Identifying Frailty in Hospitalized Older Adults with Significant Coronary Artery Disease

TLDR

The study aims to characterize physiological variation in older adults with severe CAD, assess frailty prevalence, evaluate single‑item performance measures as indicators of multidimensional frailty, and examine their association with 6‑month mortality. An observational cohort of 309 hospitalized adults aged 70 or older with at least two‑vessel CAD was assessed for frailty phenotypes, gait speed, grip strength, chair stands, cardiology variables, and 6‑month mortality. Frailty prevalence was 27 % (Composite A) and 63 % (Composite B); gait speed, chair stands, and grip strength were the most accurate single‑item frailty indicators, and after adjustment, all frailty measures—including slow gait speed (≤0.65 m/s) and weak grip strength (≤25 kg)—were independently associated with higher 6‑month mortality, with gait speed emerging as the strongest predictor.

Abstract

OBJECTIVES: To characterize physiological variation in hospitalized older adults with severe coronary artery disease (CAD) and evaluate the prevalence of frailty in this sample, to determine whether single‐item performance measures are good indicators of multidimensional frailty, and to estimate the association between frailty and 6‐month mortality. DESIGN: Observational cohort study. SETTING: Inpatient hospital cardiology ward. PARTICIPANTS: Three hundred nine consecutive inpatients aged 70 and older admitted to a cardiology service (n=309; 70% male, 84% white) with minimum two‐vessel CAD determined using cardiac catheterization. MEASUREMENTS: Two standard frailty phenotypes (Composite A and Composite B), usual gait speed, grip strength, chair stands, cardiology clinical variables, and 6‐month mortality. RESULTS: Prevalence of frailty was 27% for Composite A versus 63% for Composite B. Utility of single‐item measures for identifying frailty was greatest for gait speed (receiver operating characteristic curve c statistic=0.89 for Composite A, 0.70 for Composite B) followed by chair‐stands (c=0.83, 0.66) and grip strength (c=0.78, 0.57). After adjustment, composite scores and single‐item measures were individually associated with higher mortality at 6 months. Slow gait speed (≤0.65 m/s) and poor grip strength (≤25 kg) were stronger predictors of 6‐month mortality than either composite score (gait speed odds ratio (OR)=3.8, 95% confidence interval (CI)=1.1–13.1; grip strength OR=2.7, 95% CI=0.7–10.0; Composite A OR=1.9, 95% CI=0.60–6.1; chair‐stand OR=1.5, 95% CI=0.5–5.1; Composite B OR=1.3, 95% CI=0.3–5.2). CONCLUSION: Gait speed frailty was the strongest predictor of mortality in a population with CAD and may add to traditional risk assessments when predicting outcomes in this population.