity, walk time, and grip strength. Patients are designated as frail when score ≥3. Additionally, three cardiac surgeons independently determined patients to be frail or not frail (SPA). Surgeons were blinded to designations given by the other surgeons as well as to the mFFI score. Patients who underwent LVAD implantation were reevaluated with the mFFI at 3 and 6 months. Results Over 12 months, 30 patients (59±13 yrs) were studied. All patients were assessed by at least one surgeon, 27 by at least two, and 13 by all three. Comparing frail to not frail cohorts (by mFFI), frail patients were older, had lower albumin, and smaller LV size. SPA significantly underestimated frailty compared to formal mFFI testing (0-18% vs. 63%, p Conclusion While agreement between providers is strong, subjective assessment significantly underestimates frailty when compared to formal testing. Notably, providers were always accurate when they designated a patient as frail. Frailty scores improved in all patients after LVAD, suggesting reversibility of the frailty syndrome. Further study of frailty assessments in advanced HF may improve patient selection for AT.