The FRAilty MEasurement in Heart Failure (FRAME-HF) Project

McDonagh, Julee

The FRAilty MEasurement in Heart Failure (FRAME-HF) Project

McDonagh, Julee

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Publication Type:: Thesis
Issue Date:: 2021

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Field	Value	Language
dc.contributor.author	McDonagh, Julee
dc.date.accessioned	2022-01-19T00:50:05Z
dc.date.available	2022-01-19T00:50:05Z
dc.date.issued	2021
dc.identifier.uri	http://hdl.handle.net/10453/153328
dc.description	University of Technology Sydney. Faculty of Health.	en_US.UTF-8
dc.description.abstract	𝗕𝗮𝗰𝗸𝗴𝗿𝗼𝘂𝗻𝗱 Frailty is a complex, multifaceted syndrome frequently experienced by older people and those living with chronic disease, such as HF. The presence of frailty is a robust predictive indicator of worse outcomes in people with HF, including rehospitalisation and mortality. Despite increasing interest in assessing frailty over the last decade, there is an absence of consensus regarding the universal definition of frailty and the optimal means of assessment for this population. 𝗔𝗶𝗺 The FRAME-HF project aims to determine the most suitable and clinically relevant frailty instrument(s) for use in adults living with heart failure (HF). 𝗠𝗲𝘁𝗵𝗼𝗱𝘀 Setting and participants: The FRAME-HF project was undertaken at St Vincent’s Hospital, Sydney, Australia. This project included: 1) Individuals ≥ 18 years and older with a confirmed diagnosis of HF and 2) Cardiovascular clinicians. Design: Deductive sequential mixed methods project comprising three interrelated yet discrete studies: a systematic review (Study 1); a cross-sectional study (Study 2); and a prospective cohort study (Study 3). 𝗥𝗲𝘀𝘂𝗹𝘁𝘀 Study 1: A systematic review identified seven different frailty instruments used to identify frailty in HF studies to date, none of which were validated for use in patients living with HF. Study 2: A cross-sectional study of the association between subjective clinician estimates of frailty and a formal frailty assessment. Thirty-nine clinicians completed frailty estimates, and 75 patients had their frailty formally assessed, producing 194 paired frailty assessments. This study revealed that correlation and inter-rater agreement between pooled clinician-estimated frailty and the formal frailty assessment was fair (rs= 0.52; κ= 0.33, CI: 0.23 – 0.43), confirming that subjective clinician estimates of frailty are not a reliable replacement for formal frailty assessment in adults living with HF. Study 3: Part A evaluated the convergent and discriminant validity of three physical frailty instruments. Of the three instruments compared, the SHARE-FI and the St Vincent’s Frailty instrument displayed stronger validity than the Frailty Phenotype in this cohort. Part B revealed the six frailty instruments potentially relevant for use in adults living with HF displayed adequate predictive performance (C-statistic 0.71-0.73) and sensitivity (88-92%). 𝗖𝗼𝗻𝗰𝗹𝘂𝘀𝗶𝗼𝗻 Further work is needed to confirm these results in a larger cohort. A validated frailty instrument for use in adults with HF is needed, one that is quick and easy to use in a resource-restricted clinical environment. Frailty assessment needs to be incorporated into cardiovascular clinicians' daily practice and universally accepted as an integral part of HF clinical management.	en_US.UTF-8
dc.format	Thesis (PhD)
dc.language.iso	en_US	en_US.UTF-8
dc.relation	https://opus.lib.uts.edu.au/bitstream/10453/153328/2/02whole.pdf
dc.rights	The author owns the copyright in this thesis including all reproduction and reuse rights for the work. The work may not be altered without the permission of the copyright owner. Attribution is essential when quoting or paraphrasing from this thesis.
dc.rights	au.edu.uts.lib/ppc
dc.rights	info:eu-repo/semantics/openAccess
dc.title	The FRAilty MEasurement in Heart Failure (FRAME-HF) Project	en_US.UTF-8
dc.type	Thesis
utslib.copyright.status	open_access	*

Abstract:

𝗕𝗮𝗰𝗸𝗴𝗿𝗼𝘂𝗻𝗱 Frailty is a complex, multifaceted syndrome frequently experienced by older people and those living with chronic disease, such as HF. The presence of frailty is a robust predictive indicator of worse outcomes in people with HF, including rehospitalisation and mortality. Despite increasing interest in assessing frailty over the last decade, there is an absence of consensus regarding the universal definition of frailty and the optimal means of assessment for this population. 𝗔𝗶𝗺 The FRAME-HF project aims to determine the most suitable and clinically relevant frailty instrument(s) for use in adults living with heart failure (HF). 𝗠𝗲𝘁𝗵𝗼𝗱𝘀 Setting and participants: The FRAME-HF project was undertaken at St Vincent’s Hospital, Sydney, Australia. This project included: 1) Individuals ≥ 18 years and older with a confirmed diagnosis of HF and 2) Cardiovascular clinicians. Design: Deductive sequential mixed methods project comprising three interrelated yet discrete studies: a systematic review (Study 1); a cross-sectional study (Study 2); and a prospective cohort study (Study 3). 𝗥𝗲𝘀𝘂𝗹𝘁𝘀 Study 1: A systematic review identified seven different frailty instruments used to identify frailty in HF studies to date, none of which were validated for use in patients living with HF. Study 2: A cross-sectional study of the association between subjective clinician estimates of frailty and a formal frailty assessment. Thirty-nine clinicians completed frailty estimates, and 75 patients had their frailty formally assessed, producing 194 paired frailty assessments. This study revealed that correlation and inter-rater agreement between pooled clinician-estimated frailty and the formal frailty assessment was fair (rs= 0.52; κ= 0.33, CI: 0.23 – 0.43), confirming that subjective clinician estimates of frailty are not a reliable replacement for formal frailty assessment in adults living with HF. Study 3: Part A evaluated the convergent and discriminant validity of three physical frailty instruments. Of the three instruments compared, the SHARE-FI and the St Vincent’s Frailty instrument displayed stronger validity than the Frailty Phenotype in this cohort. Part B revealed the six frailty instruments potentially relevant for use in adults living with HF displayed adequate predictive performance (C-statistic 0.71-0.73) and sensitivity (88-92%). 𝗖𝗼𝗻𝗰𝗹𝘂𝘀𝗶𝗼𝗻 Further work is needed to confirm these results in a larger cohort. A validated frailty instrument for use in adults with HF is needed, one that is quick and easy to use in a resource-restricted clinical environment. Frailty assessment needs to be incorporated into cardiovascular clinicians' daily practice and universally accepted as an integral part of HF clinical management.

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