Ability of the FRAIL scale questionnaire to screen physical frailty and its prognostic value in older patients with cardiovascular disease and cognitive decline

AIMS: The FRAIL scale questionnaire is a brief measure of physical frailty in patients with cardiovascular disease (CVD); however, its performance in those with concomitant cognitive impairment remains uncertain. We investigated the accuracy of the FRAIL scale in identifying physical frailty defined by the Fried criteria and its association with adverse events in older patients with CVD and cognitive decline. METHODS AND RESULTS: This retrospective cohort study comprised 318 patients (male, 66.7%; median age, 79 years) with CVD (≥60 years old) who had cognitive impairment (Mini-Cog<3 points) and completed the FRAIL scale. The accuracy of the FRAIL scale for identifying physical frailty was evaluated using the area under the curve (AUC). Associations with frailty, motor functions (e.g., leg strength, walking speed, 6-min walk distance), and prognosis were tested using multivariable regression models and survival analysis. The AUC for predicting physical frailty was 0.749 (95% confidence interval [CI], 0.697-0.801). Higher FRAIL scale scores were associated with physical frailty (adjusted odds ratio, 2.087; 95% CI, 1.647-2.645) and motor function decline (all p<0.05). During follow-up (median, 335 days), 70 patients experienced the first composite event (all-cause death or cardiovascular rehospitalization). Frailty assessed by the FRAIL scale was associated with higher composite event rates (adjusted hazard ratio, 1.918; 95% CI, 1.134-3.243). CONCLUSIONS: In older patients with CVD and cognitive decline, higher FRAIL scale scores are associated with objectively assessed physical frailty and worse prognosis. These findings indicate that the FRAIL scale questionnaire is applicable for frailty screening and risk stratification in this population.