Frailty assessment and the associated outcomes in elderly patients referred for coronary interventions: preliminary results of a prospective study

Background: Frailty, characterized by reduced resilience to stressors due to diminished metabolic, neuromuscular, and physical reserves, increases the risk of adverse outcomes including mortality. With the growing elderly cardiac population, assessing frailty has become a critical focus in cardiovascular care. In clinical settings, frailty is often evaluated based on the physician’s intuition, commonly termed the “eyeball test.” This study aimed to assess the accuracy of the eyeball test for frailty detection in elderly patients undergoing coronary interventions and to examine the clinical outcomes of frail patients.

Methods: This prospective study included stable patients aged ≥70 years referred for coronary angiography, excluding those with ST-elevation myocardial infarction or unstable hemodynamics. Frailty was assessed independently by two cardiologists using two approaches: (1) a formal assessment with the Fried Frailty Index (scored 1–5, with frailty defined as ≥3) and (2) a subjective clinical evaluation (eyeball test) scored on a Fried-like scale. One year mortality, cardiovascular hospitalization and unplanned revascularization were evaluated in frail patients identified based on the Fried test.

Results: A total of 158 patients (mean age 77.3 ± 5.2 years) were analyzed. Frailty was diagnosed in 30 patients (19%) using the Fried test and in 50 patients (31.6%) via the eyeball test. The eyeball test had a sensitivity of 93.3% and a specificity of 81.5% for frailty detection, with a negative predictive value of 98.1% and a positive predictive value of 53.8%. At one year, 56.7% of frail patients experienced a cardiovascular event, 63.3% were re-hospitalized (68% of them for cardiovascular causes), 6.7% required unplanned revascularization, and 10% died.

Conclusion: Frail patients undergoing coronary interventions are at high risk for 1-year adverse outcomes. The eyeball test is an extremely reliable tool to rule out frailty. However when frailty is suspected based on the eyeball test, the diagnosis should be confirmed by a formal assessments.