Frailty Scores and Their Utility in Older Patients with Cardiovascular Disease.
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ABSTRACT:
SUBMITTER: Chung KJNC
PROVIDER: S-EPMC8054346 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:ObjectivesTo examine the capacity of existing cardiovascular disease (CVD) risk algorithms widely used in primary care, to predict frailty.DesignProspective cohort study. Risk algorithms at baseline (1997-1999) were the Framingham CVD, coronary heart disease and stroke risk scores, and the Systematic Coronary Risk Evaluation.SettingCivil Service departments in London, UK.Participants3895 participants (73% men) aged 45-69 years and free of CVD at baseline.Main outcome measureStatus of frailty at the end of follow-up (2007-2009), based on the following indicators: self-reported exhaustion, low physical activity, slow walking speed, low grip strength and weight loss.ResultsAt the end of the follow-up, 2.8% (n=108) of the sample was classified as frail. All four CVD risk scores were associated with future risk of developing frailty, with ORs per one SD increment in the score ranging from 1.35 (95% CI 1.21 to 1.51) for the Framingham stroke score to 1.42 (1.23 to 1.62) for the Framingham CVD score. These associations remained after excluding incident CVD cases. For comparison, the corresponding ORs for the risk scores and incident cardiovascular events varied between 1.36 (1.15 to 1.61) and 1.64 (1.50 to 1.80) depending on the risk algorithm.ConclusionsThe use of CVD risk scores in clinical practice may also have utility for frailty prediction.
| S-EPMC3632981 | biostudies-literature
Project description:Cardiovascular disease (CVD) has been associated with an increased risk of frailty, but the direction of the association remains unclear. This study set out to examine the bidirectional longitudinal association between CVD and frailty over an extended period of time. Data are from 1432 older adults (aged 65-88yrs) of the Longitudinal Aging Study Amsterdam (LASA), who were followed for 17 years. At baseline and follow-up, CVD was assessed through self-report, medication use and medical records, and classified as angina pectoris, myocardial infarction, heart failure (HF), stroke, and peripheral artery disease. Throughout the study, frailty was assessed using Fried's frailty criteria. Cox regression models showed that patients with HF had an increased frailty risk (HR 2.7; 95%CI: 1.5-5.1) after a median follow-up of 8.4 yrs. This finding was independent of potential confounders (age, sex, several comorbidities). Examinations of the reverse association revealed that frail older adults were not at risk of incident CVD. Of all older adults with CVD, those with HF have an increased risk of frailty and frail older adults do not have an increased risk of CVD. Our findings emphasize the need for cardiac rehabilitation programs evaluating the effect of physical exercise programs in order to prevent frailty and therewith improve quality of life and independence of care in CVD patients.
| S-EPMC5988603 | biostudies-literature
Project description:Frailty is a state of late life decline and vulnerability, typified by physical weakness and decreased physiologic reserve. The epidemiology and pathophysiology of frailty share features with those of cardiovascular disease. Gait speed can be used as a measure of frailty and is a powerful predictor of mortality. Advancing age is a potent risk factor for cardiovascular disease and has been associated with an increased risk of adverse outcomes. Older adults comprise approximately half of cardiac surgery patients, and account for nearly 80% of the major complications and deaths following surgery. The ability of traditional risk models to predict mortality and major morbidity in older patients being considered for cardiac surgery may improve if frailty, as measured by gait speed, is included in their assessment. It is possible that in the future frailty assessment may assist in choosing among therapies (e.g., surgical vs. percutaneous aortic valve replacement for patients with aortic stenosis).
| S-EPMC4308458 | biostudies-other
Project description:ObjectiveOlder 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.MethodsWe 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.ResultsThere 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).ConclusionsFrailty 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.
