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Frailty trajectories after a cardiovascular event among community-dwelling older people
Aung Zaw Zaw Phyo1, Andrew Tonkin1, Sara E Espinoza2
1School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia.
Insights
An incident cardiovascular disease (CVD) event significantly increases frailty in older adults, particularly hospitalization for heart failure and stroke. Targeted interventions are crucial for those at higher risk.
Area of Science:
- Gerontology
- Cardiology
- Public Health
Background:
- Cardiovascular disease (CVD) is a significant health concern in older adults.
- Frailty is a common condition in aging populations, increasing vulnerability to adverse health outcomes.
- The impact of incident CVD events on frailty trajectories in older individuals remains understudied.
Purpose of the Study:
- To investigate how incident cardiovascular disease (CVD) events modify frailty trajectories in older adults.
- To identify specific CVD events that most significantly alter frailty.
- To determine factors influencing changes in frailty post-CVD event.
Main Methods:
- Longitudinal study of 19,111 individuals aged 65+ without prior CVD.
- Annual assessment of frailty using the 64-item deficit-accumulation frailty index (FI) and Fried phenotype.
- Adjudication of incident CVD events (stroke, myocardial infarction, hospitalization for heart failure) and analysis using linear mixed models.
Main Results:
- Incident CVD events led to a short-term increase in both FI and Fried frailty measures.
- Following the initial increase, the frailty index (FI) continued to rise over time post-CVD.
- Hospitalization for heart failure and stroke were associated with the largest increases in frailty.
Conclusions:
- Incident cardiovascular disease events demonstrably increase frailty burden in older adults.
- Specific CVD events, like HHF and stroke, have a more pronounced effect on frailty.
- Interventions targeting frailty in older adults post-CVD are essential to mitigate clinical complications, especially for vulnerable subgroups.
Aims:
Individuals with cardiovascular disease (CVD) are more likely to become frail. However, no study has determined whether an incident CVD event alters frailty trajectories in older individuals. This study aims to determine the extent to which an incident CVD event modifies frailty trajectories and to identify factors that influence those changes.
Methods:
19,111 individuals (56.4%, women) ≥aged 65 years, who had no prior CVD event or other major health conditions at baseline, were followed for up to 11 years. Frailty was measured annually using the 64-item deficit-accumulation frailty index (FI) and Fried phenotype (Fried). Incident CVD events, including stroke, myocardial infarction and hospitalization for heart failure (HHF), were adjudicated by international experts. Linear mixed models were used to measure frailty changes.
Results:
Over a median 8.3-year follow-up, frailty trajectories increased over time and 1934 incident CVD events occurred. Following a CVD event, individuals had a short-term increase in both FI (adjusted-betas: 3.65; 95%CI, 3.34 to 3.96) and Fried (adjusted-beta: 0.32; 95%CI, 0.26 to 0.38). Afterwards, only FI continued to increase over time (adjusted-beta: 0.41, 95%CI, 0.21 to 0.62). Among the CVD events, HHF and stroke were associated with the greatest increase in frailty. Of the factors examined, being >80 years, women, living alone, or residing in regional/remote areas were associated with greater frailty burden.
Conclusion:
Our findings provide evidence that incident CVD event increases frailty burden, highlighting the need for targeted intervention to minimise frailty-related clinical complications for those most at risk.
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