3VALIDATING THE USE OF ELECTRONIC FRAILTY INDEX SCORE IN REFERRAL PATHWAYS; A RETROSPECTIVE STUDY OF HEART FAILURE DIAGNOSTIC APPOINTMENTS IN SECONDARY CARE FROM APRIL 2016 TO APRIL 2016

Abstract

Introduction: Heart failure has a prevalence of 1-3% which rises to 10 % amongst elderly patients in the UK1. In addition to clinical diagnosis, BNP and NT-pro BNP are biomarkers that are now recommended in diagnostic algorithms for detection of heart failure, and are independent predictors of mortality and other cardiac outcomes in patients with heart failure2. The electronic frailty index (eFI) score is a parameter used in primary care which helps identify and predict adverse outcomes in elderly patients. Method(s): Data for all patients in "New patient" consultant led clinics from the period of April- June 2016 were acquired from the coding department. Inclusion criteria was agreed and a proforma was designed to capture patient demographics, referral details and eFrailty Index scores. Secondary care computer programs; Electronic Patient Records (EPR) and Patient Manager (PIMs), were used to collect the relevant data. Hospital referral and clinic letters were examined for the inclusion criteria and on identifying the required subset of patients. The e-Frailty Index scores were pursued from individual patient General Practices in the London boroughs of Lambeth and Southwark. The e- Frailty Index scores were classed to fit, mildly frail, moderate frail and severely frail with numerical cut offs. The data captured in the study proforma was subsequently analysed using Microsoft Excel. Result(s): Showed a high proportion of patients with severe frailty as indicated by eFI scores referred to the department from April to June 2016. Of the 19 heart failure patients for which the eFI score was available (n = 22), 52.3% were classed as having severe frailty. NT-proBNP, while only available for 63.6% (n = 22) of the patients, only two patients were below the threshold to rule out heart failure. Higher levels of NTproBNP generally denote an increased likelihood of heart failure. It maybe that patients with higher levels can be prioritised with regards to referral pathways5. Our study further confirmed MI history is a strong indicator of heart failure diagnosis. Despite severe frailty in some patients, only two were found to be under the care of the care of the elderly team. Electronic frailty index scores are a useful tool which could be implemented in secondary care to help direct the pathway of patients and optimally manage co-morbidities leading to decreased adverse outcomes.