Frailty associated with CV outcomes in individuals without CHD

Frailty and cardiovascular outcomes in the National Health and Aging Trends Study

Literature - Damluij AA, Chung S-E, Xue Q-L et al., - Eur Heart J 2021, doi:10.1093/eurheartj/ehab-468

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 [7]: 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.

Main results

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.

Conclusion

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.’

References

Show references

1. Walston J, Robinson TN, Zieman S, McFarland F, Carpenter CR, Althoff KN, Andrew MK, Blaum CS, Brown PJ, Buta B, Ely EW, Ferrucci L, High KP, Kritchevsky SB, Rockwood K, Schmader KE, Sierra F, Sink KM, Varadhan R, Hurria A. Integrating frailty research into the medical specialties—report from a U13 conference. J Am Geriatr Soc 2017;65:2134–2139.

2. Damluji AA, Forman DE, van Diepen S, Alexander KP, Page RL, 2nd, Hummel SL, Menon V, Katz JN, Albert NM, Afilalo J, Cohen MG; American Heart Association Council on Clinical Cardiology and Council on Cardiovascular and Stroke Nursing. Older adults in the cardiac intensive care unit: factoring geriatric syndromes in the management, prognosis, and process of care: a scientific statement from the American Heart Association. Circulation 2020;141:e6–e32.

3. Schaller MS, Ramirez JL, Gasper WJ, Zahner GJ, Hills NK, Grenon SM. Frailty is associated with an increased risk of major adverse cardiac events in patients with stable claudication. Ann Vasc Surg 2018;50:38–45.

4. Kunadian V, Veerasamy M, Sinclair H, Qiu W, Das R, Ahmed J, Purcell I, Edwards R, Zaman A, Bagnall A. 5 major adverse cardiovascular events at 30-days were not significantly different between frail and non-frail older (>_75 years) patients Frailty and Cardiovascular Outcomes in the NHATS with non ST elevation acute coronary syndrome managed by invasive strategy:an analysis from the ICON1 study. Heart 2015;101:A3–A4.

5. Campo G, Maietti E, Tonet E, Biscaglia S, Ariza-Sole` A, Pavasini R, Tebaldi M, Cimaglia P, Bugani G, Serenelli M, Ruggiero R, Vitali F, Formiga F, Sanchis J, Galvani M, Minarelli M, Lucchi GR, Ferrari R, Guralnik J, Volpato S. The assessment of scales of frailty and physical performance improves prediction of major adverse cardiac events in older adults with acute coronary syndrome. J Gerontol A Biol Sci Med Sci 2020;75:1113–1119.

6. Ewe SH, Ajmone Marsan N, Pepi M, Delgado V, Tamborini G, Muratori M, Ng AC, van der Kley F, de Weger A, Schalij MJ, Fusari M, Biglioli P, Bax JJ. Impact of left ventricular systolic function on clinical and echocardiographic outcomes following transcatheter aortic valve implantation for severe aortic stenosis. Am Heart J 2010;160:1113–1120

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