Frailty in Older Adults with Cardiovascular Disease: Cause, Effect or Both?

Abstract

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.

Heart Failure and Problems with Frailty Syndrome: Why it is Time to Care About Frailty Syndrome in Heart Failure

“…[22,42] The Longitudinal Aging Study Amsterdam (LASA) revealed that community-dwelling elderly people with HF had an increased risk of frailty, independent of potential confounders such as sex, age and multimorbidity. [42] The Health ABC Study, which had a follow-up of 11.4 years and included 2,825 people with a mean age of 74 years at baseline, demonstrated that frailty is independently associated with risk of HF in older people. [22]…”

The importance of physical function as a clinical outcome: Assessment and enhancement

“…Older adults are not only inherently prone to CVD events, but to functional declines resulting from CVD as well as idiosyncratic age‐related vulnerabilities that typically arise as part of CVD in old age. Most older adults develop multiple CVDs simultaneously (eg, coronary artery disease in combination with heart failure and valve disease) as well as non‐CVDs (eg, chronic kidney disease, diabetes, and chronic obstructive pulmonary disease) and geriatric syndromes (eg, polypharmacy and frailty) that are conducive to compounding tendencies towards sedentariness, poor quality of life, frailty, disability, and dependency . Acute disease then exacerbates the problem with hospitalization‐related deconditioning, malnutrition, sedation, and even due to many of the therapies that are utilized (eg, beta blockers).…”

“…Most older adults develop multiple CVDs simultaneously (eg, coronary artery disease in combination with heart failure and valve disease) as well as non-CVDs (eg, chronic kidney disease, diabetes, and chronic obstructive pulmonary disease) and geriatric syndromes (eg, polypharmacy and frailty) that are conducive to compounding tendencies towards sedentariness, poor quality of life, frailty, disability, and dependency. [5][6][7][8] Acute disease then exacerbates the problem with hospitalization-related deconditioning, malnutrition, sedation, and even due to many of the therapies that are utilized (eg, beta blockers). Goals to improve functional outcomes are both important as a patient's priority of care, but also as a public health mandate in a population otherwise prone to disability and high cost of care.…”

The Longitudinal Aging Study Amsterdam: cohort update 2019 and additional data collections

“…In these algorithms, data from different sources are combined [21]. Algorithms were constructed for seven cardiovascular diseases (CVD) (angina pectoris, myocardial infarction, coronary artery disease, congestive heart failure, peripheral arterial disease, cardiac arrhythmia and cerebrovascular accident), diabetes mellitus and osteoarthritis [22][23][24]. Using these algorithms, respondents were categorized as definitely, possibly or not having a disease, contradictory data, or as missing when there are no data available.…”