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Frailty predictors and outcomes among older patients with cardiovascular disease: Data from Fragicor
Alberto Frisoli1, Sheila Jean McNeill Ingham2, Ângela T Paes3
1Cardiogeriatric Unit, Cardiology Division, Federal University of São Paulo, São Paulo, Brazil; Cardiology Division, Federal University of São Paulo, São Paulo, Brazil.
Insights
Older adults with cardiovascular disease (CVD) are more likely to be frail. Frailty predicts disability and increases mortality risk, highlighting the need for early diagnosis in this population.
Area of Science:
- Gerontology
- Cardiology
- Public Health
Background:
- Cardiovascular disease (CVD) is prevalent in older adults.
- Frailty is a geriatric syndrome associated with adverse health outcomes.
- Predictive factors and outcomes of frailty in CVD patients require further investigation.
Purpose of the Study:
- To identify predictive factors for frailty in older outpatients with CVD.
- To assess the predictive value of frailty for mortality, disability, and hospitalization at 1-year follow-up.
Main Methods:
- Prospective cohort study of 172 outpatients aged over 65 with at least one CVD.
- Frailty assessed using Fried's phenotype criteria (weight loss, exhaustion, weakness, slow walking, low physical activity).
- Data collected on CVD, hemodynamic parameters (blood pressure, heart rate, ejection fraction), disability, and hospitalizations.
Main Results:
- Prevalence of frailty was 39.8%, prefrail 51.5%, and robust 8.7%.
- Myocardial infarction, multiple CVDs, and lower systolic and diastolic blood pressure were significant predictors of frailty.
- Frailty independently predicted disability (OR: 3.94) and increased mortality risk threefold compared to robust individuals.
Conclusions:
- Older outpatients with CVD exhibit a higher prevalence of frailty.
- Low systolic and diastolic blood pressure are associated with frailty in this population.
- Diagnosing frailty in CVD patients is crucial due to its strong association with mortality and disability.
Abstract:
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 (10lbs 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.
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