| S-EPMC8047182 | biostudies-literature
Project description:Due to the aging and increasingly complex nature of our patients, frailty has become a high-priority theme in cardiovascular medicine. Despite the recognition of frailty as a pivotal element in the evaluation of older adults with cardiovascular disease (CVD), there has yet to be a road map to facilitate its adoption in routine clinical practice. Thus, we sought to synthesize the existing body of evidence and offer a perspective on how to integrate frailty into clinical practice. Frailty is a biological syndrome that reflects a state of decreased physiological reserve and vulnerability to stressors. Upward of 20 frailty assessment tools have been developed, with most tools revolving around the core phenotypic domains of frailty-slow walking speed, weakness, inactivity, exhaustion, and shrinking-as measured by physical performance tests and questionnaires. The prevalence of frailty ranges from 10% to 60%, depending on the CVD burden, as well as the tool and cutoff chosen to define frailty. Epidemiological studies have consistently demonstrated that frailty carries a relative risk of >2 for mortality and morbidity across a spectrum of stable CVD, acute coronary syndromes, heart failure, and surgical and transcatheter interventions. Frailty contributes valuable prognostic insights incremental to existing risk models and assists clinicians in defining optimal care pathways for their patients. Interventions designed to improve outcomes in frail elders with CVD such as multidisciplinary cardiac rehabilitation are being actively tested. Ultimately, frailty should not be viewed as a reason to withhold care but rather as a means of delivering it in a more patient-centered fashion.
| S-EPMC4571179 | biostudies-literature
Project description:IntroductionRisk factors for cardiovascular disease (CVD) also increase the risk of dementia. However, whether commonly used CVD risk scores are associated with dementia risk in older adults who do not have a history of CVD, and potential gender differences in this association, remains unclear. The aim of this study was to determine whether CVD risk scores are prospectively associated with cognitive decline and dementia in initially healthy older men and women.MethodsA total of19,114 participants from a prospective cohort of individuals aged 65+ years without known CVD or dementia were recruited. The atherosclerotic cardiovascular disease risk score (ASCVDRS), Systematic Coronary Risk Evaluation 2-Older Persons (SCORE2-OP), and the Framingham risk score (FRS) were calculated at baseline. Risk of dementia (according to DSM-IV criteria) and cognitive decline (defined as a >1.5 standard deviation decline in global cognition, episodic memory, psychomotor speed, or verbal fluency from the previous year) were assessed using hazard ratio.ResultsOver a median follow-up of 6.4 years, 850 individuals developed dementia and 4,352 cognitive decline. Men and women in the highest ASCVDRS tertile had a 41% (95% CI 1.08, 1.85) and 45% (1.11, 1.89) increased risk of dementia compared to the lowest tertile, respectively. Likewise, men and women in the highest SCORE2-OP tertile had a 64% (1.24, 2.16) and 60% (1.22, 2.11) increased risk of dementia compared to the lowest tertile, respectively. Findings were similar, but the risk was slightly lesser when examining risk of cognitive decline for both ASCVDRS and SCORE2-OP. However, FRS was only associated with the risk of cognitive decline among women (highest vs. lowest tertiles: 1.13 [1.01-1.26]).ConclusionThese findings suggest the utility of the ASCVDRS and SCORE2-OP in clinical practice, to not only assess future risk of CVD, but also as potential early indicators of cognitive impairment, even in relatively healthy older men and women.
| S-EPMC10866179 | biostudies-literature
Project description:Frailty is an independent age-associated predictor of morbidity and mortality. Despite this, many countries lack population estimates with large heterogeneity between studies. No population-based standardised metric for frailty is available. We applied the deficit accumulation model of frailty to create a frailty index (FI) using population-level estimates from the Global Burden of Disease (GBD) 2017 study across 195 countries to create a novel GBD frailty index (GBD-FI). Standard FI criteria were applied to all GBD categories to select GBD-FI items. Content validity was assessed by comparing the GBD-FI with a selection of established FIs. Properties including the rate of deficit accumulation with age were examined to assess construct validity. Linear regression models were created to assess if mean GBD-FI scores predicted one-year incident mortality. From all 554 GBD items, 36 were selected for the GBD-FI. Face validity against established FIs was variable. Characteristic properties of a FI-higher mean score for females and a deficit accumulation rate of approximately 0.03 per year, were observed. GBD-FI items were responsible for 19% of total Disability-Adjusted Life Years for those aged ?70 years in 2017. Country-specific mean GBD-FI scores ranged from 0.14 (China) to 0.19 (Hungary) and were a better predictor of mortality from non-communicable diseases than age, gender, Healthcare Access and Quality Index or Socio-Demographic Index scores. The GBD-FI is a valid measure of frailty at population-level but further external validation is required.
