The "Eyeball Test" for Risk Assessment in Aortic Stenosis: Characterizing Subjective Frailty Using Objective Measures

Background: Subjective frailty assessment is widely employed in risk stratification of patients with severe aortic stenosis (AS), but the association with objective frailty parameters is poorly characterized. Methods: Frailty was subjectively assessed (dichotomously as frail or not frail) in high-risk patients with AS referred to a Heart Valve Clinic. An objectively derived composite frailty score was derived by summing quartiles of the following frailty measures: 15-foot walk time, grip strength, independence in activities of daily living (ADL), and serum albumin. The objective measures and composite score were compared between those considered frail and not frail by subjective assessment. The relationship between frailty status and outcomes was analyzed. Results: Of 100 subjects, 31 were frail by subjective assessment. When compared to those considered not frail, there were no differences in age, sex, and BMI. However, frail subjects had higher STS scores and had significantly greater dependence in ADL, slower gait speed, weaker grip strength, and lower albumin than non-frail subjects. The composite frailty score was highly correlated with frailty designation by subjective assessment. Subjective and objective frailty were both highly predictive of treatment assignment to either medical therapy or aortic valve replacement, and of mortality. Conclusion: Among patients with AS evaluated in a Heart Valve Clinic, those considered frail by subjective assessment were slower, weaker, more malnourished, and had greater ADL impairment. Subjective assessment of frailty and objective frailty measures were similarly predictive of treatment assignment and mortality.