Development and Initial Validation of a Frailty Score for Pediatric Patients with Congenital and Acquired Heart Disease

• Published in: Pediatric cardiology 2024-04, Vol.45 (4), p.888-900
• Main Authors: Studyvin, Sarah, Birnbaum, Brian F., Staggs, Vincent S., Gross-Toalson, Jami, Shirali, Girish, Panchangam, Chaitanya, White, David A.
• Format: Article
• Language: English
• Subjects: Adolescent; Cardiac Surgery; Cardiology; Child; Cross-Sectional Studies; Fatigue - complications; Frailty; Hand Strength; Heart Diseases - complications; Heart Failure - complications; Humans; Medicine; Medicine & Public Health; Quality of Life; Vascular Surgery
• ISSN: 0172-0643; 1432-1971
• DOI: 10.1007/s00246-022-03045-1

Frailty is a multi-dimensional clinical syndrome that is associated with increased morbidity and mortality and decreased quality of life. Children/adolescents with heart disease (HD) perform significantly worse for each frailty domain compared to non-HD peers. Our study aimed to create a composite frailty score (CFS) that can be applied to children/adolescents with HD and evaluate associations between the CFS and outcomes. Children and adolescents ( n  = 30) with HD (73% single ventricle, 20% heart failure, 7% pulmonary hypertension) were recruited from 2016 to 2017 (baseline). Five frailty domains were assessed at baseline using measures validated for pediatrics: (1) Slowness: 6-min walk test; (2) Weakness: handgrip strength; (3) Fatigue: PedsQL Multi-dimensional Fatigue Scale; (4) Body composition: triceps skinfold thickness; and (5) Physical activity questionnaire. Frailty points per domain (range = 0–5) were assigned based on z -scores or raw questionnaire scores and summed to produce a CFS (0 = least frail; 25 = most frail). Nonparametric bootstrapping was used to identify correlations between CFS and cross-sectional change in outcomes over 2.2 ± 0.2 years. The mean CFS was 12.5 ± 3.5. In cross-sectional analyses of baseline data, correlations (|r|≥ 0.30) were observed between CFS and NYHA class, the number of ancillary specialists, total prescribed medications, heart failure medications/day, exercise test derived chronotropic index and percent predicted VO 2peak , and between child and parent proxy PEDsQL. At follow-up, CFS was correlated with an increase in the number of heart failure medications ( r  = 0.31). CFS was associated with cross-sectional outcomes in youth with heart disease. Longitudinal analyses were limited by small sample sizes due to loss to follow-up.