Desarrollo y validación de un índice de fragilidad electrónico utilizando datos de registro de salud electrónicos rutinarios de atención primaria

A. Clegg, C. Bates, J. Young, R.Ryan, L. Nichols, E.A. Teale, M.A. Mohammed, J. Parry, T. Marshall

Age and Ageing. 2016;45(3):353-60

There is evidence that frailty may be modifiable. International guidelines recommend routine identification of frailty to provide evidence-based treatment, but currently available tools require additional resource.

This study wants to develop and validate an electronic frailty index (eFI) using routinely available primary care electronic health record data.

In this retrospective cohort study, patients aged 65-95 years and registered at a ResearchOne or THIN practice on 14 October 2008 were eligible. The eFI was constructed using the cumulative deficit model as theoretical framework and incorporating 36 deficits. The eFI score was 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.

One-year adjusted HR for mortality was 1.92 (95% CI 1.81-2.04) for mild frailty, 3.10 (95% CI2.91-3.31) for moderate frailty and 4.52 (95% CI 4.16-4.91) for severe frailty. Corresponding estimates for hospitalization 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).

Comment:  The  eFI uses routine data to identify older people with mild, moderate and severe frailty with robust predictive validity for outcomes of mortality, hospitalization and nursing home admission. Implementation of the eFI into routine primary care practice could represent a major advance in the care of older people with frailty, through provision of more appropriate, goal-oriented care, referral for evidence-based interventions and signposting to local authority and voluntary services.