Simple screening tool assesses frailty in elderly patients with acute coronary syndrome

The highest category of scores for the Edmonton Frail Scale (EFS) in elderly patients with acute coronary syndrome was associated with increased comorbidity, longer lengths of stay, and fewer procedures and was independently associated with mortality, a study found.


The highest category of scores for the Edmonton Frail Scale (EFS) in elderly patients with acute coronary syndrome was associated with increased comorbidity, longer lengths of stay, and fewer procedures and was independently associated with mortality, a study found.

The Edmonton Frail Scale is a user-friendly screening interview that requires less than 5 minutes to administer and was designed for nongeriatricians. The scale is derived from 9 factors: cognition (drawing a clock diagram); general health status (hospital admissions and a general description); functional independence (activities of daily living); social support (individuals who can help); medication use (5 or more prescriptions, remembering to take them); nutrition (weight loss); mood (sadness or depression); unexpected urinary incontinence; and functional performance on the timed “get up and go” test.

Scores range from 0 (not frail) to 17 (very frail). Researchers seeking to assess the scale's use in acute coronary syndrome administered it as part of a pilot study of 183 consecutive patients 65 years or older who were admitted to a single center in Edmonton, Alberta, Canada.

Results appeared online Oct. 30 in the Canadian Journal of Cardiology.

Patient scores ranged from 0 to 13. Patients with higher scores were older, with more comorbidities, longer lengths of stay (EFS 0 to 3: mean, 7.0 days; EFS 4 to 6: mean, 9.7 days; and EFS ≥7: mean, 12.7 days; P=0.03), and decreased procedure use. Crude mortality rates at 1 year were 1.6% for EFS 0 to 3, 7.7% for EFS 4 to 6, and 12.7% for EFS ≥7 (P=0.05).

After adjustment for baseline risk differences using a “burden of illness” score, the hazard ratio for mortality for EFS ≥7 compared with EFS 0 to 3 was 3.49 (95% CI, 1.08 to 7.61; P=0.002).

The researchers noted the advantages and disadvantages of simple screening tools in the context of frailty. The complexity of some other methods makes simple tools attractive to clinicians, they wrote. Even if some nuances are lost, simple tools can still be predictive. In addition, the EFS has been validated in multiple settings. Still, the authors noted that this was a pilot study designed to assess the tool's use in acute coronary syndrome.

The researchers wrote, “Further work is needed to determine whether the use of a validated frailty instrument to better delineate some of the ‘unmeasured factors' involved in medical decision making in elderly patients with cardiovascular disease would provide more transparent and refined discussions of risk and the opportunity for interventions to improve this risk in this important, often disadvantaged, population.”