ISSN 1671-5411 CN 11-5329/R
Volume 18 Issue 3
Mar.  2021
Turn off MathJax
Article Contents
Please cite this article as: Gharacholou SM, Slusser JP, Lennon RJ, Flock CR, Cooper LT, Pellikka PA, Salazar JB, Singh M. Factors associated with change in frailty scores and long-term outcomes in older adults with coronary artery disease. J Geriatr Cardiol 2021; 18(3): 196−203. DOI: 10.11909/j.issn.1671-5411.2021.03.006
Citation: Please cite this article as: Gharacholou SM, Slusser JP, Lennon RJ, Flock CR, Cooper LT, Pellikka PA, Salazar JB, Singh M. Factors associated with change in frailty scores and long-term outcomes in older adults with coronary artery disease. J Geriatr Cardiol 2021; 18(3): 196−203. DOI: 10.11909/j.issn.1671-5411.2021.03.006

Factors associated with change in frailty scores and long-term outcomes in older adults with coronary artery disease

doi: 10.11909/j.issn.1671-5411.2021.03.006
More Information
  •  OBJECTIVE Older adults with coronary artery disease (CAD) are at risk for frailty. However, little is known regarding transition in frailty measures over time or its impact on outcomes. We sought to determine the association of temporal change in frailty with long-term outcome in older adults with CAD. METHODS We re-assessed for phenotypic frailty using the Fried index (0 = not frail; 1−2 = pre-frail; ≥ 3 frail) in a cohort of CAD patients ≥ 65 years old at 2 time points 5 years apart. Factors associated with frailty worsening were assessed with scatterplots and outcomes estimated using the Kaplan-Meier method. Cox models were used to assess the risk of worsening frailty on outcome. RESULTS There were 45 subjects that completed both baseline and 5-year Fried frailty assessment. Mean age was 74.6 ± 5.9 and 30 (67%) were men. Frailty incidence increased over time: baseline (3% frail, 37% pre-frail); 5 years (10% frail, 40% pre-frail). Baseline factors were not predictors of worsening frailty score, while both slower walk time (r = 0.46; P = 0.004) and diminishing grip strength (r = −0.39; P = 0.01) were associated with worsening frailty transitions. In follow-up (median 5.2 years), long-term major adverse cardiac event (MACE) free survival (P = 0.12) or hospitalization (P = 0.98) was not different for those with worsening frailty score (referent: improved/unchanged frailty). Frailty worsening had a trend towards increased risk of MACE (HR = 1.86; 95% CI: 0.65−5.27, P = 0.25). CONCLUSIONS Frailty transitions, specifically, declines in walk time and grip strength, were strongly associated with worsening frailty score in a cohort of older adults with CAD than were baseline indices, though frailty change status was not independently associated with MACE outcomes.
  • loading
  • [1]
    Buchner DM, Wagner EH. Preventing frail health. Clin Geriatr Med 1992; 8: 1−17. doi: 10.1016/S0749-0690(18)30494-4
    Sergi G, Veronese N, Fontana L, et al. Pre-frailty and risk of cardiovascular disease in elderly men and women: the Pro.V.A. study. J Am Coll Cardiol 2015; 65: 976−983. doi: 10.1016/j.jacc.2014.12.040
    Fedarko NS. The biology of aging and frailty. Clin Geriatr Med 2011; 27: 27−37. doi: 10.1016/j.cger.2010.08.006
    Fried LP, Tangen CM, Walston J, et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci 2001; 56: M146−M156. doi: 10.1093/gerona/56.3.M146
    Jones DM, Song X, Rockwood K. Operationalizing a frailty index from a standardized comprehensive geriatric assessment. J Am Geriatr Soc 2004; 52: 1929−1933. doi: 10.1111/j.1532-5415.2004.52521.x
    Walston J, Hadley EC, Ferrucci L, et al. Research agenda for frailty in older adults: toward a better understanding of physiology and etiology: summary from the American Geriatrics Society/National Institute on Aging Research Conference on Frailty in Older Adults. J Am Geriatr Soc 2006; 54: 991−1001. doi: 10.1111/j.1532-5415.2006.00745.x
    Fried LP, Kronmal RA, Newman AB, et al. Risk factors for 5-year mortality in older adults: the Cardiovascular Health Study. JAMA 1998; 279: 585−592. doi: 10.1001/jama.279.8.585
