The journal of nutrition, health & aging

, Volume 23, Issue 4, pp 373–377 | Cite as

Utility of the FRAIL Questionnaire in Detecting Heart Failure with Preserved Ejection Fraction

  • Jean WooEmail author
  • X. Yang
  • L. Tin Lui
  • Q. Li
  • K. Fai Cheng
  • Y. Fan
  • F. Yau
  • A. P. W. Lee
  • J. S. W. Lee
  • E. Fung



To test the utility of the FRAIL questionnaire as a screening tool for heart failure.


Cross sectional study.


Chinese older people in Hong Kong.


Participants aged 60 years and over were recruited from a territory-wide primary care needs assessment for older people based in community centers as well as two nonacute hospitals.


Questionnaire administered included the five-item FRAIL scale, and information regarding sociodemographic data, smoking and alcohol use, history of cardiovascular disease and diabetes, and heart failure symptoms. Handgrip strength, walking speed and 6 minute walk distance were recorded. Cardiac assessment included electrocardiogram, echocardiography, and blood assay for N-terminal prohormone of B-type natriuretic peptide (NT-proBNP).


The prevalence of diastolic dysfunction was high, being 52% in the robust group, increasing to 65% in the pre-frail and 85% in the frail group. This finding is accompanied by a corresponding increase in NT-proBNP from 64.18 pg/ml in the robust group, to 118.57 pg/ml in the pre-frail and 167.98 pg/ml in the frail group. Three of the five components of the FRAIL scale, fatigue, resistance and ambulation, were associated with increased odds ratios of diastolic dysfunction among those aged 75 years and older, while resistance alone was associated with increased odds ratio among those less than 75 years old.


Frailty is associated with heart failure with preserved ejection fraction (HFpEF), and frailty screening may be used to detect undiagnosed HFpEF. The findings support the proposal that HFpEF be considered a geriatric syndrome.

