Longitudinal Changes in Frailty and Major Adverse Cardiovascular Events in Patients With Coronary Heart Disease

Frailty is common among patients with coronary heart disease (CHD). This study aimed to examine both baseline frailty and its longitudinal changes in relation to the risk of major adverse cardiovascular events (MACEs) in patients with CHD.

Data were sourced from the ARIC (Atherosclerosis Risk in Communities) study. Frailty status was assessed using a modified Fried frailty phenotype at 2 consecutive surveys. The outcome was MACEs, defined as a composite of recurrent CHD, incident heart failure, stroke, or cardiovascular death. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% CIs.

In baseline frailty analyses, 1793 patients with CHD were included. Compared with robust patients, prefrail and frail patients had a higher risk of MACEs (HR, 1.24 [95% CI, 1.08-1.42] for prefrail; and HR, 1.75 [95% CI, 1.43-2.15] for frail). In frailty transition analyses, 862 patients with CHD were included. Patients who progressed from robust to prefrail/frail status had a higher MACE risk (HR, 1.43 [95% CI, 1.07-1.91]) compared with those who remained robust. Similarly, progression from prefrail to frail status was associated with an increased risk of MACEs (HR, 2.30 [95% CI, 1.62-3.27]) compared with stable prefrailty. Conversely, recovery from prefrail to robust status was related to a decreased MACE risk (HR, 0.62 [95% CI, 0.40-0.96]).

Both baseline frailty and its temporal changes were associated with the risk of MACEs among patients with CHD, highlighting the clinical value of monitoring and intervening for frailty in CHD management.