Development and validation of an electronic frailty index using routine primary care electronic health record data

By A. Clegg, C. Bates, John B. Young, Ronan Ryan, L. Nichols, Elizabeth Ann Teale, Mohammed A. Mohammed, J. Parry, Tom Marshall. Age and Ageing, 2016

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Background: frailty is an especially problematic expression of population ageing. International guidelines recommend routine identification of frailty to provide evidence-based treatment, but currently available tools require additional resource. Objectives: to develop and validate an electronic frailty index (eFI) using routinely available primary care electronic health record data. Study design and setting: retrospective cohort study. Development and internal validation cohorts were established using a randomly split sample of the ResearchOne primary care database. External validation cohort established using THIN database. Participants: patients aged 65–95, registered with a ResearchOne or THIN practice on 14 October 2008. Predictors: we constructed the eFI using the cumulative deficit frailty model as our theoretical framework. The eFI score is calculated by the presence or absence of individual deficits as a proportion of the total possible. Categories of fit, mild, moderate and severe frailty were defined using population quartiles. Outcomes: outcomes were 1-, 3- and 5-year mortality, hospitalisation and nursing home admission. Statistical analysis: hazard ratios (HRs) were estimated using bivariate and multivariate Cox regression analyses. Discrimination was assessed using receiver operating characteristic (ROC) curves. Calibration was assessed using pseudo-R2 estimates. Results: we include data from a total of 931,541 patients. The eFI incorporates 36 deficits constructed using 2,171 CTV3 codes. One-year adjusted HR for mortality was 1.92 (95% CI 1.81–2.04) for mild frailty, 3.10 (95% CI 2.91–3.31) for moderate frailty and 4.52 (95% CI 4.16–4.91) for severe frailty. Corresponding estimates for hospitalisation were 1.93 (95% CI 1.86–2.01), 3.04 (95% CI 2.90–3.19) and 4.73 (95% CI 4.43–5.06) and for nursing home admission were 1.89 (95% CI 1.63–2.15), 3.19 (95% CI 2.73–3.73) and 4.76 (95% CI 3.92–5.77), with good to moderate discrimination but low calibration estimates. Conclusions: the eFI uses routine data to identify older people with mild, moderate and severe frailty, with robust predictive validity for outcomes of mortality, hospitalisation and nursing home admission. Routine implementation of the eFI could enable delivery of evidence-based interventions to improve outcomes for this vulnerable group.

Subfields: Epidemiology, Geriatrics and Gerontology, Physiology

View Paper: https://www.semanticscholar.org/paper/626c78b510aa998d072c4c5e8b59d10873baf690

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Citations in the corpus

• Frailty index as a predictor of mortality: a systematic review and meta-analysis (2018, methodology): “[15-17] Two of these reviews systematically collected studies that used different frailty definitions, including frailty phenotype and the FI, and demonstrated that frailty consistently increased the risk of death in most studies.[15, 16] These reviews just listed mortality risk estimates per differ”
• 2024 ESC Guidelines for the management of elevated blood pressure and hypertension. (2024, neutral): “…ESC Guidelines prospective, observational study of 415 980 people aged > 75 years, which used a 36-item electronic frailty index to include severely frail patients, 413 the lowest mortality risk over ≤ 10 years of follow-up was observed at systolic BP of 140–160 mmHg and diastolic BP of 80–90 mmHg.”