Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Oct 1;42(37):3856-3865.
doi: 10.1093/eurheartj/ehab468.

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

Abdulla A Damluji  1   2 , Shang-En Chung  3 , Qian-Li Xue  3   4 , Rani K Hasan  2 , Mauro Moscucci  5 , Daniel E Forman  6   7 , Karen Bandeen-Roche  4 , Wayne Batchelor  1 , Jeremy D Walston  3 , Jon R Resar  2 , Gary Gerstenblith  2
Affiliations

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

Abdulla A Damluji et al. Eur Heart J. .

Abstract

Aims: Physical frailty is a commonly encountered geriatric syndrome among older adults without coronary heart disease (CHD). The impact of frailty on the incidence of long-term cardiovascular outcomes is not known.We aimed to evaluate the long-term association of frailty, measured by the Fried frailty phenotype, with all-cause-mortality and MACE among older adults without a history of CHD at baseline in the National Health and Aging Trends Study.

Methods and results: We 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 outcomes were assessed during a 6-year follow-up.Of the 4656 study participants, 3259 (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 belong to an ethnic minority. The prevalence of hypertension, falls, disability, anxiety/depression, and multimorbidity was much higher in the frail and pre-frail than the non-frail participants. In a Cox time-to-event multivariable model and during 6-year follow-up, the incidences of death and of each individual cardiovascular outcomes were all significantly higher in the frail than in the non-frail patients including major adverse cardiovascular event (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).

Conclusion: In patients without CHD, frailty is a risk factor for the development of MACEs. Efforts to identify frailty in patients without CHD and interventions to limit or reverse frailty status are needed and, if successful, may limit subsequent adverse cardiovascular events.

Keywords: Coronary disease; Frailty; Older adults.

PubMed Disclaimer

Figures

None
The ageing of the US population and the influence of frailty on the incidence of cardiovascular outcomes in over 6 years of follow-up. (A) Estimates on the projected number (%) of all older adults in 2040 were obtained from www.census.gov. (B) The cumulative incidence of each cardiovascular outcome during 6 years of follow-up was derived from the National Health and Aging and Trends Study.
Figure 1
Figure 1
(A) Kaplan–Meier survival curve illustrating major adverse cardiovascular event (MACE)-free over 6-year follow-up by frailty status at baseline in the NHATS-CMS study among patients without a history of coronary heart disease (log-rank P < 0.001). MACE was defined as a composite of all-cause mortality, acute myocardial infarction, stroke, peripheral vascular disease, and subsequent coronary disease. (B) Kaplan–Meier survival curve illustrating MACE2-free over 6-year follow-up by frailty status at baseline in the NHATS-CMS study among patients without a history of coronary heart disease (log-rank P < 0.001). MACE2 was defined as a composite of acute myocardial infarction, stroke, peripheral vascular disease, and subsequent coronary disease. (C) Kaplan–Meier survival curve illustrating the survival over 6-year follow-up by frailty status at baseline in the NHATS-CMS study among patients without a history of coronary heart disease (log-rank P < 0.001). (D) Kaplan–Meier survival curve illustrating acute myocardial infarction-free survival over 6-year follow-up by frailty status at baseline in the NHATS-CMS study among patients without a history of coronary heart disease (log-rank P = 0.003). (E) Kaplan–Meier survival curve illustrating stroke-free survival over 6-year follow-up by frailty status at baseline in the NHATS-CMS study among patients without a history of coronary heart disease (log-rank P < 0.001). (F) Kaplan–Meier survival curve illustrating peripheral vascular disease-free survival over 6-year follow-up by frailty status at baseline in the NHATS-CMS study among patients without a history of coronary heart disease (log-rank P < 0.001).
See this image and copyright information in PMC

Comment in

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. - PMC - PubMed
    1. 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. - PubMed
    1. 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. - PMC - PubMed
    1. 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 with non ST elevation acute coronary syndrome managed by invasive strategy: an analysis from the ICON1 study. Heart 2015;101:A3–A4.
    1. Campo G, Maietti E, Tonet E, Biscaglia S, Ariza-Solè 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. - PubMed

Publication types