Key words

Frailty heart failure with preserved ejection fraction FRAIL scale NT-proBNP 


  1. 1.
    Clegg A, Young J, Iliffe S, Rikkert MO, Rockwood K. Frailty in elderly people. Lancet 2013;381(9868):752–762.CrossRefGoogle Scholar
  2. 2.
    Vermeiren S, Vella–Azzopardi R, Beckwee D, Habbig AK, Scafoglieri A, Jansen B, et al. Frailty and the Prediction of Negative Health Outcomes: A Meta–Analysis. Journal of the American Medical Directors Association 2016;17(12):1163.e1–e.17.CrossRefGoogle Scholar
  3. 3.
    Gray WK, Richardson J, McGuire J, Dewhurst F, Elder V, Weeks J, et al. Frailty Screening in Low–and Middle–Income Countries: A Systematic Review. Journal of the American Geriatrics Society 2016;64(4):806–823.CrossRefGoogle Scholar
  4. 4.
    Gill TM, Gahbauer EA, Allore HG, Han L. Transitions between frailty states among community–living older persons. Archives of Internal Medicine 2006;166(4):418–423.CrossRefGoogle Scholar
  5. 5.
    Lee JSW, Auyeung TW, Leung J, Kwok T, Woo J. Transitions in Frailty States Among Community–Living Older Adults and Their Associated Factors. Journal of the American Medical Directors Association 2014;15(4):281–286.CrossRefGoogle Scholar
  6. 6.
    Morley JE, Malmstrom TK, Miller DK. A simple frailty questionnaire (FRAIL) predicts outcomes in middle aged African Americans. J Nutr Health Aging 2012;16(7):601–8.CrossRefGoogle Scholar
  7. 7.
    Woo J, Yu R, Wong M, Yeung FN, Wong M, Lum C. Frailty Screening in the Community Using the FRAIL Scale. Journal of the American Medical Directors Association 2015;16(5):412–419.CrossRefGoogle Scholar
  8. 8.
    Ferrucci L, Fabbri E. Inflammageing: chronic inflammation in ageing, cardiovascular disease, and frailty. Nature Reviews Cardiology 2018;15(9):505–522.CrossRefGoogle Scholar
  9. 9.
    Roger VL. Epidemiology of Heart Failure. Circulation Research 2013;113(6):646–659.CrossRefGoogle Scholar
  10. 10.
    Yousaf F, Collerton J, Kingston A, Kenny A, Davies K, Jagger C, et al. Prevalence of left ventricular dysfunction in a UK community sample of very old people: the Newcastle 85+ study. Heart 2012;98(19):1418–23.CrossRefGoogle Scholar
  11. 11.
    Nadruz W, Jr., Kitzman D, Windham BG, Kucharska–Newton A, Butler K, Palta P, et al. Cardiovascular Dysfunction and Frailty Among Older Adults in the Community: The ARIC Study. J Gerontol A Biol Sci Med Sci 2017;72(7):958–964.Google Scholar
  12. 12.
    Vogel MW, Slusser JP, Hodge DO, Chen HH. The Natural History of Preclinical Diastolic Dysfunction A Population–Based Study. Circulation–Heart Failure 2012;5(2):144–151.CrossRefGoogle Scholar
  13. 13.
    Lam CS, Lyass A, Kraigher–Krainer E, Massaro JM, Lee DS, Ho JE, et al. Cardiac dysfunction and noncardiac dysfunction as precursors of heart failure with reduced and preserved ejection fraction in the community. Circulation 2011;124(1):24–30.CrossRefGoogle Scholar
  14. 14.
    Kane GC, Karon BL, Mahoney DW, Redfield MM, Roger VL, Burnett JC, Jr., et al. Progression of left ventricular diastolic dysfunction and risk of heart failure. JAMA 2011;306(8):856–63.CrossRefGoogle Scholar
  15. 15.
    Kinugasa Y, Yamamoto K. The challenge of frailty and sarcopenia in heart failure with preserved ejection fraction. Heart 2017;103(3):184–189.CrossRefGoogle Scholar
  16. 16.
    Upadhya B, Taffet GE, Cheng CP, Kitzman DW. Heart failure with preserved ejection fraction in the elderly: scope of the problem. J Mol Cell Cardiol 2015;83:73–87.CrossRefGoogle Scholar
  17. 17.
    Upadhya B, Pisani B, Kitzman DW. Evolution of a Geriatric Syndrome: Pathophysiology and Treatment of Heart Failure with Preserved Ejection Fraction. J Am Geriatr Soc 2017;65(11):2431–2440.CrossRefGoogle Scholar
  18. 18.
    Cheung JTK, Yu R, Wu Z, Wong SYS, Woo J. Geriatric syndromes, multimorbidity, and disability overlap and increase healthcare use among older Chinese. BMC Geriatr 2018;18(1):147.CrossRefGoogle Scholar
  19. 19.
    Nagueh SF, Smiseth OA, Appleton CP, Byrd BF, Dokainish H, Edvardsen T, et al. Recommendations for the Evaluation of Left Ventricular Diastolic Function by Echocardiography: An Update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Journal of the American Society of Echocardiography 2016;29(4):277–314.CrossRefGoogle Scholar
  20. 20.
    Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JGF, Coats AJS, et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC)Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J 2016;37(27):2129–2200.CrossRefGoogle Scholar
  21. 21.
    Rosen S, Koretz B, D.B. R. Presention of Disease in Old Age. In: Fillit H, Rockwood K, Woodhouse K, editors. Brocklehurst’s Textbook of Geriatric Medicine and Geronotology. 7th Edition ed. Philadelphia USA: Saunders; 2010. p. 205–210.Google Scholar
  22. 22.
    Tang Y, Fung E, Xu A, Lan HY. C–reactive protein and ageing. Clin Exp Pharmacol Physiol 2017;44 Suppl 1:9–14.CrossRefGoogle Scholar
  23. 23.
    Ma L, Sha G, Zhang Y, Li Y. Circulating interleukin–6 and adiponectin as physiological correlates of frailty in Chinese older adults. J Frailty Aging 2018;7(Suppl 2):S7–S8.Google Scholar
  24. 24.
    Dollard J, Harvey G, Dent E, Trotta L, Williams N, Beilby J, et al. Older People Who Are Frequent Users of Acute Care: A Symptom of Fragmented Care? A Case Series Report on Patients’ Pathways of Care. J Frailty Aging 2018;7(3):193–195.Google Scholar
  25. 25.
    Ngandu T, Lehtisalo J, Solomon A, Levalahti E, Ahtiluoto S, Antikainen R, et al. A 2 year multidomain intervention of diet, exercise, cognitive training, and vascular risk monitoring versus control to prevent cognitive decline in at–risk elderly people (FINGER): a randomised controlled trial. Lancet 2015;385(9984):2255–2263.CrossRefGoogle Scholar
  26. 26.
    Dent E, Lien C, Lim WS, Wong WC, Wong CH, Ng TP, et al. The Asia–Pacific Clinical Practice Guidelines for the Management of Frailty. Journal of the American Medical Directors Association 2017;18(7):564–575.CrossRefGoogle Scholar
  27. 27.
    Zakeri R, Cowie MR. Heart failure with preserved ejection fraction: controversies, challenges and future directions. Heart 2018;104(5):377–384.CrossRefGoogle Scholar

Copyright information

© Serdi and Springer-Verlag International SAS, part of Springer Nature 2019

Authors and Affiliations

  • Jean Woo
    • 1
    • 4
    Email author
  • X. Yang
    • 1
    • 2
  • L. Tin Lui
    • 1
    • 2
  • Q. Li
    • 1
    • 2
  • K. Fai Cheng
    • 1
    • 2
  • Y. Fan
    • 1
  • F. Yau
    • 1
  • A. P. W. Lee
    • 1
  • J. S. W. Lee
    • 1
    • 3
  • E. Fung
    • 1
    • 2
  1. 1.Department of Medicine & Therapeutics, Faculty of MedicineThe Chinese University of Hong KongShatin, Hong Kong SARHong Kong
  2. 2.Laboratory for Heart Failure and Circulation Research, Li Ka Shing Institute of Health SciencesPrince of Wales HospitalShatin, Hong Kong SARHong Kong
  3. 3.Department of MedicineAlice Ho Miu Ling Nethersole Hospital and Tai Po HospitalTai Po, Hong Kong SARHong Kong
  4. 4.Department of Medicine & TherapeuticsPrince of Wales HospitalShatin, N.T.Hong Kong

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