Improving Social History and Frailty Assessment in Older Adults Admitted to a Tertiary Cardiac Centre

Introduction

As the population ages, more older adults with moderate to severe frailty are undergoing invasive cardiac interventions. Despite its prognostic significance, frailty is not incorporated into conventional cardiac risk scores. Best practice requires assessment of baseline function, care needs, and polypharmacy to inform intervention suitability, ceiling of care decisions, and discharge planning. The Clinical Frailty Scale (CFS) is a validated tool (1) for summarising frailty based on clinical judgement. Accurate social history documentation is essential and endorsed by both European and North American cardiology guidelines, particularly in tertiary cardiac centres(2)(3).

Aims and Objectives

To improve the assessment and documentation of social history and clinical frailty in older adults admitted to a tertiary cardiac centre in London.

Methods

Admission clerking documentation was reviewed retrospectively for patients admitted between November 2023 and January 2024, assessing inclusion of social history and CFS. An electronic SmartTool was developed to guide structured documentation, supported by educational sessions and reminder posters to the resident doctors. Documentation was reassessed prospectively between March and April 2025. A multidisciplinary team (MDT) survey evaluated the perceived impact. Statistical analysis was performed using Chi-squared testing in R.

Results

Pre-intervention, social history was documented in 25/70 (36%) of primary PCI and 24/46 (52%) of elective patients; no CFS scores were recorded. Post-intervention, documentation improved to 55/59 (93%, p<0.00001) and 43/49 (88%, p=0.00014) respectively. CFS recording improved to 40/59 (68%, p<0.00001) and 27/49 (55%, p<0.00001). All MDT respondents (n=10) agreed that improved documentation enhanced patient care.

Conclusion

A structured documentation tool combined with targeted education, significantly improved recording of social history and frailty. This quality improvement initiative was well received by the MDT and supports the value of comprehensive assessment in the care of older cardiology inpatients.

References:

1.             Kaeppeli T, Rueegg M, Dreher-Hummel T, Brabrand M, Kabell-Nissen S, Carpenter CR, et al. Validation of the Clinical Frailty Scale for Prediction of Thirty-Day Mortality in the Emergency Department. Ann Emerg Med [Internet]. 2020 Sep 1;76(3):291–300. Available from: https://doi.org/10.1016/j.annemergmed.2020.03.028

2.             Alexander KP, Newby LK, Armstrong PW, Cannon CP, Gibler WB, Rich MW, et al. Acute Coronary Care in the Elderly, Part II. Circulation [Internet]. 2007 May 15;115(19):2570–89. Available from: https://doi.org/10.1161/CIRCULATIONAHA.107.182616

3.             Vitale C, Jankowska E, Hill L, Piepoli M, Doehner W, Anker SD, et al. Heart Failure Association of the European Society of Cardiology position paper on frailty in patients with heart failure. Eur J Heart Fail [Internet]. 2019 Nov 1;21(11):1299–305. Available from: https://doi.org/10.1002/ejhf.1611