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Frailty and CV Outcomes in National Health and Aging Trends Study
Quick Takes
- Compared to nonfrail subjects, prefrail and frail older patients had a higher risk of developing MACE, including mortality during the 6-year follow-up.
- It seems reasonable to integrate frailty assessment as part of primary cardiovascular (CV) prevention programs in older adults at risk for CVD.
- The efficacy and safety of physical activity programs, nutritional interventions, and cognitive training to prevent or reverse physical frailty in reducing MACE among patients at risk for CVD needs to be prospectively tested.
Study Questions:
What is the long-term association of frailty with all-cause-mortality and major adverse cardiac events (MACE) among older adults without a history of coronary heart disease (CHD) at baseline in the National Health and Aging Trends Study?
Methods:
The investigators used the National Health and Aging Trends Study, a prospective cohort study linked to a Medicare sample. Participants with a prior history of CHD were excluded. Frailty was measured during the baseline visit using the Fried physical frailty phenotype. Cardiovascular (CV) outcomes were assessed during a 6-year follow-up. Proportional hazard models were used to assess the association between frailty and CV outcomes among older adults at 6-year follow-up. Kaplan–Meier curves were constructed to evaluate the association of frailty status at baseline with MACE and each individual CV outcome. Log-rank statistic was calculated for each curve.
Results:
Of the 4,656 study participants, 3,259 (70%) had no history of CHD 1 year prior to their baseline visit. Compared to those without frailty, subjects with frailty were older (mean age 82.1 vs. 75.1 years, p < 0.001), more likely to be female (68.3% vs. 54.9%, p < 0.001), and more likely to belong to an ethnic minority. The prevalence of hypertension, falls, disability, anxiety/depression, and multimorbidity was much higher in the frail and prefrail than the nonfrail participants. In a Cox time-to-event multivariable model and during 6-year follow-up, the incidences of death and of each individual CV outcome were all significantly higher in the frail than in the nonfrail patients including MACE (hazard ratio [HR], 1.77; 95% confidence interval [CI], 1.53-2.06), death (HR, 2.70; 95% CI, 2.16-3.38), acute myocardial infarction (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 coronary artery disease (HR, 1.35; 95% CI, 1.11-1.65).
Conclusions:
The authors concluded that in patients without CHD, frailty is a risk factor for the development of MACE.
Perspective:
This study reports that as compared to nonfrail subjects, prefrail and frail older patients had a higher risk of developing MACE, including mortality during the 6-year follow-up, even after adjusting for demographic characteristics, traditional CV risk factors, and multimorbidity at baseline. Based on these and other data, it seems reasonable to integrate frailty assessment as part of primary CV prevention programs in older adults at risk for CV disease (CVD). Furthermore, the efficacy and safety of physical activity programs, nutritional interventions, and cognitive training to prevent or reverse physical frailty in reducing MACE among patients at risk for CVD needs to be prospectively tested, as the US older adult population expands rapidly in the near future.
Clinical Topics: Acute Coronary Syndromes, Cardiovascular Care Team, Diabetes and Cardiometabolic Disease, Geriatric Cardiology, Prevention, Vascular Medicine, Atherosclerotic Disease (CAD/PAD), Exercise, Hypertension
Keywords: Accidental Falls, Acute Coronary Syndrome, Anxiety, Cognition, Coronary Artery Disease, Coronary Disease, Depression, Exercise, Frail Elderly, Frailty, Geriatrics, Hypertension, Multimorbidity, Myocardial Infarction, Myocardial Ischemia, Nutrition Assessment, Peripheral Vascular Diseases, Primary Prevention, Risk Factors, Stroke, Vascular Diseases
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