Frailty predicts long-term mortality in elderly subjects with chronic heart failure (original) (raw)
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Frailty predictors and outcomes among older patients with cardiovascular disease: Data from Fragicor
Archives of Gerontology and Geriatrics, 2015
The aim of this study was to evaluate predictive factors for frailty among older outpatient adults with cardiovascular disease (CVD) and to assess the predictive value of frailty in regard to mortality, disability and hospitalization at 1-year follow-up. A prospective cohort study was carried out with subjects over 65 years of age from an outpatient Cardiology clinic, with at least one CVD. At baseline, we classified frailty as proposed by Fried, i.e.; unintentional weight loss (10 lbs in the past year), self-reported exhaustion, weakness (measured by grip strength), slow walking speed, and low physical activity. A frail person was defined by the presence of three or more criteria, prefrail by one or two and robust by the absence of them. Disability, previous hospitalizations, falls, morphometric and socio-demographic variables were collected; as well as the presence of CVD and hemodynamic parameters (HP): systolic (SPB) and diastolic blood pressure (DBP), heart rate (HR) and ejection fraction (EF). At 1-year follow-up, the outcomes assessed were: disability, number of hospitalizations and death. 172 subjects were included in this study with a mean age of 77 years old. The prevalence of frail was 39.8%, prefrail 51.5% and robust was 8.7%. Among the CVD and HP evaluated, myocardial infarction (MI), presence of three or more CVDs, lower SPB and DBP were significant and independent factors associated with the frailty phenotype. At 1-year follow up, frailty was an independent predictor for disability (Odds Ratio (OR): 3.94 (1.59-9.75); p = 0.003) and it increased death probability by three times if compared to the robust group. In conclusion, older outpatients with CVD have a higher probability to be frail than older adults who do not have a CVD. Low SPB and DBP must always be taken into consideration due to their high association with frailty. It is also important to diagnose frailty in this population due to the high association with mortality and disability.
Role of Frailty in Patients With Cardiovascular Disease
American Journal of Cardiology, 2009
Frailty is a geriatric syndrome of increased vulnerability to stressors that has been implicated as a causative and prognostic factor in patients with cardiovascular disease (CVD). The American Heart Association and the Society of Geriatric Cardiology have called for a better understanding of frailty as it pertains to cardiac care in the elderly. The aim of this study was to systematically review studies of frailty in patients with CVD. A search was conducted of Ovid MEDLINE, EMBASE, the Cochrane Database, and unpublished sources. Inclusion criteria were an assessment of frailty using systematically defined criteria and a study population with prevalent or incident CVD. Nine studies were included, encompassing 54,250 elderly patients with a mean weighted follow-up of 6.2 years. In community-dwelling elders, CVD was associated with an odds ratio (OR) of 2.7 to 4.1 for prevalent frailty and an OR of 1.5 for incident frailty in those who were not frail at baseline. Gait velocity (a measure of frailty) was associated with an OR of 1.6 for incident CVD. In elderly patients with documented severe coronary artery disease or heart failure, the prevalence of frailty was 50% to 54%, and this was associated with an OR of 1.6 to 4.0 for all-cause mortality after adjusting for potential confounders. In conclusion, there exists a relation between frailty and CVD; frailty may lead to CVD, just as CVD may lead to frailty. The presence of frailty confers an incremental increase in mortality. The role of frailty assessment in clinical practice may be to refine estimates of cardiovascular risk, which tend to be less accurate in the heterogenous elderly patient population.
