Association between frailty and CV outcomes in older subjects without CHD
Frailty and cardiovascular outcomes in the National Health and Aging Trends Study
Introduction and methods
Frailty is a clinical state in which vulnerability to stressors is increased due to lower reserves across multiple physiological systems. This leads to functional decline, increased death and higher risk of complications from disease and therapeutic interventions [1,2].
Previous studies that assessed the effect of frailty on CV outcomes included populations at high CV risk [3-6]. However, the association between frailty and major adverse CV events (MACE) in individuals without known coronary heart disease (CHD) is not well understood.
In this study, the long-term association of frailty with all-cause mortality and MACE was examined in older adults without a history of CHD using data from the National Health and Aging Trends Study (NHATS).
NHATS is a prospective cohort study that studies functioning in later life. Detailed information on geriatric risks were collected. Adults ≥65 years enrolled during the 2011 NHATS baseline visit were included. Frailty was assessed using the 5 domains of the Fried physical frailty phenotype : exhaustion, low physical activity, weakness, slowness and shrinking. Individuals were frail if 3 or more criteria were present, those with one or two criteria were pre-frail. MACE was defined as death from any cause, acute MI, any subsequent CHD, stroke or peripheral vascular disease and was reported at 6-year follow-up. Of 3259 individuals included, 1535 (47%) were pre-frail and 527 (16%) were frail.
- After full adjustment, frailty was associated with MACE (HR 1.77, 95%CI:1.53-2.06), death (HR 2.70, 95%CI:2.16-3.38), AMI (HR 1.95, 95%CI: 1.31-2.90), stroke (HR 1.71,95%CI: 1.34-2.17), peripheral vascular disease (HR 1.80, 95%CI: 1.44-2.27) and CAD (HR 1.35, 95%CI: 1.11-1.65) at 6-year follow-up compared to the non-frail group.
- Also, pre-frailty was associated with MACE (HR 1.34, 95%CI:1.21-1.49), death (HR 1.64, 95%CI:1.36-1.98), AMI (HR 1.36, 95%CI: 1.01-1.82), stroke (HR 1.25,95%CI: 1.05-1.49), peripheral vascular disease (HR 1.49, 95%CI: 1.25-1.77) and CAD (HR 1.17, 95%CI: 1.02-1.35) compared to the non-frail group.
Pre-frailty and frailty were associated with risk of mortality and MACE during 6 years of follow-up after adjustment of traditional CV risk factors in the NHATS study.
The authors concluded: ‘Efforts to integrate frailty assessment as part of primary cardiovascular prevention programs in older adults at risk for cardiovascular disease are essential in daily clinical cardiovascular practice.’