Frailty and cardiovascular outcomes in the National Health and Aging Trends Study

Managing Hypercholesterolemia in Adults Older Than 75 years Without a History of Atherosclerotic Cardiovascular Disease: An Expert Clinical Consensus From the National Lipid Association and the American Geriatrics Society

The risk of atherosclerotic cardiovascular disease increases with advancing age. Elevated LDL-cholesterol and non-HDL-cholesterol levels remain predictive of incident atherosclerotic cardiovascular events among individuals older than 75 years. Risk prediction among older individuals is less certain because most current risk calculators lack specificity in those older than 75 years and do not adjust for co-morbidities, functional status, frailty, and cognition which significantly impact prognosis in this age group. Data on the benefits and risks of lowering LDL-cholesterol with statins in older patients without atherosclerotic cardiovascular disease are also limited since most primary prevention trials have included mostly younger patients. Available data suggest that statin therapy in older primary prevention patients may reduce atherosclerotic cardiovascular events and that benefits from lipid-lowering with statins outweigh potential risks such as statin-associated muscle symptoms and incident Type 2 diabetes mellitus. While some evidence suggests the possibility that statins may be associated with incident cognitive impairment in older adults, a preponderance of literature indicates neutral or even protective statin-related cognitive effects. Shared decision-making which is recommended for all patients when considering statin therapy is particularly important in older patients. Randomized clinical trial data evaluating the use of non-statin lipid-lowering therapy in older patients are sparse. Deprescribing of lipid-lowering agents may be appropriate for select patients older than 75 years with life-limiting diseases. Finally, a patient-centered approach should be taken when considering primary prevention strategies for older adults.

Predictive Value of Inflammation Markers for Frailty in Older Patients with CVD

Background

Chronic inflammation plays a pivotal role in the development of frailty in patients with cardiovascular diseases (CVD). Systemic inflammatory response index (SIRI) has been shown to reflect the overall inflammatory status. This study aimed to investigate the relationship between SIRI and frailty in older patients with CVD, and to develop a nomogram for predicting the risk of frailty in this population.

Methods

A total of 234 older patients with CVD were included. Inflammation markers were derived from routine blood tests, and frailty status was assessed using the FRAIL scale. Clinical and laboratory characteristics were compared between patients with or without frailty. Multivariate logistic regression was employed to identify significant variables for inclusion in the nomogram. The performance of the nomogram, including its discrimination and calibration, was rigorously evaluated.

Results

A total of 98 cases were assigned to the frailty group and 136 to the non-frailty group. Patients in the non-frailty group were generally younger, more likely to have normal kidney function, and better blood pressure control. Frail patients exhibited a higher degree of systemic inflammation compared to non-frail patients (P < 0.05). Age, LDL-C and SIRI were identified as three independent risk factors with significant potential for predicting frailty in CVD patients. Therefore, we constructed a clinical nomogram model for frailty based on age, LDL-C and SIRI. The nomogram for frailty had considerable discriminative and calibrating abilities.

Conclusion

In summary, our study demonstrated a significant association between elevated levels of inflammation markers, particularly SIRI, and an increased risk of frailty. Furthermore, by integrating age, LDL-C and SIRI, we established a nomogram to predict the risk of frailty in older patients with CVD.

Impact of Depression on Activation and Summer Heat Adaptation in Older Adults With Cardiovascular Concerns: Empirical Research Quantitative

AIM

To investigate the effects of depression on patient activation and summer heat adaptation, considering important contributory factors in older adults with increased cardiovascular health concerns on extremely hot days.

DESIGN

Cross-sectional study adhering to the STROBE guidelines.

METHODS

Between July and August 2020, a questionnaire survey was administered to 245 older adults at increased risk of cardiovascular diseases in rural areas. Data were collected utilising validated and reliable tools to assess patient activation, depression, summer heat adaptation, frailty, physical activity and other health-related characteristics. Hierarchical regression, mediation and path analyses were conducted to examine the association between activation, depression and summer heat adaptation, while controlling for covariates.

RESULTS

Most participants exhibited the lowest level of activation (75.1%) and a low/moderate level of summer heat adaptation (80.4%). Depression negatively affected activation (β = -0.247), while its indirect effect on patient activation through summer heat adaptation was insignificant (p > 0.05). Education (β = 0.380) and a family history of cardiovascular disease (β = 0.121) positively influenced activation, while alcohol consumption had a negative influence (β = -0.219). When integrating the influence of these three contributory factors, the associative relationship between depression and activation through summer heat adaptation demonstrated a good model fit (chi-square = 8.944, p > 0.05; comparative fit index = 0.987; root mean square error of approximation = 0.045).

CONCLUSION

Improving older adults' activation for self-managing chronic conditions in summer requires tackling depression, enhancing heat adaptation and addressing concerns related to lack of education and alcohol consumption.

PATIENT OR PUBLIC CONTRIBUTION

Patients with cardiovascular diseases were involved in piloting the questionnaire and provided examples to address older adults' concerns related to self-management and heat adaptation.

Plasma proteomic signature of risk and prognosis of frailty in the UK Biobank

The availability of proteomics data in large, population-based cohort studies offers an unprecedented opportunity to understand the onset and progression of aging-related diseases and syndromes. We examined the proteomic signature of the onset of frailty and the progression to death among the prefrail and frail. A total of 2920 proteins were assayed using Olink among 43,895 participants (aged 39-70 years) in the UK Biobank. Using multinomial logistic models, we identified 102 and 90 proteins cross-sectionally associated with baseline prefrailty and frailty (Bonferroni-corrected p-value < 0.05), respectively. Additionally, cox regression identified 87 and 48 proteins associated with death among initially prefrail (n = 16,661) and frail (n = 1647) individuals, respectively. Eight overlapping proteins were cross-sectionally associated with prefrailty and frailty at baseline and prospectively associated with death among prefrail and frail individuals. CD300E, GDF15, and PLAUR were the most significant proteins among these eight proteins. LASSO regression selected 73 and 23 proteins predicting death in prefrail and frail participants, respectively. Protein-based prediction models based on LASSO regression and the light gradient boosting machine classifier demonstrated satisfactory discrimination, calibration, and reclassification among the prefrail and frail. GDF15, WFDC2, and NEFL were the most important proteins predicting death among prefrail and frail individuals. Proteins associated with the onset and progression of prefrailty and frailty were enriched in pathways involving protein metabolism, cellular signaling in disease, apoptosis, and inflammation. Our research could uncover novel therapeutic targets for addressing the onset and progression of frailty, potentially informing the design of patient-centered treatment strategies and management plans.

Pre-frailty is associated with higher risk of gastroesophageal reflux disease: a large prospective cohort study

To investigate the prospective association of frailty status, especially the early stage, with the long-term risk of Gastroesophageal reflux disease (GERD) in a large prospective cohort. We included participants who were free of GERD and cancer at baseline and use of aspirin and non-steroidal anti-inflammatory drugs (NSAIDs) from the UK Biobank (UKB). Frailty status was assessed using Fried phenotype including five items (weight loss, exhaustion, low grip strength, low physical activity, slow walking pace) and classified as non-frail, pre-frail, and frail. The outcome was incident GERD. The frailty status was assessed using Cox proportional hazard model. Among 327,965 participants (mean age 56.6 years) at baseline, 151,689 (46.3%) were pre-frail and 14,288 (4.4%) were frail. During a median of 13.5-years of follow-up, 31,027 (9.5%) participants developed GERD. Compared with non-frail participants, pre-frail (hazard ratios [HR] = 1.21, 95% confidence interval [CI] 1.18-1.24) and frail (HR = 1.60, 95% CI 1.52-1.68) participants had significantly higher risks of GERD. Among the five indicators of frailty, exhaustion demonstrated the strongest association with the risk of GERD (HR = 1.42, 95% CI 1.38-1.47). Subgroup analysis showed strong associations among younger (< 60 years), female, high-educated, unemployed participants, and those who had BMI < 18.5 kg/m2 (all P for interaction < 0.05). Frailty, especially pre-frail, which is potentially reversible, was associated with higher risk of GERD in middle-aged and older individuals. The findings underscore the importance of integrating routine frailty assessments and interventions, especially at the early stage, to improve digestive health.

Physical activity, frailty, and kinesiophobia among older adult patients with coronary heart disease in China

BACKGROUND

Physical activity (PA) offers advantages in the secondary prevention of coronary heart disease (CHD). However, in older adults, frailty and kinesiophobia may exert negative influences on PA engagement.

OBJECTIVE

To investigate PA, frailty, and kinesiophobia among older adult patients with CHD in China.

METHODS

This cross-sectional study enrolled older adult patients with CHD in the cardiac outpatient care unit of the *** University. The International Physical Activity Questionnaire, the Frailty Phenotype Scale, and the Tampa Scale of Kinesiophobia were used to evaluate PA, frailty, and kinesiophobia, respectively.