Frailty and risk of cardiovascular disease and mortality
PLOS ONE, 2022
Background Prospective cohort studies suggest that frailty is associated with an increased risk of incident cardiovascular disease (CVD) morbidity and mortality, but their mechanistic and developmental relations are not fully understood. We investigated whether frailty predicted an increased risk of incident nonfatal and fatal CVD among community-dwelling older adults. Methods A population cohort of 5015 participants aged 55 years and above free of CVD at baseline was followed for up to 10 years. Pre-frailty and frailty were defined as the presence of 1-2 and 3-5 modified Fried criteria (unintentional weight loss, weakness, slow gait speed, exhaustion, and low physical activity), incident CVD events as newly diagnosed registered cases of myocardial infarction (MI), stroke, and CVD-related mortality (ICD 9: 390 to 459 or ICD-10: I00 to I99). Covariate measures included traditional cardio-metabolic and vascular risk factors, medication therapies, Geriatric Depression Scale (GDS), Mini-Mental State Exam (MMSE), and blood biomarkers (haemoglobin, albumin, white blood cell counts and creatinine). Results Pre-frailty and frailty were significantly associated with elevated HR = 1.26 (95%CI: 1.02-1.56) and HR = 1.54 (95%CI:1.00-2.35) of overall CVD, adjusted for cardio-metabolic and vascular risk factors and medication therapies, but not after adjustment for GDS depression and MMSE cognitive impairment. The HR of association between frailty status and both CVD mortality and overall mortality, however, remained significantly elevated after full adjustment for depression, cognitive and blood biomarkers. Conclusion Frailty was associated with increased risk of CVD morbidity and especially mortality, mediated in parts by traditional cardio-metabolic and vascular risk factors, and co-morbid
The impact of frailty on health related quality of life in heart failure
European Journal of Cardiovascular Nursing, 2011
Background/Aims: Most heart failure (HF) hospital discharges involve people N 65 years, many frail. The purpose of this study was to determine if frailty explains variability in health related quality of life (HRQOL) in older adults with HF over and above known correlates. Methods: A frailty index score was developed by weighting age, number of comorbid conditions, and symptom severity. A multivariate hierarchical regression analysis of known predictors of HRQOLgender, income, ethnicity, health perception, NYHA classwere entered first and then the frailty index was entered and regressed on HRQOL in 2 unique samples. Results: When known predictors were tested on a sample they explained 11% (p 0.14) of the variance in HRQOL; when the frailty index score was added 24% (p 0.001) was explained. When the index was validated in a second sample, known predictors explained 15% (p 0.04) of the variance; with the frailty index score 40% (p 0.000) was explained. Conclusion: Frailty explains significant amounts of variance in HRQOL in HF. Treating comorbid conditions and controlling symptoms may improve HRQOL in HF patients. These findings support the need for further research into the impact of frailty on HRQOL in HF patients.
Frailty significantly impairs the short term prognosis in elderly patients with heart failure
Journal of Geriatric Cardiology : JGC, 2018
Background Frailty is a condition of elderly characterized by increased vulnerability to stressful events with high risk of adverse outcomes. The purpose of this study was to evaluate the association between frailty and adverse outcomes including death and hospitalization due to heart failure in elderly patients. Methods We included patients aged ≥ 65 years with the diagnosis of heart failure. The clinical and laboratory data, echocardiography and ECGs were recorded. Additionally, the frailty scores of the patients were evaluated according to Canadian Study of Health and Aging. All the patients were divided as frail or non-frail. The groups were compared for their characteristics and the occurrence of clinical outcomes. Results We included 86 eligible patients. The median follow-up time was four months. The mean age was 75 ± 6.5 years. Of these 86 patients, 17 (19.7%) patients encountered an event (death and/or hospitalization). Nine patients (10.4%) died during follow-up. Thirty pa...
European journal of heart failure, 2016
The aim of this study was to evaluate the prevalence, clinical features, and the independent impact of frailty-a geriatric syndrome characterized by the decline of physiological systems-and its components, on prognosis after heart failure (HF) hospitalization. FRAIL-HF is a prospective cohort study including 450 non-dependent patients ≥70 years old hospitalized for HF. Frailty was screened according to the biological phenotype criteria (low physical activity, weight loss, slow walking speed, weak grip strength, and exhaustion). The independent influence of frailty on mortality, functional decline, and readmission risks was calculated adjusted for HF characteristics and co-morbidities. Mean age was 80 ± 6 years; 76% fulfilled frailty criteria. Frail patients were older, more often female, but showed no differences in chronic co-morbidities, LVEF, and NT-proBNP levels. Slow walking speed was the most discriminative component between frail (89.2%) and non-frail patients (26%). Overall,...
