AI-Enabled Frailty Risk Prediction in Adult Congenital Heart Disease

The PROMIS Depression Short Form evaluates negative mood, feelings of hopelessness, helplessness, and loss of interest.

The PROMIS Anxiety Short Form assesses emotional distress related to feelings of fear, worry, tension, and hyperarousal.

Each scale consists of multiple items rated on a 5-point Likert scale (1 = Never, 2 = Rarely, 3 = Sometimes, 4 = Often, 5 = Almost Always) based on the participant's experiences during the past 7 days.

Raw scores are summed and converted to PROMIS T-scores, standardized to a population mean of 50 with a standard deviation of 10.

Possible raw score range: 8-40 (for the 8-item short form).

Higher scores indicate greater levels of depressive or anxiety symptoms (worse outcomes).

This study used the Chinese version of the Satisfaction With Life Scale (SWLS) (Wu & Yao, 2006), which consists of five items rated on a seven-point Likert scale ranging from 1 (strongly disagree) to 7 (strongly agree). Higher total scores indicate greater overall life satisfaction. The scale has been applied in adult patients with congenital heart disease (Liu, Lu, et al., 2024) and demonstrated excellent internal consistency, with a Cronbach's α of 0.93, indicating good reliability of the Chinese version.

Duckworth et al. (2007) proposed the Grit Scale to conceptualize grit as comprising two dimensions: Perseverance of Effort (six items) and Consistency of Interests (six items), yielding a total of 12 items. The overall internal consistency of the original scale was 0.85, with Cronbach's α values of 0.78 for the Perseverance of Effort subscale and 0.84 for the Consistency of Interests subscale, indicating good reliability (Duckworth & Quinn, 2009).

The Chinese version of the Grit Scale (Grit-10) was adapted from the original 12-item English version and revised to include 10 items loading on two factors. The Passion factor (reverse-coded) includes items such as "I often set a goal but then quickly change it," whereas the Perseverance factor includes items such as "I finish whatever I begin." Responses are rated on a five-point Likert scale ranging from 1 (not at all like me) to 5 (very much like me). Each item is scored from 1 to 5; odd-numbered items are reverse-coded and even-numbere

The Fatigue Assessment Scale-Chinese version (FAS-C) is a self-reported instrument designed to measure subjective fatigue and is particularly suitable for use in populations with chronic illnesses, cardiovascular diseases, and the general adult population (Michielsen et al., 2003). The original FAS consists of 10 items encompassing two domains: physical fatigue and mental fatigue. The Chinese version was developed through a rigorous process of translation, back-translation, and cultural adaptation, and has demonstrated satisfactory psychometric properties, including excellent internal consistency (Cronbach's α = 0.92) and good test-retest reliability (Lee, 2024).

Each item is rated on a five-point Likert scale ranging from 1 (never) to 5 (always), yielding a total score between 10 and 50, with higher scores indicating greater fatigue severity. The FAS-C is brief and easy to administer, with high sensitivity in distinguishing different levels of fatigue, making it suitable for clinica