Application of Four Frailty Assessment Tools in Elderly Patients With Coronary Heart Disease PCI and Its Relationship With Quality of Life.

Background

Frailty is highly prevalent among elderly patients with coronary heart disease (CHD) undergoing percutaneous coronary intervention (PCI) and is associated with adverse clinical outcomes and impaired health-related quality of life. However, different frailty assessment tools vary in their conceptual frameworks, assessment domains, and predictive performance, and their applicability in elderly PCI populations remains unclear.

Aims

To compare four commonly used frailty assessment tools, including the Frailty Phenotype (FP), FRAIL scale, Tilburg Frailty Indicator (TFI), and Frailty Index (FI), and to investigate their associations with quality of life in elderly patients with CHD undergoing PCI.

Methods

This cross-sectional study included 244 elderly patients with CHD undergoing PCI at a tertiary hospital in Shanghai from August to December 2024. Frailty was assessed using the Frailty Phenotype (FP), FRAIL scale, Tilburg Frailty Indicator (TFI), and Frailty Index (FI), and quality of life using the 12-Item Short Form Health Survey (SF-12). Agreement was evaluated using the Kappa statistic. Associations with physical component summary (PCS) and mental component summary (MCS) scores were assessed using correlation and multivariable linear regression, while discriminatory performance was examined using receiver operating characteristic (ROC) and Bayesian discriminant analyses.

Results

Mean PCS and MCS scores were 40.08 ± 11.23 and 52.30 ± 7.82, respectively. Frailty prevalence was 40.6% by FP, 8.6% by FRAIL, 28.3% by TFI, and 22.1% by FI. Agreement was fair to moderate (Kappa = 0.242-0.496). Higher frailty scores were independently associated with lower PCS and MCS after adjustment for age, sex, education, smoking, and comorbidity burden. FP and FI showed comparable discrimination for PCS, whereas TFI had the highest AUC for MCS. Classification accuracy was highest for FP in PCS and TFI in MCS (both 79.51%).

Conclusion

Frailty was consistently associated with poorer quality of life. FP and FI performed similarly for physical health, whereas TFI showed the most favorable performance for mental health.