Importance of frailty in patients with cardiovascular disease
European heart journal, 2014
Cardiovascular diseases (CVDs) are the leading cause of morbidity and mortality. With the ageing population, the prognostic determinants among others include frailty, health status, disability, and cognition. These constructs are seldom measured and factored into clinical decision-making or evaluation of the prognosis of these at-risk older adults, especially as it relates to high-risk interventions. Addressing this need effectively requires increased awareness and their recognition by the treating cardiologists, their incorporation into risk prediction models when treating an elderly patient with underlying complex CVD, and timely referral for comprehensive geriatric management. Simple measures such as gait speed, the Fried score, or the Rockwood Clinical Frailty Scale can be used to assess frailty as part of routine care of elderly patients with CVD. This review examines the prevalence and outcomes associated with frailty with special emphasis in patients with CVD.
Association of frailty with survival: A systematic literature review
Ageing Research Reviews, 2013
Frailty is a known risk factor for those aged 65 and over, and its prevalence increases with age. Definitions of frailty vary widely, and prevalence estimates are affected by the way frailty is defined. Systematic reviews have yet to examine the literature on the association between definitions of frailty and mortality.
Frailty and Its Potential Relevance to Cardiovascular Care
Mayo Clinic Proceedings, 2008
Frailty is characterized by vulnerability to acute stressors and is a consequence of decline in overall function and physiologic reserves. An estimated 7% of the US population older than 65 years and 30% of octogenarians are frail. The domains to define frailty include mobility, strength, balance, motor processing, cognition, nutrition, endurance, and physical activity. Pathophysiologic pathways leading to frailty involve a multisystem cascade that includes neuroendocrine dysfunction with lower insulinlike growth factor and dehydroepiandrosterone sulfate and an altered inflammatory milieu with increased levels of C-reactive protein, interleukins, tumor necrosis factor α, and abnormal coagulation. Frailty predicts death and heralds the transition to disability in general populations. As the population with coronary artery disease shifts toward older patients, physicians must consider the role of frailty in their patients. This review will enable clinicians to recognize frailty and consider its relevance in their daily practice. We also elaborate on reasons to consider frailty in older adults with cardiovascular disease and focus on its early identification, on referral to specialists, and on care after serious cardiac events. During the past century, the average life expectancy has lengthened, resulting in a larger older population presenting with acute and chronic cardiovascular diseases. Variation in the health status of older patients is apparent, ranging from robust to frail. An estimated 7% of the US population older than 65 years and 30% of octogenarians are frail. 1 Frailty, a construct well described and debated in the geriatric literature, is characterized by vulnerability to acute stressors and is a consequence of decline in overall function and physiologic reserves. Frail patients have a reduced ability to maintain homeostasis in the face of acute stress. Cardiovascular practice guidelines acknowledge the importance of global health status in older adults, stating that decisions on management in the elderly should reflect considerations of general health, comorbidities, cognitive status, and life expectancy. 2-4 As the population with coronary artery disease (CAD) ages, cardiologists must be ready to consider the role of frailty in their patients. 5 In light of this situation, this review examines the definitions, incidence and prevalence, proposed pathophysiologic pathways, and outcomes associated with frailty. In so doing, it will enable clinicians to recognize frailty and consider its relevance in their daily practice. English-language publications in PubMed and references from relevant articles published between 1970 and 2007 were reviewed. Main search terms were frailty, comorbidity, falls,
Frailty may be a risk marker for adverse outcome in patients with congestive heart failure
ESC Heart Failure
Aims To examine the availability of frailty concept with objective criteria for risk stratification in patients with congestive heart failure (CHF). Methods and results Study design was secondary analysis of our CHF cohort. We selected 181 patients who completed clinical assessments and were successfully followed 2-year post discharge. To set frailty criteria, grip strength <26 kg in men and <17 kg in women (weakness) and performance measure for activities of daily living-8 ≧21 points (exhaustion) were defined for predicting 6 min walking distance <300 m (slowness) by the receiver-operating characteristics. During 2 years of follow up, subjects who met all the criteria had a 4 times greater risk of cardiac event compared with those with no frailty criteria. Conclusion The findings of present study suggest that frailty criteria may serve as a new clinical marker for management of patients with CHF.