Table 2.

Operationalizing Frailty Assessments for Research and Clinical Practice in Cardiac Amyloidosis^a

Component	Preferred Tool	Time	Completed by	Optional Approaches/Research needed	Research Needed
Physical frailty: Modified fried frailty					Robust frailty biomarkers differentiating HF from amyloidosis as a cause of frailty
Loss of muscle mass/unintentional weight loss	SHARE-FI Scale: What has your appetite been like? Or have you been eating more, the same or less than usual?	<5 min	Medical/nursing	DXA or BIA scan or preferably MRI/ CT scan of psoas muscle or pectoralis muscle.	Potential use of noninvasive muscle ultrasound, and which muscle to measure?81
Weakness	5-repeat chair stands (eg, rising up and down from a chair 5 times without using arms/hands)	<1 min	Nursing	Handgrip strength measured with a dynamometer	Role of strength training earlier in life to prevent weakness
Slowness	Gait speed over 5 m	<5 min	Nursing	Gait speed over 4-10 m
Physical exhaustion	SHARE-FI Scale: “In the last week, did you feel on at least 3 d, that everything you did was an effort?”	<5 min	Medical/nursing	Validated fatigue questionnaire (eg, FACIT-Fatigue, PROMIS Fatigue)
Low physical activity	SHARE-FI Scale: “How often do you engage in activities that require a low or moderate level of energy such as gardening, cleaning the car, or doing a walk?	<5 min	Medical/nursing	Validated physical activity questionnaire which captures low to moderate intensity activities (eg, CHAMPS, PASE) or Duke Activity Status index, accelerometer, or daily tracking device	Role of strength training earlier in life to prevent weakness
Cognitive function
	Montreal Cognitive Assessment	10 min	Medical/nursing	Mini-Cog, MMSE ,and formal neurocognitive testing	Link between amyloidosis and cognition
Depressive symptoms/anxiety
	Patient Health Questionnaire-2 or -9 Hospital Anxiety and Depression Scale	<1 min (−2) or 2-5 min (−9)	Medical/nursing	Generalized Anxiety Disorder Instrument (GAD-7)

BIA = bioelectrical impedance analysis; CHAMPS = Community Healthy Activities Model Program for Seniors; CT = computed tomography; DXA = dual-energy X-ray absorptiometry; FACIT = functional assessment of chronic illness therapy; MMSE = Mini-Mental State Examination; MRI = magnetic resonance imaging; PASE = Physical Activity Scale for the Elderly; PROMIS = Patient-Reported Outcomes Measurement Information System.

^aAdopted from International Society of Heart and Lung Transplant consensus document.³