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Agreement between Fried Frailty Phenotype and Cumulative Deficits Frailty Indices: A Prospective Multi-Center Study

Publication ,  Conference
Rozenberg, D; Singer, LG; Neely, ML; Weber, JM; Kopetskie, HA; Sever, ML; Kirchner, J; Frankel, CW; Todd, JL; Williams, N; Robien, MA ...
Published in: The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation
April 1, 2020

PURPOSE: Frailty is gaining increased recognition in the evaluation of lung transplant (LTx) candidates. The Fried Frailty Phenotype (FFP) index has been the most commonly used instrument and is associated with pre- and post-transplant morbidity and mortality. A novel, alternative approach to assessing frailty is the Cumulative Deficits Frailty Index (CFI), which evaluates health deficits across multiple domains that may aid in refining candidacy evaluation. As a preliminary assessment, we aimed to understand the distribution of frailty scores among LTx candidates and assess agreement between the FFP and the CFI. METHODS: This was a prospective, multi-center study of a subset of participants in the Clinical Trials in Organ Transplantation-20 cohort who completed both the FFP and CFI assessments pre-transplant. FFP was characterized using 5 criteria (unintentional weight loss, grip strength, energy levels, gait speed and physical activity), with FFP frailty defined (≥3 criteria frail; 1-2 pre-frail; and 0 not frail). The CFI was comprised of 40 health items abstracted from medical records with frailty defined as >10/40 (score of 0.25) deficits. Agreement between total FFP and CFI scores was assessed using Cohen's Kappa statistic and we also evaluated the distribution of CFI scores by each sub-component of the FFP. RESULTS: The cohort was comprised of 124 LTx candidates (median age 62 years, 56% male, median LAS 39) with 57% having restrictive lung disease. 11 (9%) LTx candidates were frail on the FFP, whereas 85 (69%) were pre-frail (grouped as non-frail). The median CFI score for the cohort was 0.23 (IQR 0.15-0.28) with 48 (39%) deemed frail. 79 (64%) had matching frail and non-frail statuses between the indices with agreement assessed as poor [Kappa 0.11 95% CI (-0.02 to 0.24)]. The median CFI scores were more concordant with FFP domains of weight loss [Frail FFP: 0.26 (IQR 0.20-0.29) vs. Not Frail FFP: 0.21 (0.15-0.28)], physical activity [0.25 (0.21-0.28) vs. 0.21 (0.15-0.28)], and gait speed [0.25 (0.19-0.33) vs. 0.21 (0.15-0.28)], but not with grip strength or energy levels. CONCLUSION: In this multi-center study, agreement between frailty indices was poor suggesting the CFI potentially captures a different construct than FFP. The study is ongoing evaluating the prognostic utility of these indices with early post-transplant outcomes.

Duke Scholars

Published In

The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation

DOI

EISSN

1557-3117

Publication Date

April 1, 2020

Volume

39

Issue

4

Start / End Page

S314

Related Subject Headings

  • Surgery
  • 3202 Clinical sciences
  • 3201 Cardiovascular medicine and haematology
  • 1102 Cardiorespiratory Medicine and Haematology
 

Citation

APA
Chicago
ICMJE
MLA
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Rozenberg, D., Singer, L. G., Neely, M. L., Weber, J. M., Kopetskie, H. A., Sever, M. L., … Snyder, L. D. (2020). Agreement between Fried Frailty Phenotype and Cumulative Deficits Frailty Indices: A Prospective Multi-Center Study. In The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation (Vol. 39, p. S314). https://doi.org/10.1016/j.healun.2020.01.707
Rozenberg, D., L. G. Singer, M. L. Neely, J. M. Weber, H. A. Kopetskie, M. L. Sever, J. Kirchner, et al. “Agreement between Fried Frailty Phenotype and Cumulative Deficits Frailty Indices: A Prospective Multi-Center Study.” In The Journal of Heart and Lung Transplantation : The Official Publication of the International Society for Heart Transplantation, 39:S314, 2020. https://doi.org/10.1016/j.healun.2020.01.707.
Rozenberg D, Singer LG, Neely ML, Weber JM, Kopetskie HA, Sever ML, et al. Agreement between Fried Frailty Phenotype and Cumulative Deficits Frailty Indices: A Prospective Multi-Center Study. In: The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation. 2020. p. S314.
Rozenberg, D., et al. “Agreement between Fried Frailty Phenotype and Cumulative Deficits Frailty Indices: A Prospective Multi-Center Study.” The Journal of Heart and Lung Transplantation : The Official Publication of the International Society for Heart Transplantation, vol. 39, no. 4, 2020, p. S314. Scopus, doi:10.1016/j.healun.2020.01.707.
Rozenberg D, Singer LG, Neely ML, Weber JM, Kopetskie HA, Sever ML, Kirchner J, Frankel CW, Todd JL, Williams N, Robien MA, Belperio J, Budev MM, Tsuang W, Reynolds JM, Turner D, Shah PD, Palmer SM, Snyder LD. Agreement between Fried Frailty Phenotype and Cumulative Deficits Frailty Indices: A Prospective Multi-Center Study. The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation. 2020. p. S314.
Journal cover image

Published In

The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation

DOI

EISSN

1557-3117

Publication Date

April 1, 2020

Volume

39

Issue

4

Start / End Page

S314

Related Subject Headings

  • Surgery
  • 3202 Clinical sciences
  • 3201 Cardiovascular medicine and haematology
  • 1102 Cardiorespiratory Medicine and Haematology