Eyeballing for Frailty Assessment in Elderly Patients Referred for Coronary Angiography

BACKGROUND: Frailty is increasingly recognized as a key determinant of outcomes in elderly patients undergoing invasive cardiac procedures. While structured instruments such as the Fried test are recommended, frailty is often assessed intuitively by physicians using eyeballing. We aimed to evaluate the diagnostic accuracy of physician eyeballing for frailty detection in elderly patients referred for coronary angiography. METHODS: A prospective observational study including patients aged ≥ 70 years undergoing coronary angiography. Frailty was independently assessed by two cardiologists in a blinded fashion: (1) a formal Fried test, and (2) physician eyeballing, scored on a Fried-like scale. The primary outcome was the diagnostic accuracy of the eyeballing compared with the Fried test, quantified by sensitivity, specificity, positive and negative predictive values and receiver operating characteristic (ROC) analysis. Secondary outcomes included 6-month mortality, cardiovascular rehospitalization, recurrent myocardial infarction, and unplanned revascularization. RESULTS: The 200 patients had a mean age of 77.3 ± 5.3 years. Frailty prevalence by Fried criteria was 16.5%. The eyeballing demonstrated high sensitivity (93.9%) and negative predictive value (NPV) (98.5%), with specificity of 80.8%, PPV of 49.2%, and an area under the curve (AUC) of 0.87. Subgroup analyses showed consistent accuracy, although specificity was lower in women and hospitalized patients. Frailty as defined by the Fried test was associated with higher 6-month mortality and rehospitalization. CONCLUSIONS: Eyeballing is a rapid and reliable tool to exclude frailty in elderly patients undergoing coronary angiography. However, when frailty is suspected, confirmation with a structured tool is indicated.