RESULTS

A total of 239 participants (mean age: 72.0 ± 7.5 years, 148 males) were enrolled. The rates of frailty and pre-frailty were 20.5 % and 46.4 %, respectively. The mean kinesiophobia score was 43.13±5.48. The median metabolic equivalent of task of PA was 2784 MET-min/week, and 25.1 % of the patients did not reach the minimum recommended by AHA (150 mins/week). Spearman rank correlation analysis showed that PA was negatively correlated with frailty (r = -0.559, P < 0.001) and kinesiophobia (r = -0.463, P < 0.001). Multivariable logistic regression analysis showed that frailty [OR = 0.412, 95 % confidence interval (CI): 0.304-0.559, P < 0.001] and kinesiophobia (OR=0.936, 95 % CI: 0.879-0.997, P = 0.040) were independently associated with PA after adjustment for age, cardiovascular adverse events, comorbidities, Barthel index, and history of dizziness.

CONCLUSIONS

Older adult patients with CHD had low levels of PA. Frailty and kinesiophobia were independently associated with PA in older adult patients with CHD. Reversing frailty and reducing kinesiophobia in older adult patients with CHD may increase PA levels.

Frailty as a Prognostic Indicator for In-Hospital Mortality and Clinical Outcomes in Acute Coronary Syndrome: A Systematic Review and Meta-Analysis

BACKGROUND & AIMS

Frailty is a significant predictor of adverse outcomes in patients with acute coronary syndrome (ACS). However, its impact on short-term clinical outcomes remains unclear. We conducted a systematic review and meta-analysis to investigate the associations between frailty and adverse clinical outcomes in patients with ACS.

METHODS

We systematically searched the Embase, MEDLINE, and CENTRAL databases from inception to 1 August 2023 for observational cohort studies, cross-sectional studies, or clinical trials involving hospitalised adults with ACS. Studies utilising validated frailty screening tools and examining the associations between frailty and clinical endpoints, such as in-hospital mortality, length of hospital stay, major bleeding, and stroke, were included. The meta-analysis was performed via random effects models and meta-regression analyses.

RESULTS

Among the 4,458 records identified, 42 were deemed eligible, and data from 14 studies were included in the analysis. Frailty was significantly associated with increased in-hospital all-cause mortality (relative risk [RR] 2.89; 95% confidence interval [CI] 2.49-3.34) and prolonged length of hospitalisation (standardised mean difference [SMD] 2.01; 95% CI 1.48-2.46), with frail patients with ACS spending an average of 3.5 more days in the hospital. Furthermore, frail patients with ACS presented a significantly greater risk of adverse outcomes than non-frail patients with ACS did (RR 1.86; 95% CI 1. 41-2.46). Subgroup analysis revealed a significant increase in major bleeding events (RR 2.03; 95% CI 1.51-2.73) among frail patients with ACS, whereas the incidence of stroke showed a nonsignificant trend towards elevation (RR 1.23; 95% CI 0.56-2.72).

CONCLUSIONS

Frailty is strongly associated with in-hospital all-cause mortality, prolonged length of hospitalisation, and adverse clinical outcomes such as major bleeding in patients with ACS.

Analysis of the relationship between abdominal aortic calcification and frailty in the middle-aged and older US population

Background and Objective: Abdominal aortic calcification (AAC) is a marker of cardiovascular disease and is associated with increased mortality in middle-aged and older populations. However, its relationship with frailty remains unclear. Methods: Data were obtained from the 2013-2014 National Health and Nutrition Examination Survey. AAC was quantified using the Kauppila scoring system based on dual-energy X-ray absorptiometry. Frailty was assessed using the frailty index. Multivariable logistic regression models examined the association between AAC and frailty. Results: A total of 2987 adults aged ≥40 years were included. Compared to individuals with an AAC-8 score of 0, low-risk (AAC-8 score = 1-2; OR: 1.24; 95 % CI, 1.00-1.53) and high-risk AAC (AAC-8 score ≥ 3; OR: 1.83; 95 % CI, 1.03-3.23) were associated with higher odds of frailty. Similarly, mild to moderate AAC (0 < AAC-24 score ≤ 6; OR: 1.26; 95 % CI, 1.03-1.54) and severe AAC (AAC-24 score > 6; OR: 1.79; 95 % CI, 1.07-2.99) showed positive associations with frailty. Conclusions: Among middle-aged and older populations in the United States, there exists a positive correlation between AAC and frailty. Our findings suggest that the AAC score holds promise as a valuable tool for the early identification of frailty.

Impact of Frailty on Antihypertensive Treatment in Older Adults

BACKGROUND

The association between systolic blood pressure and all-cause mortality differs between frail and nonfrail individuals, highlighting uncertainties about the effectiveness of antihypertensive treatments in frail populations.

METHODS

Using data from the SHEP trial (Systolic Hypertension in the Elderly Program), a baseline frailty index (FI), including 55 variables, was constructed. Fine-Gray subdistribution hazard models and Cox proportional hazards regression models were used to explore the association between baseline FI and the risks of stroke, cardiovascular disease, and all-cause death, as well as to examine whether the impact of antihypertensive treatment on these outcomes was modified by baseline FI.

RESULTS

A total of 4692 participants (mean age, 72.1 years; 56.7% women) were included, with a mean (SD) FI of 0.134 (0.061). During a median follow-up period of 4.4 years, FI was associated with a higher risk of stroke (subdistribution hazard ratio, 1.24 [95% CI, 1.10-1.39]; per SD higher FI), cardiovascular disease (subdistribution hazard ratio, 1.18 [95% CI, 1.09-1.26]), and all-cause death (hazard ratio, 1.37 [95% CI, 1.26-1.50]), after adjustment for age, sex, race, education and treatment group. Although those with higher levels of frailty were at higher risk for all outcomes, there was no evidence of an interaction between baseline FI and antihypertensive treatment (P for interaction >0.05 for all outcomes).

CONCLUSIONS

In individuals with isolated systolic hypertension, antihypertensive treatment improved associated outcomes even among those with a higher degree of frailty. These findings from the SHEP trial reinforce evidence from other seminal antihypertensive trials, which collectively inform the appropriate treatment of frail individuals with hypertension.

REGISTRATION

URL: https://www.clinicaltrials.gov; Unique identifier: NCT00000514.

SIRT1: a potential therapeutic target for coronary heart disease combined with anxiety or depression

Coronary heart disease (CHD) combined with anxiety or depression is increasingly receiving attention in the clinical field of cardiology, and exploring the comorbidity pathological mechanisms of cardiovascular disease combined with psychological disorders is a hot research topic for scholars in this field. Current research suggests that Silent Information Regulatory Factor 1 (SIRT1) may serve as a potential biomarker for the comorbidity mechanism and treatment of CHD with anxiety or depression. SIRT1 is considered a promising therapeutic target for CHD combined with anxiety or depression, with the ability to regulate inflammatory cytokine levels, alleviate oxidative stress damage, activate multiple signalling pathways, reduce platelet hyperresponsiveness, and exert neuroprotective and cardioprotective effects. In this comprehensive review, we deeply studied the structure, function, and mechanism of SIRT1, and discussed its protective effects in the cardiovascular and nervous system. The latest progress in the mechanism of SIRT1's role in CHD combined with anxiety or depression was emphasised, including its specific mechanisms in regulating inflammatory response, alleviating oxidative stress, and mediating various signalling pathways. In addition, this article also summarises the therapeutic potential of SIRT1 as a potential biomarker in patients with CHD combined with anxiety or depression.

Managing hypercholesterolemia in adults older than 75 years without a history of atherosclerotic cardiovascular disease: An Expert Clinical Consensus from the National Lipid Association and the American Geriatrics Society

The risk of atherosclerotic cardiovascular disease increases with advancing age. Elevated low-density lipoprotein (LDL)-cholesterol and non-high-density lipoprotein (non-HDL)-cholesterol levels remain predictive of incident atherosclerotic cardiovascular events among individuals older than 75 years. Risk prediction among older individuals is less certain because most current risk calculators lack specificity in those older than 75 years and do not adjust for co-morbidities, functional status, frailty, and cognition which significantly impact prognosis in this age group. Data on the benefits and risks of lowering LDL-cholesterol with statins in older patients without atherosclerotic cardiovascular disease are also limited since most primary prevention trials have included mostly younger patients. Available data suggest that statin therapy in older primary prevention patients may reduce atherosclerotic cardiovascular events and that benefits from lipid-lowering with statins outweigh potential risks such as statin-associated muscle symptoms and incident type 2 diabetes mellitus. While some evidence suggests the possibility that statins may be associated with incident cognitive impairment in older adults, a preponderance of literature indicates neutral or even protective statin-related cognitive effects. Shared decision-making which is recommended for all patients when considering statin therapy is particularly important in older patients. Randomized clinical trial data evaluating the use of non-statin lipid-lowering therapy in older patients are sparse. Deprescribing of lipid-lowering agents may be appropriate for select patients older than 75 years with life-limiting diseases. Finally, a patient-centered approach should be taken when considering primary prevention strategies for older adults.

Frailty trajectories after a cardiovascular event among community-dwelling older people

AIMS

Individuals with cardiovascular disease (CVD) are more likely to become frail. However, no study has determined whether an incident CVD event alters frailty trajectories in older individuals. This study aims to determine the extent to which an incident CVD event modifies frailty trajectories and to identify factors that influence those changes.

METHODS

19,111 individuals (56.4%, women) ≥aged 65 years, who had no prior CVD event or other major health conditions at baseline, were followed for up to 11 years. Frailty was measured annually using the 64-item deficit-accumulation frailty index (FI) and Fried phenotype (Fried). Incident CVD events, including stroke, myocardial infarction and hospitalization for heart failure (HHF), were adjudicated by international experts. Linear mixed models were used to measure frailty changes.

