Validation of the essential frailty toolset: can frailty be measured in the virtual clinic?

The Essential Frailty Toolset (EFT) is a valid measurement of frailty in people with heart valve disease. COVID-19 has prompted the transition to virtual health consultations and necessitates the validation of the virtual assessment of frailty to support treatment decision and improve outcomes. We conducted a prospective observational cohort study to compare the measurement of EFT in person and virtual format within a maximum 2-week window of repeated measurements. The weighted Kappa tests was used to measure the agreement of EFT scores between assessments. We explored the effect of the sequence of measurement using the Cochran-Mantel-Haenszel statistic to test the general association between the timing of measurement and differences of EFT score. We recruited a sample of 85 patients, with a mean age of 81 ± 6 years, including 51 men (60%); the primary valvular heart diseases were aortic stenosis (n=72, 84.7%), mitral regurgitation (n=5, 5.9%) and tricuspid regurgitation (n=8, 9.4%). The virtual measurement of frailty was conducted using a standardised protocol. The platform for virtual connection selected by patients was FaceTime (n=33, 38.8%) and Zoom (52, 61.2%); the median (IQR) number of days between the in-person and the virtual assessment was 5 (2, 9 ). The weighted Kappa estimate was 0.63 (95% CI 0.52, 0.75), indicating a strong agreement between the separate scores obtained. The test for the general association was non-significant (p=0.99), indicating a lack of evidence of detecting an association between EFT scores and the chronological order of assessment. The EFT can be reliably measured virtual in older patients with valvular heart disease. Future research is required to understand patients' perspectives of participating in this clinical assessment in a virtual clinic.