    Sanchez E, Vidan MT, Serra JA, et al. Prevalence of geriatric syndromes and impact on clinical and functional outcomes in older patients with acute cardiac diseases. Heart 2011; 97: 1602−1606. doi: 10.1136/hrt.2011.227504
    Afilalo J, Eisenberg MJ, Morin JF, et al. Gait speed as an incremental predictor of mortality and major morbidity in elderly patients undergoing cardiac surgery. J Am Coll Cardiol 2010; 56: 1668−1676. doi: 10.1016/j.jacc.2010.06.039
    Gharacholou SM, Reid KJ, Arnold SV, et al. Cognitive impairment and outcomes in older adult survivors of acute myocardial infarction: findings from the translational research investigating underlying disparities in acute myocardial infarction patients' health status registry. Am Heart J 2011; 162: 860−869. doi: 10.1016/j.ahj.2011.08.005
    Studenski S, Perera S, Patel K, et al. Gait speed and survival in older adults. JAMA 2011; 305: 50−58. doi: 10.1001/jama.2010.1923
    Newman AB, Gottdiener JS, McBurnie MA, et al. Associations of subclinical cardiovascular disease with frailty. J Gerontol A Biol Sci Med Sci 2001; 56: M158−M166. doi: 10.1093/gerona/56.3.M158
    Muscedere J, Afilalo J, Araujo de Carvalho I, et al. Moving towards common data elements and core outcome measures in frailty research. J Frailty Aging 2020; 9: 14−22.
    Pinter D, Ritchie SJ, Gattringer T, et al. Predictors of gait speed and its change over three years in community-dwelling older people. Aging (Albany NY) 2018; 10: 144−153.
    Schaefer SY, Sullivan JM, Peterson DS, et al. Cognitive function at admission predicts amount of gait speed change in geriatric physical rehabilitation. Ann Phys Rehabil Med 2020; 63: 359−361. doi: 10.1016/
    Fulk GD, Ludwig M, Dunning K, et al. Estimating clinically important change in gait speed in people with stroke undergoing outpatient rehabilitation. J Neurol Phys Ther 2011; 35: 82−89. doi: 10.1097/NPT.0b013e318218e2f2
    Duan-Porter W, Vo TN, Ullman K, et al. Hospitalization-associated change in gait speed and risk of functional limitations for older adults. J Gerontol A Biol Sci Med Sci 2019; 74: 1657−1663. doi: 10.1093/gerona/glz027
    Malhotra R, Tareque MI, Tan NC, et al. Association of baseline hand grip strength and annual change in hand grip strength with mortality among older people. Arch Gerontol Geriatr 2020; 86: 103961. doi: 10.1016/j.archger.2019.103961
    Granic A, Davies K, Jagger C, et al. Initial level and rate of change in grip strength predict all-cause mortality in very old adults. Age Ageing 2017; 46: 970−976. doi: 10.1093/ageing/afx087
    Sirola J, Tuppurainen M, Honkanen R, et al. Associations between grip strength change and axial postmenopausal bone loss--a 10-year population-based follow-up study. Osteoporos Int 2005; 16: 1841−1848. doi: 10.1007/s00198-005-1944-y
    Sirola J, Rikkonen T, Tuppurainen M, et al. Maintenance of muscle strength may counteract weight-loss-related postmenopausal bone loss--a population-based approach. Osteoporos Int 2006; 17: 775−782. doi: 10.1007/s00198-005-0054-1
    Leong DP, Teo KK, Rangarajan S, et al. Prognostic value of grip strength: findings from the Prospective Urban Rural Epidemiology (PURE) study. Lancet (London, England) 2015; 386: 266−273. doi: 10.1016/S0140-6736(14)62000-6
    Wang MC, Li TS, Li CI, et al. Frailty, transition in frailty status and all-cause mortality in older adults of a Taichung community-based population. BMC Geriatr 2019; 26: 1−8.
    Liu ZY, Wei YZ, Wei LQ, et al. Frailty transitions and types of death in Chinese older adults: a population-based cohort study. Clin Interv Aging 2018; 13: 947−956. doi: 10.2147/CIA.S157089
    Pandey A, Kitzman D, Reeves, G, et al. Frailty is intertwined with heart failure: mechanisms, prevalence, prognosis, assessment, and management. JACC Heart Fail 2019; 7: 1001−1011. doi: 10.1016/j.jchf.2019.10.005
  • JGC-202102-002-Supplementary.jpg
  • 加载中


    通讯作者: 陈斌,
    • 1. 

      沈阳化工大学材料科学与工程学院 沈阳 110142

    1. 本站搜索
    2. 百度学术搜索
    3. 万方数据库搜索
    4. CNKI搜索

    Figures(2)  / Tables(3)

    Article Metrics

    Article views (26) PDF downloads(5) Cited by()
    Proportional views


    DownLoad:  Full-Size Img  PowerPoint