RESULTS

Over a median 8.3-year follow-up, frailty trajectories increased over time and 1934 incident CVD events occurred. Following a CVD event, individuals had a short-term increase in both FI (adjusted-betas: 3.65; 95%CI, 3.34 to 3.96) and Fried (adjusted-beta: 0.32; 95%CI, 0.26 to 0.38). Afterwards, only FI continued to increase over time (adjusted-beta: 0.41, 95%CI, 0.21 to 0.62). Among the CVD events, HHF and stroke were associated with the greatest increase in frailty. Of the factors examined, being >80 years, women, living alone, or residing in regional/remote areas were associated with greater frailty burden.

CONCLUSION

Our findings provide evidence that incident CVD event increases frailty burden, highlighting the need for targeted intervention to minimise frailty-related clinical complications for those most at risk.

Interacting and joint effects of frailty and inflammation on cardiovascular disease risk and the mediating role of inflammation in middle-aged and elderly populations

BACKGROUND

Frailty and inflammation may increase the risk of cardiovascular disease (CVD), but their interacting and joint effects on CVDs remain unclear. To explore the interaction effects of frailty and inflammation on CVDs and the role of inflammation in the relationship between frailty and CVDs to provide better understanding of the underlying pathogenesis of CVD.

METHODS

A total of 220,608 initially CVD-free participants were recruited from the UK Biobank database and were categorized into non-frailty, pre-frailty, and frailty groups based on Fried's criteria. The participants were also grouped according to the low-grade inflammation (INFLA) score and its components: the neutrophil-lymphocyte ratio, C-reactive protein, white blood cell count, and platelet count. Cox proportional hazards models with hazard ratios (HRs) and 95% confidence intervals (CIs) were used to assess the effects of frailty phenotypes and inflammation on CVD risk. Mediation analysis was used to quantify the role of inflammation in the association between frailty and CVDs. The potential interactions between frailty and inflammation in terms of CVD risk were also evaluated using additive and multiplicative scales.

RESULTS

During a median follow-up of 13.3 years, 48,978 participants developed CVDs. After adjusting for various confounders, participants with pre-frailty and frailty had a higher risk of CVDs than those with non-frailty (HRs: 1.20 (95% CI: 1.18-1.23) and 1.80 (95% CI: 1.69-1.91), respectively). A higher risk of CVDs was observed among participants with moderate and high INFLA scores than those with low INFLA scores (HRs: 1.09 (95% CI: 1.07-1.12) and 1.27 (95% CI: 1.24-1.30), respectively). The INFLA score and its components had limited mediating effects in the association between frailty and CVDs. Significant interactions were observed between frailty phenotypes and INFLA scores on CVDs on the multiplicative scale but not on the additive scale.

CONCLUSION

Inflammation may amplify the harmful effect of frailty on the incidence of CVDs. Improving frailty alone might not substantially reduce the risk of CVDs, but effectively controlling inflammation might help to reduce the negative effects of frailty on cardiovascular health.

Roadmap for alleviating the manifestations of ageing in the cardiovascular system

Ageing of the cardiovascular system is associated with frailty and various life-threatening diseases. As global populations grow older, age-related conditions increasingly determine healthspan and lifespan. The circulatory system not only supplies nutrients and oxygen to all tissues of the human body and removes by-products but also builds the largest interorgan communication network, thereby serving as a gatekeeper for healthy ageing. Therefore, elucidating organ-specific and cell-specific ageing mechanisms that compromise circulatory system functions could have the potential to prevent or ameliorate age-related cardiovascular diseases. In support of this concept, emerging evidence suggests that targeting the circulatory system might restore organ function. In this Roadmap, we delve into the organ-specific and cell-specific mechanisms that underlie ageing-related changes in the cardiovascular system. We raise unanswered questions regarding the optimal design of clinical trials, in which markers of biological ageing in humans could be assessed. We provide guidance for the development of gerotherapeutics, which will rely on the technological progress of the diagnostic toolbox to measure residual risk in elderly individuals. A major challenge in the quest to discover interventions that delay age-related conditions in humans is to identify molecular switches that can delay the onset of ageing changes. To overcome this roadblock, future clinical trials need to provide evidence that gerotherapeutics directly affect one or several hallmarks of ageing in such a manner as to delay, prevent, alleviate or treat age-associated dysfunction and diseases.

Associations of estimated glucose disposal rate with frailty progression: results from two prospective cohorts

BACKGROUND

Frailty is a common geriatric syndrome associated with many adverse health outcomes. Identifying the risk factors of frailty is crucial and the insulin resistance (IR) is considered as a potential target. The estimated glucose disposal rate (eGDR) is a simple and reliable surrogate marker of IR. Associations of eGDR with frailty have not been explored. This study aimed to investigate the associations of eGDR with frailty progression.

METHODS

We used data from two prospective cohorts of the China Health and Retirement Longitudinal Study (CHARLS) and Health and Retirement Study (HRS). The eGDR was calculated as follows: eGDR (mg/kg/min) = 21.158 - (0.09×waist circumference) - (3.407×hypertension) - (0.551×glycosylated hemoglobin A1c) [waist circumference (cm), hypertension (yes = 1/no = 0), and glycosylated hemoglobin A1c (%)]. Participants were divided into three categories by tertiles of eGDR. Frailty index (FI) was calculated every two years and used to assess the degree of frailty which ranged from 0 to 100. Frailty progression was assessed by repeated measurements of FI during follow-up. Linear mixed-effect models were used to analyze the associations of eGDR with frailty progression.

RESULTS

8872 participants from CHARLS (mean age: 58.9 years, female: 53.3%) and 5864 participants from HRS (mean age: 67.0 years, female: 59.0%) were included. The median follow-up periods were 7.0 years in the CHARLS and 12.8 years in the HRS, respectively. Compared to participants with lower tertile (T1) of eGDR, those with upper tertile (T3) of eGDR showed decelerated FI progression (CHARLS, β: -0.294, 95%CI -0.390 to -0.198, P < 0.001; HRS, β: -0.378, 95%CI -0.474 to -0.281, P < 0.001). Continuous eGDR was also associated with FI progression for significant deceleration in FI progression with per 1 SD increase in eGDR (CHARLS, β: -0.142, 95%CI -0.181 to -0.103, P < 0.001; HRS, β: -0.170, 95%CI -0.209 to -0.130, P < 0.001). These associations were still observed after excluding baseline frail participants. Furthermore, the associations of eGDR with FI progression were consistent among participants with and without diabetes.

CONCLUSION

Regardless of diabetes or not, a higher level of eGDR was associated with the decelerated frailty progression. Our findings highlight the role of eGDR in frailty progression and recommend taking effective interventions to improve eGDR for preventing frailty progression.

The relationship between frailty and major adverse cardiovascular and cerebrovascular events in Chinese older adults: the mediating effect of lipid accumulation products

BACKGROUND

Previous studies have proven the relationship between frailty and major adverse cardiovascular and cerebrovascular events (MACCE). However, the potential mechanisms need to be further explored. This study aimed to investigate the mediating effect of lipid accumulation products (LAP) in the relationship between frailty and MACCE.

METHODS

This study recruited 7901 participants aged 45 and above from wave 2011 and 2018 of the China Longitudinal Study of Health and Retirement (CHARLS). Logistic regression models were employed to examine the relationship between frailty and MACCE and the mediating effects of LAP, using the bootstrap method to confirm path effects.

RESULTS

Frailty group presented the highest risk of MACCE (OR 1.07, 95% CI 1.03-1.10). Frailty directly impacted MACCE (β = 0.045, P = 0.007). Frailty had a significant effect on LAP (β = 12.21, P < 0.01), while LAP had a significant impact on MACCE (β = 11.14, p = 0.014). The mediation effect of LAP accounted for 1.7% of the total effect regarding the frailty with MACCE.

CONCLUSION

LAP mediate the relationship between frailty and MACCE. Our findings suggest that instructing frailty patients to have a reasonable diet and exercise to control LAP at a low level may be an effective measure to reduce MACCE.

Poor Olfaction and Risk of Stroke in Older Adults: The Atherosclerosis Risk in Communities Study

BACKGROUND

Poor olfaction may be associated with adverse cerebrovascular events, but empirical evidence is limited. We aimed to investigate the association of olfaction with the risk of stroke in the Atherosclerosis Risk in Communities Study.

METHODS

We included 5799 older adults with no history of stroke at baseline from 2011 to 2013 (75.5±5.1 years, 59.0% female and 22.2% Black). Olfaction was assessed by the 12-item Sniffin' Sticks odor identification test and defined as poor (number correct ≤8), moderate (9-10), or good (11-12). Participants were followed from baseline to the date of the first stroke, death, last contact, or December 31, 2020, whichever occurred first. We used the discrete-time subdistribution hazard model to estimate the marginal cumulative incidence of stroke across olfactory statuses and adjusted risk ratios, accounting for covariates and competing risk of death.