| S-EPMC7460080 | biostudies-literature
Project description:Frailty affects the physical, cognitive, and social domains exposing older adults to an increased risk of cardiovascular disease (CVD) and death. The mechanisms linking frailty and cardiovascular outcomes are mostly unknown. Here, we studied the association of abundance (flow cytometry) and gene expression profile (RNAseq) of stem/progenitor cells (HSPCs) and molecular markers of inflammaging (ELISA) with the cardiorespiratory phenotype and prospective adverse events of individuals classified according to levels of frailty. Two cohorts of older adults were enrolled in the study. In a cohort of pre-frail 35 individuals (average age: 75 years), a physical frailty score above the median identified subjects with initial alterations in cardiorespiratory function. RNA sequencing revealed S100A8/A9 upregulation in HSPCs from the bone marrow (>10-fold) and peripheral blood (>200-fold) of individuals with greater physical frailty. Moreover higher frailty was associated with increased alarmins S100A8/A9 and inflammatory cytokines in peripheral blood. We then studied a cohort of 104 more frail individuals (average age: 81 years) with multi-domain health deficits. Reduced levels of circulating HSPCs and increased S100A8/A9 concentrations were independently associated with the frailty index. Remarkably, low HSPCs and high S100A8/A9 simultaneously predicted major adverse cardiovascular events at 1-year follow-up after adjustment for age and frailty index. In conclusion, inflammaging characterized by alarmin and pro-inflammatory cytokines in pre-frail individuals is mirrored by the pauperization of HSPCs in frail older people with comorbidities. S100A8/A9 is upregulated within HSPCs, identifying a phenotype that associates with poor cardiovascular outcomes.
2022-03-23 | GSE190446 | GEO
Project description:BackgroundElderly (65 and older) fall-related injuries are a significant cause of morbidity and mortality. Although frailty predicts poor outcomes in geriatric trauma, literature comparing frailty scoring systems remains limited. Herein, we evaluated which frailty scoring system best predicts falls over time in the elderly.Materials and methodsAcute surgical patients 65 y and older were enrolled and prospectively observed. Demographics and frailty, assessed using the FRAIL Scale, Trauma Specific Frailty Index (TSFI), and Canadian Frailty Scale (CSHA-CFS), were collected at enrollment and 3 mo intervals following discharge for 1 y. Surveys queried the total number and timing of falls. Changes in frailty over time were assessed by logistic regression and area under the curve (AUC).ResultsFifty-eight patients were enrolled. FRAIL Scale and CSHA-CFS scores did not change over time, but TSFI scores did (P ≤ 0.01). Worsening frailty was observed using TSFI at 6 (P ≤ 0.01) and 12 mo (P ≤ 0.01) relative to baseline. Mortality did not differ based on frailty using any frailty score. Increasing frailty scores and time postdischarge was associated with increased odds of a fall. AUC estimates with 95% CI were 0.72 [0.64, 0.80], 0.81 [0.74, 0.88], and 0.76 [0.68, 0.84] for the FRAIL Scale, TSFI, and CSHA-CFS, respectively.ConclusionsThe risk of falls postdischarge were associated with increased age, time postdischarge, and frailty in our population. No scale appeared to significantly outperform the other by AUC estimation. Further study on the longitudinal effects of frailty is warranted.
| S-EPMC7736528 | biostudies-literature
Project description: Not available
| S-EPMC8220380 | biostudies-literature