Frailty Screening Tool may Miss Early Intervention for Hospitalized COPD Patients

Frailty among patients  is linked with severe morbidity and mortality. Melanie Chin, MD, MScHQ, Division of Respirology, Department of Medicine, University of Ottawa, and investigators aimed to assess the efficacy of the Hospital Frailty Risk Score (HFRS), a population-based screening tool, in detecting frailty among these patients. According to the study HFRS had poor detection rates compared to the bedside Clinical Frailty Scale (CFS).

The results indicate that the use of HFRS may result in missed opportunities to identify frailty and provide early intervention for these patients, such as pulmonary rehabilitation. Frailty is a common problem among patients with COPD and early intervention can improve outcomes and reduce healthcare costs. Therefore, the findings of this study highlight the need for accurate and effective frailty screening tools in this population.

What's the best assessment for frailty in hospitals?

According to the data, the prospect for pulmonary rehabilitation is one of the gaps that might be overlooked when utilizing HFRS. After comparing the ability of HFRS with CFS to detect frailty in patients with chronic obstructive pulmonary disease, investigators found that among the 99 patients with COPD exacerbation, the HFRS had a low sensitivity of 27% and high specificity of 93% to detect frailty compared to the CFS.

The optimal probability threshold for the HFRS was 1.4 points or higher, with a corresponding sensitivity of 69% and specificity of 57% to detect frailty. These results suggest that the HFRS may not be effective in identifying frailty in hospitalized patients with COPD exacerbation compared with the CFS.

Identifying frailty in COPD patients is crucial for improving their outcomes, reducing hospital readmissions and mortality rates, as well as optimizing the use of healthcare resources. Therefore, using a more reliable screening tool for frailty, such as the CFS, is essential to provide appropriate care for patients with COPD exacerbation.

Evaluating Frailty Risk Scores

The study was conducted in a respiratory ward of a single tertiary care academic hospital in Canada, and included consenting adult inpatients who were admitted with acute COPD exacerbation between December 2016 and June 2019. The HFRS was calculated using hospital administrative data, while the CFS was assessed by healthcare professionals.

The primary outcomes of the study were the sensitivity and specificity of the HFRS to detect frail and nonfrail individuals according to the CFS assessments of frailty. The secondary outcome was the optimal probability threshold of the HFRS to discriminate between frail and nonfrail patients.

The results of this study showed moderate agreement between the HFRS and CFS assessments of frailty, and the HFRS had moderate sensitivity and specificity to detect frailty compared to the CFS. The optimal probability threshold of the HFRS to discriminate between frail and nonfrail individuals was also identified.

The findings of this study provide important insights into the accuracy and agreement of frailty assessment tools in hospitalized patients with COPD, which can inform clinical practice and future research in this area.

In conclusion, the HFRS had poor detection rates of frailty among hospitalized patients with COPD compared to the CFS. The use of accurate and effective frailty screening tools is critical for early intervention and improved outcomes for this patient population. Future studies are needed to develop and validate screening tools that are tailored to the unique needs of patients with COPD.

Reference:

1. Chin M, Kendzerska T, Inoue J, et al. Comparing the Hospital Frailty Risk Score and the Clinical Frailty Scale Among Older Adults With Chronic Obstructive Pulmonary Disease Exacerbation. JAMA Netw Open. 2023;6(2):e2253692. doi:10.1001/jamanetworkopen.2022.53692