RESULTS

After up to 9.6 years of follow-up, we identified 332 incident stroke events. The adjusted marginal cumulative incidence of stroke at 9.6-year follow-up was 5.3% (95% CI, 4.2%-6.3%), 5.9% (95% CI, 4.8%-7.1%), and 7.7% (95% CI, 6.5%-9.1%) for good, moderate, and poor olfaction, respectively. Compared with good olfaction, poor olfaction was significantly associated with higher stroke risk throughout follow-up, albeit the association modestly attenuated after 6 years. Specifically, the adjusted risk ratios were 2.14 (95% CI, 1.22-3.94) at year 2, 1.98 (95% CI, 1.43-3.02) at year 4, 1.91 (95% CI, 1.43-2.77) at year 6, 1.49 (95% CI, 1.17-2.00) at year 8, and 1.45 (95% CI, 1.16-1.95) at year 9.6. Results were robust in multiple subgroup and sensitivity analyses.

CONCLUSIONS

In older adults, poor olfaction assessed by a single olfaction test was associated with the higher risk of stroke in the next 10 years.

Association of frailty index with all-cause and cardiovascular mortality with different diabetic status: NHANES 1999-2018

AIMS

The relationship between frailty and mortality among individuals with varying diabetic statuses represents a burgeoning area of concern and scholarly interest within the medical community. However, there are limited studies that explore the relationship between frailty and mortality, as well as cause-specific mortality among individuals with non-diabetes, prediabetes, and diabetes patients. Hence, this study aims to investigate the relationship between the frailty statues and all-cause mortality, as well as cause-specific mortality in individuals with varying diabetic statuses using the data in the NHANES database.

METHODS

The study utilized data from the National Health and Nutrition Examination Survey (NHANES) 1999-2018, incorporating a final sample size of 57, 098 participants. Both univariable and multivariable-adjusted logistic regression analyses, as well as Cox regression analysis were employed to examine the relationship between frailty index (FI) and mortality.

RESULTS

This study, found a significant positive correlation between the frailty and the increased risk of all-cause mortality non-diabetic [OR 4.277, 95%CI (3.982, 4.594), P < 0.001], prediabetic [OR 2.312, 95%CI (2.133, 2.506), P < 0.001], and diabetic patients [OR 3.947, 95%CI (3.378, 4.611), P < 0.001]. This correlation still existed even after adjusting for confounding factors including age, sex, BMI, poverty, fasting insulin, education, smoke, alcohol drink, waist, hypertension, hyperlipidemia, fasting glucose, HbA1c, eGFR, creatinine and total bilirubin. Our result also suggested a significant positive correlation between the frailty index and the increased risk of CVD mortality among non-diabetic [OR 3.095, 95%CI (2.858, 3.352), P < 0.001] and prediabetic [OR 5.985, 95%CI (5.188, 6.904), P < 0.001] individuals. However, in patients with diabetes, the correlation between frailty and CVD mortality lost significance after adjusting for possible confounding factors [OR 1.139, 95%CI (0.794, 1.634), P > 0.05].

CONCLUSION

A nonlinear relationship has been identified between the FI and all-cause mortality, as well as CVD mortality in non-diabetic and pre-diabetic population. In diabetic patients, there was a significant positive correlation between the frailty and the increased risk of all-cause mortality, but not with CVD mortality. Renal function and liver function might potentially acted as an intermediary factor that elevated the risk of CVD mortality in frail patients with diabetes.

Frailty prevalence, invasive treatment frequency, and in-hospital outcome in patients hospitalized for acute coronary syndrome in Germany (2005-2022): a nationwide registry study

Background

Frailty is a significant predictor for adverse outcomes. Yet, data on prevalence and treatment of frail patients with acute coronary syndrome (ACS) remains limited. We aimed to investigate frailty prevalence, interventional treatment frequency, and in-hospital outcome for all patients hospitalized for ACS in Germany from 2005 to 2022 and validate the Hospital Frailty Risk Score (HFRS) in this population.

Methods

Data for 2005-2022 from the Statistical Federal Office included all cases with primary diagnosis of ACS treated in Germany. Patients were categorized into low, intermediate, and high frailty by HFRS. Diagnoses, procedures, and in-hospital outcomes were analyzed. Univariable and multivariable logistic regressions as well as sensitivity analyses were performed.

Findings

Between 2005 and 2022, 5,889,972 ACS patients were hospitalized in Germany. Mean age was 69 years (standard deviation (SD) ± 12.85 years) and 2,060,224 (34.98%) were female. In-hospital mortality was 6.2%. Among all, 5,001,812 (84.9%) had a low, 784,106 (13.3%) an intermediate, and 104,054 (1.8%) a high HFRS. High-frailty patients were less likely to undergo coronary intervention than low-frailty patients (47.0% vs. 70.6%, p < 0.001), had longer hospital stays (21.6 days SD 19.4 ± vs. 5.6 days SD ± 5.2, p < 0.001), and higher in-hospital mortality (adjusted odds ratio (OR) 3.34 [confidence interval (95% CI) 3.29-3.4]).

Interpretation

Nearly one-sixth of ACS-patients were frail according to HFRS. Frail patients had longer hospital stays, less often received interventional procedures, and showed substantially increased in-hospital mortality. In our aging population, frailty will play an increasing role in patient management. Frailty scores based on electronic patient records, like the HFRS, offer clinicians a tool for assessing in-hospital outcome in ACS patients, potentially enabling more individualized treatment approaches.

Funding

None.

Complexities in Geriatric Cardiology: Clinical Dilemmas and Gaps in Evidence

Cardiovascular diseases (CVD) are undoubtedly the leading cause of morbidity and mortality in the elderly. Population aging is a global phenomenon. In developed countries, by the year 2050 one in four people will be aged 65+ years. This ongoing growth of the aging population leads to an increasing burden of CVD. The management of CVD in geriatric patients requires specific considerations. Aging is associated with complex pathophysiology due to decreased organ reserve, which is clinically described as frailty. Additionally, the aging population is extremely heterogenous and frequently characterized by a combination of unique features, including atypical disease presentation, multimorbidity, polypharmacy, altered pharmacokinetics, cognitive impairment, renal impairment, dysautonomia, elevated risk of falls, sarcopenia, and frailty. Furthermore, significant gaps in evidence exist largely due to the limited representation of the very elderly, and especially frail patients, in randomized controlled trials. When combined with issues related to life expectancy, goals of care, bioethics, and patients' preferences, these factors pose intricate challenges for healthcare providers. This literature review summarizes selected clinical scenarios that often introduce dilemmas in the management of elderly patients in cardiology practice, emphasizing the intersection of geriatric medicine and cardiology. These include blood pressure management, management of dyslipidemia, anticoagulation in atrial fibrillation, medical and device treatment of heart failure, antiplatelet and interventional management of acute coronary syndromes, and peri-procedural considerations in severe aortic stenosis. The above will provide guidance for clinical practice, as well as implications for health policies and future research in the field of geriatric cardiology.

Exploring the Causal Relationship Between Frailty and Chronic Obstructive Pulmonary Disease: Insights From Bidirectional Mendelian Randomization and Mediation Analysis

Background

Observational studies have underscored a robust association between frailty and chronic obstructive pulmonary disease (COPD), yet the causality remains equivocal.

Methods

This study employed bidirectional two-sample Mendelian randomization (MR) analysis. Univariable MR investigated the causal relationship between frailty and COPD. Genetic correlation was assessed using linkage disequilibrium score (LDSC) regression. Multivariable MR and mediation analysis explored the influence of various confounders and their mediating effects. The primary analytic approach was inverse variance weighted (IVW).

Results

LDSC analysis revealed moderate genetic correlations between frailty and Global Biobank Meta-Analysis Initiative (GBMI) COPD (rg = 0.643, P = 6.66×10-62) as well as FinnGen COPD (rg = 0.457, P = 8.20×10-28). IVW analysis demonstrated that frailty was associated with increased risk of COPD in both the GBMI cohort (95% CI, 1.475 to 2.158; P = 2.40×10-9) and the FinnGen database (1.411 to 2.434; 9.02×10-6). Concurrently, COPD was identified as a susceptibility factor for frailty (P < 0.05). These consistent findings persisted after adjustment for potential confounders in MVMR. Additionally, mediation analysis revealed that walking pace mediated 19.11% and 15.40% of the impact of frailty on COPD risk, and 17.58% and 23.26% of the effect of COPD on frailty risk in the GBMI and FinnGen cohorts, respectively.

Conclusion

This study has strengthened the current evidence affirming a reciprocal causal relationship between frailty and COPD, highlighting walking pace as a pivotal mediator.

