ArticleAge and ageing2025
Development and external validation of the electronic frailty index 2 using routine primary care electronic health record data.
Article in Age and ageing, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 23 papers.
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Who cites it
23 citing papers in PubMed.
- Frailty index deficit interchangeability: an empirical test using random survival forests in adults with cardiovascular disease.Age and ageing · 2026Article
- Hearing Aid Use Attenuates the Association Between Hearing Loss and Frailty: A 2003-2018 NHANES Cross Sectional Analysis.Journal of the American Geriatrics Society · 2026Article
- How do we proactively identify and offer interventions to older adults living with frailty in the community?Future healthcare journal · 2026Article
- Community-based health and social care demand associated with frailty in people aged 50 and over in England 2025-40: routine data analyses and simulation modelling.Age and ageing · 2026Article
- Frailty and health resource utilization in 5450 adults with acute myeloid leukaemia: A population-based study from Ontario, Canada.British journal of haematology · 2026Article
- Proxy indicators to support independent ageing-in-place in older people with frailty: a Delphi-style expert consultation survey.BMC geriatrics · 2026Article
- Factors associated with mortality in older sepsis patients: a nationwide retrospective cohort study in Germany.Age and ageing · 2026Observational
- External Validation of a Community Pharmacy-Based Screening Tool for Frailty That Uses Routinely Collected Data.Drugs & aging · 2026Article
- Frailty: new horizons in older patients needing surgery.Annals of the Royal College of Surgeons of England · 2026Article
- Why should we assess the degree of frailty in primary care?The British journal of general practice : the journal of the Royal College of General Practitioners · 2026Article
- Developing and validating the CE-MACE model to predict 1-year major adverse cardiovascular events post-COPD exacerbation using routine healthcare data.The European respiratory journal · 2026Article
- Joint association of frailty and social isolation with depressive symptoms among middle-aged and older Chinese adults: a nationwide cohort study.Scientific reports · 2026Article
- FI-CGA and eFI-CGA in Frailty Care: a Scoping Review.Canadian geriatrics journal : CGJ · 2026Review
- A cross-sectional study of the relationship between community dwelling older adults' self-perceived frailty and their electronic frailty index score.BMC geriatrics · 2026Article
- Electronic frailty index based on comprehensive geriatric assessment in primary care: feasibility, validity, and reliability.BMC geriatrics · 2026Article
- Frailty and Cardiovascular Risk.European cardiology · 2026Review
- Challenges and strategies in the care of older adults across the continuum of intensive and post-intensive care medicine.Intensive care medicine · 2026Review
- Cohort profile: Creation of an e-cohort to Address the Evaluation of Population Secondary Prevention Quality and Outcomes Post-Stroke (ESP-QOPS) in Wales.International journal of population data science · 2026Article
- Health and care service utilisation in the last year of life before non-sudden death in Wales, 2014-2023, by palliative care registration: a population-based retrospective cohort study.The Lancet regional health. Europe · 2025Article
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Authors and funding
12 authors.
Funding
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Abstract
backgroundThe electronic frailty index (eFI) is nationally implemented into UK primary care electronic health record systems to support routine identification of frailty. The original eFI has some limitations such as equal weighting of deficit variables, lack of time constraints on variables known to resolve and definition of frailty category cut-points. We have developed and externally validated the eFI2 prediction model to predict the composite risk of home care package; hospital admission for fall/fracture; care home admission; or mortality within one year, addressing the limitations of the original eFI.
methodsLinked primary, secondary and social care data from two independent retrospective cohorts of adults aged ≥65 in 2018 was used; the population of Bradford using the Connected Bradford dataset (development cohort, 78 760 patients) and the population of Wales, from the Secure Anonymised Information Linkage databank (external validation cohort, 660 417 patients). Candidate predictors included the original eFI variables, supplemented with variables informed by literature reviews and clinical expertise. The composite outcome was modelled using Cox regression.
resultsIn internal validation the model had excellent discrimination (C-index = 0.803, Nagelkerke's R2 = 0.0971) with good calibration (Calibration slope = 1.00). In external validation, the model had good discrimination (C-index = 0.723, Nagelkerke's R2 = 0.064), with some evidence of miscalibration (Calibration slope = 1.104).
conclusionsThe eFI2 demonstrates robust prediction for key frailty-related outcomes, improving on the original eFI. Our use of novel methodology to develop and validate the eFI2 will advance the field of frailty-related research internationally, setting a new methodological standard.
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