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Progression of frailty and cardiovascular outcomes among Medicare beneficiaries
Yusi Gong1, Yang Song1, Jiaman Xu1
1Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
Insights
Frailty progression significantly increases the risk of major adverse cardiovascular events, mortality, and stroke in older adults. This progression, independent of baseline frailty, leads to fewer days alive at home.
Area of Science:
- Gerontology
- Cardiovascular Medicine
- Public Health
Background:
- Frailty is a known risk factor for adverse cardiovascular outcomes, independent of age and comorbidities.
- The specific impact of frailty progression on cardiovascular health outcomes remains unclear.
Purpose of the Study:
- To investigate the association between frailty progression and adverse cardiovascular outcomes.
- To determine if this association is independent of baseline frailty and age.
Main Methods:
- Analysis of Medicare Fee-for-Service beneficiaries aged 65+ enrolled from 2003-2015.
- Utilized linear mixed effects models to assess changes in a claims-based frailty index (CFI).
- Employed survival analysis to link frailty progression to adverse health outcomes.
Main Results:
- 60% of 8.9 million beneficiaries experienced frailty progression over a median of 2.4 years.
- Frailty progression was linked to significantly higher risks of major adverse cardiovascular and cerebrovascular events (MACCE), all-cause mortality, myocardial infarction, heart failure, and ischemic stroke.
- A graded increase in risk was observed with more rapid frailty progression, alongside fewer days alive at home (DAH).
Conclusions:
- Frailty progression, independent of age and baseline frailty, is associated with increased MACCE and mortality in older adults.
- Progression of frailty correlates with higher risks of myocardial infarction, heart failure, and ischemic stroke.
- Increased frailty progression leads to a significant reduction in days alive at home.
Background:
Frailty is associated with adverse cardiovascular outcomes independent of age and comorbidities, yet the independent influence of frailty progression on cardiovascular outcomes remains uncertain.
Methods:
To determine whether frailty progression is associated with adverse cardiovascular outcomes, independent of baseline frailty and age, we evaluated all Medicare Fee-for-Service beneficiaries ≥65 years at cohort inception with continuous enrollment from 2003 to 2015. Linear mixed effects models, adjusted for baseline frailty and age, were used to estimate change in a validated claims-based frailty index (CFI) over a 5-year period. Survival analysis was used to examine frailty progression and risk of adverse health outcomes.
Results:
There were 8.9 million unique patients identified, mean age 77.3 ± 7.2 years, 58.7% female, 10.9% non-White race. In total, 60% had frailty progression and 40% frailty regression over median follow-up of 2.4 years. Compared to those with frailty regression, when adjusting for age and baseline CFI, those with frailty progression had a significantly greater risk of incident major adverse cardiovascular and cerebrovascular events (MACCE) (hazard ratio [HR] 1.31, 95% confidence interval [CI] 1.31-1.31), all-cause mortality (HR 1.34, 95% CI 1.34-1.34), acute myocardial infarction (HR 1.08, 95% CI 1.07-1.09), heart failure exacerbation (HR 1.30, 95% CI 1.29-1.30), ischemic stroke (HR 1.14, 95% CI 1.14-1.15). There was also a graded increase in risk of each outcome with more rapid progression, as well as significantly fewer days alive at home (DAH) with more rapid progression compared to the slowest progression group (270.4 ± 112.3 vs. 308.6 ± 93.0 days, rate ratio 0.88, 95% CI 0.87-0.88, p < 0.001).
Conclusions:
In this large, nationwide sample of older Medicare beneficiaries, frailty progression, independent of age and baseline frailty, was associated with fewer DAH and a graded risk of MACCE, all-cause mortality, myocardial infarction, heart failure, and ischemic stroke compared to those with frailty regression.
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