Effects of Different Exercise Interventions on Fall Risk and Gait Parameters in Frail Patients After Open Heart Surgery: A Pilot Study

Background and Objectives: Research on the effectiveness of different exercise programs on reducing fall risk and improving gait parameters among frail patients after open heart surgery is scarce. Therefore, the aim of this study was to evaluate and compare the effects of different exercise interventions on fall risk and gait parameters in frail patients after open heart surgery during inpatient rehabilitation. Materials and Methods: A prospective randomized study was conducted at Kulautuva Hospital of Rehabilitation, Hospital of Lithuanian University of Health Sciences Kauno Klinikos, from July 2021 to November 2023. A total of 105 pre-frail and frail patients were randomized into three groups: control (CG, n = 35), intervention 1 (IG-1, n = 35), and intervention 2 (IG-2, n = 35). All three groups completed a conventional rehabilitation program that included aerobic training tailored based on each person's health status six times/week. The IG-1 additionally received multicomponent dynamic aerobic balance and strength training three times/week, and the IG-2 received a combined computer-based interactive program three times/week. The overall stability index, as an outcome of fall risk, Short Physical Performance Battery (SPPB) score, and gait parameters (geometry, stance, and timing) were assessed before and after rehabilitation. Results: Of the 105 patients, 87 completed the study. The median age of the patients was 71 years (range: 65-88); 64.76% were male. After rehabilitation, within-group comparisons showed a significant improvement in the overall stability index, SPPB, and all phase gait parameters in all groups. Of all geometry gait parameters, none of the groups showed a significant improvement in step width, and foot rotation was significantly reduced only in the IG-2. All timing gait parameters improved in the CG and IG-2 after rehabilitation, while in the IG-1, only gait speed was significantly improved. Between-group comparisons after rehabilitation revealed significant differences in the overall stability index among the groups and in all phase gait parameters except for stance phase between the IG-1 and the IG-2. The greatest significant difference was documented for the double stance phase between the IG-1 and the IG-2, and the smallest was recorded for the single limb support phase. Significantly greater differences in step time and stride time were found in the IG-1 and the IG-2 than in the CG. Conclusions: All applied interventions were effective in reducing fall risk based on the overall stability index. However, interactive exercise interventions decreased fall risk based on the overall stability index by one-fifth as compared to the conventional rehabilitation program. The incorporation of interactive exercise interventions in rehabilitation resulted in improved double stance phase, stride time, and step time parameters, but did not have any effect on gait speed as compared to other exercise interventions.

Prognostic Value of Frailty in Patients With Takotsubo Cardiomyopathy

BACKGROUND

There is scarce data on the prognostic value of frailty in patients with Takotsubo cardiomyopathy (TCM). This study aimed to assess the association between frailty and in-hospital outcomes in patients with TCM.

METHODS

Adult admissions with TCM were included using the 2016-2019 National Inpatient Sample database. The primary outcome was in-hospital mortality and secondary outcomes included cardiogenic shock, in-hospital cardiac arrest, stroke/transient ischemic attack (TIA), length of hospital stay, and total charges. Frailty was assessed using the hospital frailty risk score (HFRS), and admissions were divided into two groups: low risk and intermediate/high risk of frailty. Logistic regression was used to estimate odds ratios (OR) with their 95% confidence intervals (CI).

RESULTS

A total of 32 360 patients were included; the median age was 67 (58-76) years and 90% were female. The median HFRS was 2.6 (1.1-5.3). In the adjusted models, in-hospital mortality was significantly higher in the intermediate/high risk of frailty group (OR 3.60, 95% CI 2.16-6.02) compared to the low-risk group. Similarly, admissions with intermediate/high risk of frailty had a significantly higher risk of cardiogenic shock (OR 3.66, 95% CI 2.77-4.80), in-hospital cardiac arrest (OR 2.57, 95% CI 1.55-4.24), and stroke/TIA (OR 5.68, 95% CI 3.51-9.20). There was a significantly higher hospital charges and length of hospital stay in the intermediate/high-risk group. In the restricted cubic spline regression models, the frailty score was nonlinearly associated with all outcomes.

CONCLUSIONS

Our results suggest that frailty is useful as a prognostic factor for in-hospital events in patients with TCM.

Impacts of Depressive Symptoms on the Effectiveness of a Theory-Driven Exercise Intervention Among Community-Dwelling (Pre)frail Older Adults

OBJECTIVES

To investigate whether baseline depressive symptoms impacted the effectiveness of an exercise intervention among (pre)frail older adults.

METHODS

This is a subanalysis of a stepped-wedge cluster randomized trial implementing an exercise intervention, with an application of the integration of the Health Belief Model, Theory of Planned Behavior, and Health Action Process Approach, among 149 community-dwelling (pre)frail older adults. The intervention effectiveness was examined by baseline depressive symptoms (depressive symptoms (n = 40) and non-depressive symptoms (n = 109).

RESULTS

Intervention effects were observed among (pre)frail older adults regardless of baseline depressive symptoms on frailty, social function, as well as physical and mental quality of life (QoL). (Pre)frail people with depressive symptoms, compared to those without depressive symptoms, were likely to benefit more in muscle mass, muscle strength, lower extremity function, activities of daily living (ADLs), cognitive function, depressive symptoms, and physical QoL, but less in dynamic balance, instrumental ADLs (IADLs), and mental QoL.

CONCLUSIONS

These findings implicate that cognitive and psychological strategies should be integrated into exercise interventions among (pre)frail people with depressive symptoms to improve their functional independence and well-being.

CLINICAL IMPLICATIONS

Interventions that accommodate depressive symptoms may result in improved outcomes for (pre)frail people with depressive symptoms.

Assessing Frailty-Specific Treatment Effect in Cardiovascular Disease: A Systematic Review

BACKGROUND

Clinicians are increasingly considering using frailty assessments to individualize treatment for older patients. It remains uncertain whether interventions to reduce cardiovascular disease (CVD) events offer similar benefits between older adults with and without frailty.

METHODS

A systematic literature search was undertaken in PubMed and Embase, adhering to PRISMA guidelines. Key inclusion criteria were randomized controlled trials published between January 2007 and September 2024 with CVD outcomes as an endpoint and data on frailty-specific treatment effects. Data were collected for population characteristics, intervention, follow-up time, frailty measure, outcome rates, and frailty subgroup treatment effect. Due to heterogeneity among the studies, the results were not pooled.

RESULTS

The search identified 151 unique studies, of which 18 were included. Using Cochrane Risk of Bias 2.0, 12 out of the 18 studies have low risk of bias. The intervention was more effective in frail participants than in non-frail counterparts in two studies (e.g., aerobic exercise), less effective in frail participants in three studies (e.g., intensive lifestyle intervention), similarly effective across frailty levels in seven studies (e.g., prasugrel), and inconclusive in six studies (e.g., edoxaban). Some treatments were similarly effective across frailty level by hazard ratio but had a greater reduction in absolute risk for frail versus non-frail patients.

CONCLUSIONS

Cardiovascular interventions may provide differential benefits by patients' frailty. These findings suggest the potential utility of frailty assessment for optimizing cardiovascular interventions.

Deprescribing Cardiovascular Medications in Older Adults Living with Frailty

Certain medications have shown significant effectiveness in reducing the incidence of cardiovascular events and mortality, leading them to be among those that are prescribed most commonly for Canadian seniors. However, polypharmacy, which disproportionately affects older adults, is particularly concerning for frail individuals who are at higher risk for adverse medication-related events. The deprescribing process is the discontinuation, either immediate or gradual, of inappropriate medications, to address polypharmacy and improve outcomes. Nonetheless, the incorporation of deprescribing principles into clinical practice present challenges, including the limited amount of data available on the clinical benefits of deprescription, and a lack of consensus on how to deprescribe. The current narrative review explores frailty as a basis for deciding to deprescribe medication. The evidence regarding the benefits of use of medications prescribed for common cardiovascular conditions (including acetylsalicylic acid, statins, and antihypertensives) in older adults with frailty is reviewed. The review also examines the issue of who should initiate the deprescribing process, and the associated psychological implications. Although no one-size-fits-all approach to deprescription is available, patient goals should be prioritized. For older adults with frailty, healthcare professionals must consider carefully whether the benefits of use of a cardiovascular medication outweighs the potential harms. Ideally, the deprescribing process should involve shared decision-making among physicians, other health professionals, and patients and/or their substitute decision-makers, with the common goal of improving patient outcomes.

Unraveling the influences of hemodynamic lag and intrinsic cerebrovascular reactivity on functional metrics in ischemic stroke

Resting-state functional magnetic resonance imaging (rs-fMRI) is a prominent tool for investigating functional deficits in stroke patients. However, the extent to which the hemodynamic lags (LAG) and the intrinsic cerebrovascular reactivity (iCVR) may affect the rs-fMRI metrics in different scales needs to be clarified for ischemic stroke. In this study, 73 ischemic stroke patients and 74 healthy controls (HC) were recruited to investigate how the correction of the LAG and/or iCVR would influence resting-state functional magnetic resonance imaging (rs-fMRI) metrics of three different spatial scales (local-scale, meso-scale and global-scale) in ischemic stroke. The analysis revealed that the Stroke pattern of all functional metrics using different correction strategies resembled the HC pattern. The highest overlap was observed in the Stroke pattern with correction for both LAG and iCVR, while the pattern without correction showed the lowest overlap. Most functional metrics after correction showed higher sensitivity in detecting between-group differences than those without correction. Moreover, our results were generally reproducible in an independent dataset. Collectively, these findings emphasize the necessity of considering LAG and iCVR effects to investigate stroke-related functional alterations, and highlight the significance of correction strategies for accurately interpreting the findings in rs-fMRI study of ischemic stroke.

Impact of Masticatory Performance and the Tongue-Lip Motor Function on Incident Adverse Health Events in Patients with Metabolic Disease

AIM

The present study aimed to determine whether decreased masticatory performance and tongue-lip motor function are associated with an increased incidence of adverse health events in patients with metabolic disease.

METHODS

One thousand patients with metabolic diseases including diabetes, dyslipidemia, hypertension, and hyperuricemia were recruited. Masticatory performance was assessed using a gummy jelly test, wherein glucose elution from chewed gummy jelly was measured. The tongue-lip motor function was measured using repeatedly pronounced syllables per second. Their association with the incidence of adverse health events (a composite of all-cause death, cardiovascular disease, bone fracture, malignant neoplasm, pneumonia, and dementia) was investigated using the generalized propensity score (GPS) method.

