Frailty in acute coronary syndrome: From risk stratification to clinical decision-making

Table 1 Comparative characteristics of validated frailty assessment tools in patients with acute coronary syndrome

Tool	Type of assessment	Time required	Training requirements	Clinical advantages	Limitations
Clinical Frailty Scale[20]	9-point clinical scale	< 5 minutes, bedside	Minimal	Strong prognostic indicator of short-term and long-term mortality in ACS[54]	Subjective; requires clinical judgement
Edmonton Frail Scale[49]	Multidimensional questionnaire	Approximately 10 minutes	Moderate	Better discrimination for mortality and prolonged hospital stay in ACS; improves GRACE/EuroSCORE II[60]	Time-consuming in emergency settings
Fried Frailty Phenotype[12]	Phenotypic model (5 criteria)	10-15 minutes	Moderate (requires measurements)	Prognostic value for mortality and complications in ACS[61]	Requires equipment and patient cooperation
FRAIL scale	5-item questionnaire	< 5 minutes	Minimal	Very quick and simple, suitable for acute phases[63]	Less sensitive for mild frailty
Hospital Frailty Risk Score[51]	Administrative index - ICD-10	Automated (EHR)	Access to administrative data	Suitable for large-scale use; improves mortality prediction in ACS[64]	Less clinical detail
Laboratory Frailty Index[52]	Index based on laboratory data	Automated	Access to lab results	Objective; enhances prognostic models in ACS	Does not account for psychosocial factors
Physical performance tests (SPPB, gait speed, TUG, grip strength)[95]	Objective performance-based tests	5-10 minutes	Training in measurement techniques	Prognostic value for MACE and mortality in ACS	Requires patient’s physical participation
SHARE-FI/Frailty Index[17]	Deficit accumulation index	Automated or questionnaire	Access to data or brief training	Multidimensional; used in ACS with evidence of prognostic value	Fewer ACS-specific studies
Tilburg Frailty Indicator[50]	Multidimensional tool (physical, psychological, social)	10-15 minutes	Moderate	Covers nonphysical dimensions; evidence for prognosis in cardiac patients[69]	Not extensively validated specifically for ACS

FRAIL: Fatigue, Resistance, Ambulation, Illness and Loss of Weight Index; SPPB: Short Physical Performance Battery; TUG: Timed Up and Go Test; SHARE-FI: Survey of Health, Ageing and Retirement in Europe-Frailty Instrument; ICD-10: International Classification of Diseases, Tenth Revision; EHR: Electronic health record; ACS: Acute coronary syndrome; GRACE: Global Registry of Acute Coronary Event; EuroSCORE II: European System for Cardiac Operation Risk Evaluation II; MACE: Major adverse cardiovascular events.