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Frailty Trajectories After Treatment for Coronary Artery Disease in Older Patients
Elizabeth A Freiheit1, David B Hogan2, Scott B Patten2
1From the Department of Community Health Sciences (E.A.F., D.B.H., S.B.P., W.A.G., C.J.M.), Department of Medicine (D.B.H., T.A., W.A.G., M.K.), Department of Psychiatry (S.B.P.), Department of Cardiac Sciences (T.A.), Department of General Internal Medicine (W.A.G.), Mathison Centre for Mental Health Research and Education (S.B.P.), and Libin Cardiovascular Institute of Alberta (T.A., W.A.G., M.K.), University of Calgary, Calgary, Alberta, Canada; Department of Anesthesia, University of Toronto, Toronto, Ontario, Canada (H.W.); Department of Critical Care Medicine, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada (H.W.); the Schools of Pharmacy and Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada (C.J.M.); and the Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada (C.J.M.). elizfreiheit@gmail.com.
Insights
Frailty generally worsens after coronary artery disease treatment, following a U-shaped curve. However, younger patients (<75 years) undergoing revascularization (CABG or PCI) may experience sustained frailty reduction.
Area of Science:
- Cardiology
- Gerontology
- Public Health
Background:
- Frailty is a significant predictor of adverse cardiovascular outcomes.
- The long-term frailty trajectory following coronary artery disease (CAD) treatment remains largely unknown.
Purpose of the Study:
- To investigate the changes in frailty over 30 months after different treatments for coronary artery disease.
- To explore how age and treatment modality influence frailty trajectories in CAD patients.
Main Methods:
- A cohort of 374 patients undergoing cardiac catheterization and subsequent treatment (coronary artery bypass graft, percutaneous coronary intervention, or medical therapy) were followed for 30 months.
- Frailty Index (FI) scores were assessed at baseline and at 6, 12, and 30 months post-treatment.
- Random-effects models analyzed FI score trajectories, comparing differences by sex, age, and treatment group.
Main Results:
- Overall, frailty scores worsened 12 and 30 months after treatment, following a U-shaped trajectory (P<0.001).
- Patients aged 75 years and older showed increased frailty post-treatment, regardless of intervention.
- Younger patients (<75 years) receiving percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) demonstrated sustained frailty improvement, unlike those treated with medical therapy alone.
Conclusions:
- Frailty typically follows a U-shaped pattern after coronary artery disease treatment, with initial improvement followed by worsening.
- Age and treatment strategy significantly impact frailty trajectories, highlighting the need for personalized care.
- Further research is warranted to confirm these findings and explore clinical benefits of frailty-guided interventions.
Background:
Frailty is an independent risk factor for cardiovascular outcomes. However, its trajectory after coronary artery disease treatment is unknown.
Methods And Results:
Three hundred seventy-four patients undergoing nonemergent cardiac catheterization followed by treatment (ie, 128 coronary artery bypass graft [CABG], 150 percutaneous coronary intervention [PCI], 96 medical therapy only) were observed for 30 months. A frailty index (FI) score was calculated at baseline (before initial treatment) and 6, 12, and 30 months after treatment. Random-effects models compared FI score trajectories by sex, age, and treatment group. Mean baseline FI scores were 0.170, 0.154, and 0.154 for CABG, PCI, and medical therapy only, respectively. FI scores decreased (improved) 6 months after initial treatment, then increased (worsened) at 12 and 30 months (P<0.001 for differences over time). Women had nonsignificantly higher FI scores than men (P=0.097) but followed the same trajectory (P=0.352 for differences over time). In patients aged ≥75 years, FI scores increased postbaseline for CABG and medical therapy only and after 6 months for PCI patients. Patients <75 years assigned to PCI and CABG experienced a sustained frailty reduction, whereas those assigned to medical therapy only showed stable frailty over the 30-month follow-up period (P value for differences over time by age and treatment group=0.041).
Conclusions:
With coronary artery disease treatment, frailty generally follows a U-shaped trajectory, but the pattern may differ by age and treatment. Further investigation is needed to confirm these observations and determine whether patients might benefit from consideration of frailty status.
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