RESULTS

During a median follow-up period of 36.6 (interquartile range, 35.0-37.7) months, adverse health events were observed in 191 patients. The GPS adjusted dose-response function demonstrated that masticatory performance was inversely associated with the incidence of adverse health events. The 3-year incidence rate was 22.8% (95% confidence interval, 19.0-26.4%) for the lower quartile versus 13.6% (10.5-16.7%) for the upper quartile (P＜0.001). Similarly, the tongue-lip motor function was inversely associated with the incidence of adverse health events, with a 3-year incidence rate of 23.6% (20.0-27.0%) for the lower quartile versus 13.2% (10.4-15.9%) for the upper quartile (P＜0.001).

CONCLUSIONS

Decreased masticatory performance and tongue-lip motor function were associated with an increased incidence of adverse health events in patients with metabolic disease.

Invasive Versus Conservative Strategy in Older Adults ≥75 Years of Age With Non-ST-segment-Elevation Acute Coronary Syndrome: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

BACKGROUND

Older adults with non-ST-segment-elevation acute coronary syndrome are less likely to undergo an invasive strategy compared with younger patients. Randomized controlled trials traditionally exclude older adults because of their high burden of geriatric conditions.

METHODS AND RESULTS

We searched for randomized controlled trials comparing invasive versus medical management or a selective invasive (conservative) strategy for older patients (age≥75 years) with non-ST-segment-elevation acute coronary syndrome. Fixed effects meta-analysis was conducted to estimate the odds ratio (OR) with 95% CI for the composite of death or myocardial infarction (MI) and individual secondary end points of all-cause death, cardiovascular death, MI, revascularization, stroke, and major bleeding. Nine studies with 2429 patients (invasive: 1228 versus control: 1201) with a mean follow-up of 21 months were included. An invasive strategy was associated with a significantly decreased risk of a composite of death and MI (OR, 0.67 [95% CI, 0.54-0.83], P<0.001), MI (OR, 0.56 [95% CI, 0.45-0.70], P<0.001) and subsequent revascularization (OR, 0.27 [95% CI, 0.16-0.48], P<0.001). There was no difference in all-cause death (OR, 0.84 [95% CI, 0.65-1.10], P=0.21), cardiovascular death (OR, 0.85 [95% CI, 0.63-1.15], P=0.30), stroke (OR, 0.74 [95% CI, 0.38-1.47], P=0.39), or major bleeding (OR, 1.24 [95% CI, 0.42-3.66], P=0.70).

CONCLUSIONS

In older patients ≥75 years old with non-ST-segment-elevation acute coronary syndrome, an invasive strategy reduced the risk of a composite of death and MI, MI, and subsequent revascularization compared with a conservative strategy alone. Older adults with higher burden of geriatric conditions should be included in future trials to improve generalizability to this growing population.

The Impact of Frailty on Patients With AF and HFrEF Undergoing Catheter Ablation: A Nationwide Population Study

Background

Frailty is a common geriatric syndrome often coexisting with cardiovascular diseases such as atrial fibrillation (AF) and heart failure (HF) with reduced ejection fraction (HFrEF). While catheter ablation (CA) has demonstrated efficacy in reducing major adverse cardiovascular events and improving mortality and quality of life, the influence of frailty among this population remains unknown.

Objectives

The authors aimed to identify the prevalence of frailty among patients with HFrEF and AF undergoing CA and its influence on cardiovascular mortality and discharge disposition.

Methods

From January 2016 to December 2019, we used the Nationwide Inpatient Sample to identify patients with AF and HFrEF. Frailty was identified by the presence of ≥1 diagnostic cluster utilizing the Johns Hopkins Adjusted Clinical Groups with malnutrition, dementia, impaired vision, decubitus ulcer, urinary incontinence, loss of weight, poverty, barriers to access to care, difficulty walking, and falls as indicators. We compared clinical outcomes among frail vs nonfrail patients, including all-cause in-hospital mortality, major adverse cardiovascular events, other major complications, discharge disposition, and hospital length of stay using multivariable regression analysis.

Results

Of 113,115 weighted admissions, 11,725 (10.4%) were classified as frail. Frail patients were older (median age: 76 [IQR: 15] years vs 70 [IQR: 15] years, P < 0.001) than nonfrail patients. Frailty was associated with increased odds of all-cause hospital mortality (adjusted odds ratio [aOR]: 2.64; 95% CI: 1.87-3.72; P < 0.001), major adverse cardiovascular events (aOR: 2.00; 95% CI: 1.62-2.47; P < 0.001), and nonhome discharge (aOR: 3.31; 95% CI: 2.78-3.94; P < 0.001). Frail patients also experienced longer hospital length of stay (median 9 [IQR: 10] days vs 5 [IQR: 5] days, P < 0.001) after adjustment by Poisson regression (coefficient: 0.53; 95% CI: 0.46-0.59; P < 0.001).

Conclusions

Frailty is associated with worse outcomes in patients with HFrEF undergoing CA for AF. The integration of frailty models in clinical practice may facilitate prognostication and risk stratification to optimize patient selection for CA.

Progression of frailty and cardiovascular outcomes among Medicare beneficiaries

BACKGROUND

Frailty is associated with adverse cardiovascular outcomes independent of age and comorbidities, yet the independent influence of frailty progression on cardiovascular outcomes remains uncertain.

METHODS

To determine whether frailty progression is associated with adverse cardiovascular outcomes, independent of baseline frailty and age, we evaluated all Medicare Fee-for-Service beneficiaries ≥65 years at cohort inception with continuous enrollment from 2003 to 2015. Linear mixed effects models, adjusted for baseline frailty and age, were used to estimate change in a validated claims-based frailty index (CFI) over a 5-year period. Survival analysis was used to examine frailty progression and risk of adverse health outcomes.

RESULTS

There were 8.9 million unique patients identified, mean age 77.3 ± 7.2 years, 58.7% female, 10.9% non-White race. In total, 60% had frailty progression and 40% frailty regression over median follow-up of 2.4 years. Compared to those with frailty regression, when adjusting for age and baseline CFI, those with frailty progression had a significantly greater risk of incident major adverse cardiovascular and cerebrovascular events (MACCE) (hazard ratio [HR] 1.31, 95% confidence interval [CI] 1.31-1.31), all-cause mortality (HR 1.34, 95% CI 1.34-1.34), acute myocardial infarction (HR 1.08, 95% CI 1.07-1.09), heart failure exacerbation (HR 1.30, 95% CI 1.29-1.30), ischemic stroke (HR 1.14, 95% CI 1.14-1.15). There was also a graded increase in risk of each outcome with more rapid progression, as well as significantly fewer days alive at home (DAH) with more rapid progression compared to the slowest progression group (270.4 ± 112.3 vs. 308.6 ± 93.0 days, rate ratio 0.88, 95% CI 0.87-0.88, p < 0.001).

CONCLUSIONS

In this large, nationwide sample of older Medicare beneficiaries, frailty progression, independent of age and baseline frailty, was associated with fewer DAH and a graded risk of MACCE, all-cause mortality, myocardial infarction, heart failure, and ischemic stroke compared to those with frailty regression.

Mid-life plasma proteins associated with late-life prefrailty and frailty: a proteomic analysis

Physical frailty is a syndrome that typically manifests in later life, although the pathogenic process causing physical frailty likely begins decades earlier. To date, few studies have examined the biological signatures in mid-life associated with physical frailty later in life. Among 4,189 middle-aged participants (57.8 ± 5.0 years, 55.8% women) from the Atherosclerosis Risk in Community (ARIC) study, we evaluated the associations of 4,955 plasma proteins (log 2-transformed and standardized) measured using the SomaScan platform with their frailty status approximately 20 years later. Using multinomial logistic regression models adjusting for demographics, health behaviors, kidney function, total cholesterol, and comorbidities, 12 and 221 proteins were associated with prefrailty and frailty in later life, respectively (FDR p < 0.05). Top frailty-associated proteins included neurocan core protein (NCAN, OR = 0.66), fatty acid-binding protein heart (FABP3, OR = 1.62) and adipocyte (FABP4, OR = 1.65), as well proteins involved in the contactin-1 (CNTN1), toll-like receptor 5 (TLR5), and neurogenic locus notch homolog protein 1 (NOTCH1) signaling pathway relevant to skeletal muscle regeneration, myelination, and inflammation. Pathway analyses suggest midlife dysregulation of inflammation, metabolism, extracellular matrix, angiogenesis, and lysosomal autophagy among those at risk for late-life frailty. After further adjusting for midlife body mass index (BMI) - an established frailty risk factor - only CNTN1 (OR = 0.75) remained significantly associated with frailty. Post-hoc analyses demonstrated that the top 41 midlife frailty-associated proteins mediate 32% of the association between mid-life BMI and late-life frailty. Our findings provide new insights into frailty etiology earlier in the life course, enhancing the potential for prevention.

