Table 2.A.

Physical Frailty Assessment and Screening Tools Commonly Used in CVD

Measurement Tool	Description	Utilization	Limitation
Fried Criteria[45]	Consists of 5 components: Slowness- 5-m gait speed Weakness- handgrip strength measured by hand dynamometer Exhaustion- self reported (tool or scale?) Low physical activity measured by Minnesota Leisure Time Activity Questionnaire (Men <383 kcal/week, Women <270 kcal/week) Weight loss of ≧ 10 lb Score: 0 robust, 1–2 pre-frail, ≧ 3 frail	Well established criteria for physical frailty	Accurate assessment of exhaustion and low physical activity are patient-reported and can be unreliable. Weight loss patients with HF can be difficult to assess
Essential Frailty Toolset (EFT)	Consists of 4 items with a composite score of 5 Five chair rises without using arms (1 point if ≧15s, 2 points if unable) Cognitive function measured by MMSE (1 point if < 24) Hemoglobin (1 point if < 13 g/dl in men and <12 g/dl in women) Serum albumen (1 point if <3.5 g/dl) Score: 0 robust, 1–2 prefrail, ≧ 3 frail	Validated for risk assessment with biological and functional components Compared to other frailty assessments, EFT demonstrated to be the strongest predictor for mortality and disability after TAVR and SAVR [95]
Short Physical Performance Battery (SPPB)[96]	Multidomain physical assessment of lower extremity function and mobility that includes 3 physical tests, each score from 0–4, composite score 12. Five-meter gait speed (endurance) Five chair rises (strength) Tandem stand for ≧ 10 s (balance) Score: 10–12 robust, 9–7 prefrail, ≦ 6 severe frailty	Functional metric that is often used as a measure for physical frailty which has been extended to patients with CVD Highly predictive of outcomes (mortality, disability) in many clinical applications [97–99]	Ceiling Effect that limits its utility in adults with relatively greater functional capacity.
Clinical Frailty Scale (CFS)[100,101]	Judgment-based tool to screen for frailty. Consists of 9 categories based on an individual’s level of wellness and fitness. Very fit— robust, active, exercises regularly. Fit— without active disease symptoms but less fit, active occasionally. Managing Well— medical conditions are well controlled, but not regularly active beyond routine walking. Very Mild Frailty— not dependent in ADLs, but has disease symptoms that limit activities, complain of fatigue and slowness. Mild Frailty— move evident slowing (not sure what this means), needs help with IADL (finance, transportation, heavy housework, meal preparation, medications). Moderate Frailty—needs help with all outside activities and most ADLs, often has problems with stairs, needs assistance with bathing and dressing. Severe Frailty— completely dependent for personal care caused by physical or cognitive impairment, but not at high risk of dying within 6 months. Very Severe Frailty— completely dependent for personal care and approaching end of life. Terminally Ill— approaching end of life with a life expectancy of <6 months.	Screening tool for frailty	Susceptible to interobserver variability
Edmonton Frail Scale (EFS)[102]	Multidomain scale consists of 10 domains with a cumulative score of 17. Two domains are assessed by performance-based tools: Clock test for cognitive function, TUG for balance and mobility. The other 8 domains are functional independence, burden of medical illness and quality of life, health attitude, social support, medication use, nutrition, mood, and continence. Score: ≧12 frail; 0–5 robust, 6–7 Vulnerable, 8–9 Mild frailty, 10–11 Moderate frailty, 12–17 Severe frailty	Rapid screening tool
Gait Speed	5-m or 4-meter gait speed Slow: <0.83 m/s (>6s) Very slow: <0.65 m/s (>7.7 s) Extremely slow: <0.50 m/s (>10 s)	Functional metric that is often used as a measure for physical frailty which has been extended to patients with CVD Correlates with Fried scale and independent predictor of health outcomes.[103–105]	Although convenient, single performance assessments have diminished specificity.

Abbreviations: AVR = aortic valve replacement, CGA = Comprehension Geriatric Assessment, CVD = cardiovascular disease, HF = heart failure, MMSE = Mini-Mental Status Examination, SAVR = surgical aortic valve replacement, TAVR = transcutaneous aortic valve replacement, TUG = Timed Get Up and Go.