Feasibility of Frailty Assessment Integrated with Cardiac Implantable Electronic Device Clinic Follow-up: A Pilot Investigation

Background: The concept of frailty was originally created to explain why individuals of the same age have differing risk of disease, and it has since been found to be negatively associated with outcomes for a wide range of medical conditions, including cardiovascular disease and cardiac procedures. Although numerous risk scores and assessment tools have been proposed, opportunities for practical assessment of frailty remain limited. In this pilot study, we examine the feasibility of using routine follow-up of patients with cardiac implantable electronic devices (CIEDs) for assessment of frailty. Methods: From September 2017 through March 2018, 49 consecutive patients seen in CIED clinic were enrolled. Among the frailty assessments performed at the clinic visit included a 4-meter walk time, FRAIL scale calculation, Rockwood Frailty score assessment by another treating provider, mini-cog assessment, and analysis of daily activity measures on the CIED. Results: Among the three device manufacturers of patients’ CIEDs, only Boston Scientific released analyzable activity time series data. On nine patients in whom daily activity data could be analyzed, there was no difference in mean daily activity (148.3 ± 31.9 vs. 100.1 ± 25.1 min/day, p = .27) between patients with and without an abnormal frailty or cognitive assessment, although interestingly, those with an abnormal assessment had a higher standard deviation of activity per day (52.6 ± 5.9 vs. 31.4 ± 4.7 min/day, p = .03). Conclusion: It is possible that a higher variation in daily activity over the course of a year could be a better indicator of frailty or cognitive impairment than average daily activity.