Genetically predicted frailty index and risk of chronic kidney disease

Previous findings have reported the association between frailty and chronic kidney disease. However, the causality remains ambiguous. This study aimed to determine whether frailty index is causally associated with chronic kidney disease. We obtained the frailty genome-wide association study (GWAS) data and chronic kidney disease GWAS data from the FinnGen R5 (total n = 216,743; case = 3902, control = 212,841) as the exposure and outcome, respectively. A two-sample Mendelian randomization (MR) analysis was primarily conducted using the inverse-variance weighted (IVW), weighted median and MR-Egger regression analyses. Multivariable MR analysis (MVMR) was conducted for additional adjustment. In the two-sample Mendelian randomization analyses, a total of 14 single nucleotide polymorphisms (SNPs) were recognized as effective instrumental variables. The IVW method showed evidence to support a causal association between frailty index and chronic kidney disease (beta = 1.270; 95% CI 0.608 to 1.931; P < 0.001). MR-Egger revealed a causal association between frailty index and chronic kidney disease (beta = 3.612; 95% CI 0.805 to 6.419; P = 0.027). MR-Egger regression revealed that directional pleiotropy was unlikely to be biasing the result (intercept =  - 0.053; P = 0.119). The weighted median approach and weighted mode method also demonstrated a causal association between frailty index and chronic kidney disease (beta = 1.148; 95% CI 0.278 to 2.019; P = 0.011; beta = 2.194; 95% CI 0.598 to 3.790; P = 0.018). Cochran's Q test and the funnel plot indicated no directional pleiotropy. MVMR analysis revealed that the causal association between frailty index and chronic kidney disease remained after adjusting for potential confounders, body-mass index, inflammatory bowel disease, waist-hip ratio, and C-reactive protein. Our study provides evidence of causal association between frailty and chronic kidney disease from genetic perspectives.

Frailty and Loneliness in Older Adults: A Narrative Review

(1) Background: In a society with an advancing aging rate, medical systems are coming under pressure due to an increasing flow of older patients with multiple somatic diseases, exacerbated by their psychological and sociological backgrounds. We aimed to investigate the relationship between frailty and loneliness in older adults and to provide a holistic perspective on these concepts. Our research question was "Is there a link between the loneliness and frailty in older people?" (2) Methods: To assess the link between loneliness and frailty, we conducted a search accessing Index Medicus and PubMed; the timeframe of our research was from 2013 until 2023. Data regarding the study population, as well as loneliness and frailty assessments and approaches, were extracted. (3) Results: A positive relationship between loneliness and the appearance and progression of frailty in older adults is argued for. (4) Conclusions: Frailty and loneliness in older adults are often interconnected and can have a significant impact on their overall well-being. Early identification of frailty by assessing risk factors (including loneliness and/or social isolation) should become a standard of care for older patients. Appropriate combined interventions that effectively address both frailty and loneliness (physical exercises, psychological support, and social engagement) can promote healthier aging, prevent health deterioration, maintain independence, and reduce healthcare costs.

Treating Hypercholesterolemia in Older Adults for Primary Prevention of Cardiovascular Events

As the population ages, the demographic of adults aged 75 years and older in the U.S. is projected to grow to 45 million by 2050. Hypercholesterolemia is directly linked to atherosclerotic cardiovascular disease (ASCVD), which remains the leading cause of death in older adults. However, primary prevention of ASCVD through lipid-lowering agents remains unclear among older adults owing to limited involvement of older adults in current trials, lack of dedicated trials, and evidence primarily derived from secondary and retrospective analyses. Therefore, this article aims to (1) review key updates from the latest guidelines on treatment of hypercholesterolemia in older adults, (2) highlight limitations of the current ASCVD risk scores in the geriatric population, (3) present outcomes from key studies on the use of lipid-lowering agents and associated side effects, including a brief review of novel agents such as bempedoic acid, although very few adults over age 75 were included in these trial, and (4) finally, highlight upcoming dedicated trials of statins in older adults for the primary prevention of important geriatric outcomes as well as ASCVD.

2024 Guidelines of the Taiwan Society of Cardiology on the Primary Prevention of Atherosclerotic Cardiovascular Disease --- Part I

Atherosclerotic cardiovascular disease (ASCVD) is one of the leading causes of death worldwide and in Taiwan. It is highly prevalent and has a tremendous impact on global health. Therefore, the Taiwan Society of Cardiology developed these best-evidence preventive guidelines for decision-making in clinical practice involving aspects of primordial prevention including national policies, promotion of health education, primary prevention of clinical risk factors, and management and control of clinical risk factors. These guidelines cover the full spectrum of ASCVD, including chronic coronary syndrome, acute coronary syndrome, cerebrovascular disease, peripheral artery disease, and aortic aneurysm. In order to enhance medical education and health promotion not only for physicians but also for the general public, we propose a slogan (2H2L) for the primary prevention of ASCVD on the basis of the essential role of healthy dietary pattern and lifestyles: "Healthy Diet and Healthy Lifestyles to Help Your Life and Save Your Lives". We also propose an acronym of the modifiable risk factors/enhancers and relevant strategies to facilitate memory: " ABC2D2EFG-I'M2 ACE": Adiposity, Blood pressure, Cholesterol and Cigarette smoking, Diabetes mellitus and Dietary pattern, Exercise, Frailty, Gout/hyperuricemia, Inflammation/infection, Metabolic syndrome and Metabolic dysfunction-associated fatty liver disease, Atmosphere (environment), Chronic kidney disease, and Easy life (sleep well and no stress). Some imaging studies can be risk enhancers. Some risk factors/clinical conditions are deemed to be preventable, and healthy dietary pattern, physical activity, and body weight control remain the cornerstone of the preventive strategy.

Impact of VO 2peak on the Clinical Outcomes of Older Patients With Coronary Heart Disease in China

PURPOSE

The aim of this study was to explore the role of cardiopulmonary exercise test parameters, especially peak oxygen uptake (VO 2peak ), in predicting the incidence of adverse cardiovascular events in older Chinese patients with coronary heart disease (CHD).

METHODS

Older patients with CHD who underwent cycle ergometer cardiopulmonary exercise test at the Cardiac Rehabilitation Clinic of Chinese PLA General Hospital from July 1, 2015 to January 31, 2020 were enrolled. The follow-up intervals were 6 mo. Cox regression was used to analyze the relationship between VO 2peak and adverse cardiovascular events. Restricted cubic splines and subgroup analyses were used to observe the relationship between VO 2peak and the hazard ratio (HR) of the primary end point event (PEE), which included a composite of all-cause death, nonfatal recurrent myocardial infarction, unscheduled revascularization, and stroke. The composite end point event was the PEE combined with cardiac rehospitalization.

RESULTS

A total of 1223 participants (mean age 68 ± 5 yr) were included. Median follow-up was 68 mo. Mean VO 2peak was 16.5 ± 4.0 mL/kg/min, and VO 2peak was an independent predictor of the PEE (HR = 0.929; 95% CI, 0.891-0.970; P = .001). This association was further validated by restricted cubic spline and subgroup analyses. Peak oxygen uptake was also an independent risk factor for the composite end point event (HR = 0.968; 95% CI, 0.941-0.996; P = .025).

CONCLUSION

In conclusion, VO 2peak is an independent risk factor for adverse cardiovascular events in older Chinese patients with CHD, and more optimal therapy should be recommended to patients with lower VO 2peak .

Measuring Frailty Using Self-Report or Automated Tools to Identify Risk of Cardiovascular Events and Mortality: The Million Veteran Program

BACKGROUND

Frailty, a syndrome of physiologic vulnerability, increases cardiovascular disease (CVD) risk. Whether in person or automated frailty tools are ideal for identifying CVD risk remains unclear. We calculated 3 distinct frailty scores and examined their associations with mortality and CVD events in the Million Veteran Program, a prospective cohort of nearly 1 million US veterans.

METHODS AND RESULTS

Veterans aged ≥50 years and enrolled from 2011 to 2018 were included. Two frailty indices (FI) based on the deficit accumulation theory were calculated: the questionnaire-based 36-item Million Veteran Program-FI and 31-item Veterans Affairs-FI using claims data. We calculated Fried physical frailty using the self-reported, 3-item Study of Osteoporotic Fractures. Multivariable-adjusted Cox models examined the association of frailty by each score with primary (all-cause and CVD mortality) and secondary (myocardial infarction, stroke, and heart failure) outcomes. In 190 688 veterans (69±9 years, 94% male, 85% White), 33, 233 (17%) all-cause and 10 115 (5%) CVD deaths occurred. Using Million Veteran Program-FI, 29% were robust, 42% pre-frail, and 29% frail. Frailty prevalence increased by age group (27% in 50-59 to 42% in ≥90 years). Using the Million Veteran Program-FI, over 6±2 years, frail veterans had a higher hazard of all-cause (hazard ratio [HR], 3.05 [95% CI, 2.95-3.16]) and CVD mortality (HR, 3.65 [95% CI, 3.43-3.90]). Findings were concordant for the Veterans Affairs-FI and Study of Osteoporotic Fractures frailty definitions, and remained significant even among younger veterans aged 50-59 years.

CONCLUSIONS

Irrespective of frailty measure, frailty is associated with a higher risk of all-cause mortality and adverse CVD events. Further study of frailty in veterans aged <60 years old is warranted.

Case report: heart failure related to intravitreal injection of anti-VEGF

BACKGROUND

Intravitreal injection of anti-vascular endothelial growth factor is considered the first-line treatment for polypoidal choroidal vasculopathy. It has potential risks for circulatory system, which should be particularly carefully evaluated in older patients. In this case study, we aim to discuss the potential impact of this treatment regimen on cardiac health.

