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Frailty and cardiovascular mortality in more than 3 million US Veterans
William Shrauner1,2,3, Emily M Lord1, Xuan-Mai T Nguyen1
1Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, 150 South Huntington Ave, Boston, MA 02130, USA.
Insights
Frailty significantly increases cardiovascular (CV) mortality risk in older adults. This risk escalates with frailty severity, independent of existing CV disease, highlighting a critical area for intervention.
Area of Science:
- Gerontology
- Cardiovascular Medicine
- Public Health
Background:
- Frailty is a known risk factor for mortality and cardiovascular (CV) events.
- Limited contemporary data exist on frailty's impact on CV mortality in the modern era of CV prevention.
Purpose of the Study:
- To investigate the association between frailty and CV mortality in a large cohort of older US Veterans.
- To examine the relationship between frailty and major CV events, including myocardial infarction, stroke, and revascularization.
Main Methods:
- Analysis of 3,068,439 US Veterans aged 65+ from 2002-2017.
- Frailty assessed using a validated 31-item frailty index (0-1 scale).
- Survival analysis adjusted for demographics, comorbidities, and medication use.
Main Results:
- Frailty was associated with increased CV mortality risk across all levels of severity.
- Increased risk observed for myocardial infarction and stroke, but not revascularization.
- The median frailty score increased and stabilized over the study period.
Conclusions:
- Both the presence and severity of frailty are independently linked to CV mortality in older adults.
- Findings represent the largest and most contemporary analysis of frailty and CV mortality.
- Further research is needed to identify strategies for mitigating frailty-related CV risk.
Aims:
Frailty is associated with an increased risk of all-cause mortality and cardiovascular (CV) events. Limited data exist from the modern era of CV prevention on the relationship between frailty and CV mortality. We hypothesized that frailty is associated with an increased risk of CV mortality.
Methods And Results:
All US Veterans aged ≥65 years who were regular users of Veteran Affairs care from 2002 to 2017 were included. Frailty was defined using a 31-item previously validated frailty index, ranging from 0 to 1. The primary outcome was CV mortality with secondary analyses examining the relationship between frailty and CV events (myocardial infarction, stroke, revascularization). Survival analysis models were adjusted for age, sex, ethnicity, geographic region, smoking, hyperlipidaemia, statin use, and blood pressure medication use. There were 3 068 439 US Veterans included in the analysis. Mean age was 74.1 ± 5.8 years in 2002, 76.0 ± 8.3 years in 2014, 98% male, and 87.5% White. In 2002, the median (interquartile range) frailty score was 0.16 (0.10-0.23). This increased and stabilized to 0.19 (0.10-0.32) for 2006-14. The presence of frailty was associated with an increased risk of CV mortality at every stage of frailty. Frailty was associated with an increased risk of myocardial infarction and stroke, but not revascularization.
Conclusion:
In this population, both the presence and severity of frailty are tightly correlated with CV death, independent of underlying CV disease. This study is the largest and most contemporary evaluation of the relationship between frailty and CV mortality to date. Further work is needed to understand how this risk can be diminished.
Key Question:
Can an electronic frailty index identify adults aged 65 and older who are at risk of CV mortality and major CV events?
Key Finding:
Among 3 068 439 US Veterans aged 65 and older, frailty was associated with an increased risk of CV mortality at every level of frailty. Frailty was also associated with an increased risk of myocardial infarction and stroke, but not revascularization.
Take Home Message:
Both the presence and severity of frailty are associated with CV mortality and major CV events, independent of underlying CV disease.
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