CASE PRESENTATION

This case report describes an elderly patient with no prior history of heart disease who exhibited unexpected heart enlargement and dysfunction. Throughout the patient's hospital stay, various potential causes were investigated, leading to the hypothesis that a 10-year history of intravitreal injections of anti-vascular endothelial growth factor could be related to the observed clinical manifestations. The patient was advised to discontinue this treatment, and after a 2-month follow-up period, there was a gradual improvement in the patient's cardiac structure and function.

CONCLUSION

This manuscript highlights the importance of conducting cardiac examinations before and after anti-vascular endothelial growth factor treatment, especially for individuals at risk of heart diseases like the elderly. It emphasizes the need to carefully weigh the benefits and risks of treatment regimens to ensure optimal therapeutic outcomes.

Prebiotics improve frailty status in community-dwelling older individuals in a double-blind, randomized, controlled trial

BACKGROUNDFrailty significantly affects morbidity and mortality rates in the older population (age >65 years). Age-related degenerative diseases are influenced by the intestinal microbiota. However, limited research exists on alterations in the intestinal microbiota in frail older individuals, and the effectiveness of prebiotic intervention for treating frailty remains uncertain.OBJECTIVEWe sought to examine the biological characteristics of the intestinal microbiome in frail older individuals and assess changes in both frailty status and gut microbiota following intervention with a prebiotic blend consisting of inulin and oligofructose.METHODSThe study consisted of 3 components: an observational analysis with a sample size of 1,693, a cross-sectional analysis (n = 300), and a multicenter double-blind, randomized, placebo-controlled trial (n = 200). Body composition, commonly used scales, biochemical markers, intestinal microbiota, and metabolites were examined in 3 groups of older individuals (nonfrail, prefrail, and frail). Subsequently, changes in these indicators were reevaluated after a 3-month intervention using the prebiotic mixture for the prefrail and frail groups.RESULTSThe intervention utilizing a combination of prebiotics significantly improved frailty and renal function among the older population, leading to notable increases in protein levels, body fat percentage, walking speed, and grip strength. Additionally, it stimulated an elevation in gut probiotic count and induced alterations in microbial metabolite expression levels as well as corresponding metabolic pathways.CONCLUSIONSThe findings suggest a potential link between changes in the gut microbiota and frailty in older adults. Prebiotics have the potential to modify the gut microbiota and metabolome, resulting in improved frailty status and prevention of its occurrence.TRIAL REGISTRATIONClinicalTrials.gov NCT03995342.

Frailty and Cardiovascular Health

The incidence of frailty and cardiovascular disease (CVD) increases as the population ages. There is a bidirectional relationship between frailty and CVD, and both conditions share several risk factors and underlying biological mechanisms. Frailty has been established as an independent prognostic marker in patients with CVD. Moreover, its presence significantly influences both primary and secondary prevention strategies for adults with CVD while also posing a barrier to the inclusion of these patients in pivotal clinical trials and advanced cardiac interventions. This review discusses the current knowledge base on the relationship between frailty and CVD, how managing CVD risk factors can modify frailty, the influence of frailty on CVD management, and future directions for frailty detection and modification in patients with CVD.

Current Management of Non-ST-Segment Elevation Acute Coronary Syndrome

Cardiovascular disease constitutes the leading cause of morbimortality worldwide. Non-ST-segment elevation acute coronary syndrome (NSTE-ACS) is a common cardiovascular condition, closely related to the ageing population and significantly affecting survival and quality of life. The management of NSTE-ACS requires specific diagnosis and therapeutic strategies, thus highlighting the importance of a personalized approach, including tailored antithrombotic therapies and regimens, combined with timely invasive management. Moreover, specific and frequent populations in clinical practice, such as the elderly and those with chronic kidney disease, pose unique challenges in the management of NSTE-ACS due to their increased risk of ischemic and hemorrhagic complications. In this scenario, comprehensive management strategies and multidisciplinary care are of great importance. Cardiac rehabilitation and optimal management of cardiovascular risk factors are essential elements of secondary prevention since they significantly improve prognosis. This review highlights the need for a personalized approach in the management of NSTE-ACS, especially in vulnerable populations, and emphasizes the importance of precise antithrombotic management together with tailored revascularization strategies, as well as the role of cardiac rehabilitation in NSTE-ACS patients.

The role of statin therapy in older adults: best practices and unmet challenges

INTRODUCTION

Cardiovascular disease (CVD) is associated with significant morbidity, functional decline, and mortality in older adults. The role of statins for primary CVD prevention in older adults remains unclear, largely due to systematic exclusion of these individuals in trials that inform current practice guidelines, leading to conflicting national and international practice recommendations for statin use for primary prevention of CVD in adults aged 75 and older.

AREAS COVERED

In this narrative review, we performed a literature review utilizing PubMed, and ultimately focus on seven major national and international guidelines of lipid lowering therapy. Through the lens of two clinical cases, we review physiologic changes in lipid metabolism with aging, discuss the relationship between cholesterol and cardiovascular events in older adults, examine the national and international guidelines and the available evidence informing these guidelines for statin use in primary prevention of CVD in older adults. Finally we review practical clinical considerations for drug monitoring and deprescribing in this population.

EXPERT OPINION

Guidelines for the use of statins for primary CVD prevention in older adults is conflicting. Collectively, evidence to date suggests statin therapy may be beneficial for primary CVD prevention in older adults free of life-limiting comorbidities. Randomized controlled trials are currently underway to address current evidence gaps.

Biological basis and treatment of frailty and sarcopenia

In an ageing society, the importance of maintaining healthy life expectancy has been emphasized. As a result of age-related decline in functional reserve, frailty is a state of increased vulnerability and susceptibility to adverse health outcomes with a serious impact on healthy life expectancy. The decline in skeletal muscle mass and function, also known as sarcopenia, is key in the development of physical frailty. Both frailty and sarcopenia are highly prevalent in patients not only with advanced age but also in patients with illnesses that exacerbate their progression like heart failure (HF), cancer, or dementia, with the prevalence of frailty and sarcopenia in HF patients reaching up to 50-75% and 19.5-47.3%, respectively, resulting in 1.5-3 times higher 1-year mortality. The biological mechanisms of frailty and sarcopenia are multifactorial, complex, and not yet fully elucidated, ranging from DNA damage, proteostasis impairment, and epigenetic changes to mitochondrial dysfunction, cellular senescence, and environmental factors, many of which are further linked to cardiac disease. Currently, there is no gold standard for the treatment of frailty and sarcopenia, however, growing evidence supports that a combination of exercise training and nutritional supplement improves skeletal muscle function and frailty, with a variety of other therapies being devised based on the underlying pathophysiology. In this review, we address the involvement of frailty and sarcopenia in cardiac disease and describe the latest insights into their biological mechanisms as well as the potential for intervention through exercise, diet, and specific therapies.

The impact of frailty on short-term prognosis in discharged adult stroke patients: A multicenter prospective cohort study

BACKGROUND

Frailty is commonly observed in stroke patients and it is associated with adverse outcomes. However, there remains a gap in longitudinal studies investigating the causal relationship between baseline frailty and short-term prognosis in discharged adult stroke patients.

OBJECTIVE

To examine the causal impact of frailty on non-elective readmission and major adverse cardiac and cerebral events, and investigate its associations with cognitive impairment and post-stroke disability.

DESIGN

A multicenter prospective cohort study.

SETTING

Two tertiary hospitals in Central and Northwest China.

PARTICIPANTS

667 adult stroke patients in stroke units were included from January 2022 to June 2022.

METHODS

Baseline frailty was assessed by the Frailty Scale. Custom-designed questions were utilized to assess non-elective readmission and major adverse cardiac and cerebral events as primary outcomes. Cognitive impairment, assessed using the Mini-Mental State Examination Scale (MMSE), and post-stroke disability, measured with the Modified Rankin Scale (mRS), were considered secondary outcomes at a 3-month follow-up. The impact of baseline frailty on non-elective readmission and major adverse cardiac and cerebral events was examined using bivariate and multiple Cox regression analyses. Furthermore, associations between baseline frailty and cognitive impairment, or post-stroke disability, were investigated through generalized linear models.

RESULTS

A total of 5 participants died, 12 had major adverse cardiac and cerebral events, and 57 had non-selective readmission among 667 adult stroke patients. Frailty was an independent risk factor for non-selective readmission (hazard ratio [HR]: 2.71, 95 % confidence interval [CI]: 1.59, 4.62) and major adverse cardiac and cerebral events (HR: 3.77, 95 % CI: 1.07, 13.22) for stroke patients. Baseline frailty was correlated with cognitive impairment (regression coefficient [β]: -2.68, 95 % CI: -3.78, -1.58) adjusting for socio-demographic and clinical factors and follow-up interval. However, the relationship between frailty and cognitive impairment did not reach statistical significance when further adjusting for baseline MMSE (β: -0.39, 95 % CI: -1.43, 0.64). Moreover, baseline frailty was associated with post-stroke disability (β: 0.36, 95 % CI: 0.08, 0.65) adjusting for socio-demographic and clinical variables, follow-up interval, and baseline mRS.

CONCLUSIONS

The finding highlights the importance of assessing baseline frailty in discharged adult stroke patients, as it is significantly associated with non-elective readmission, major adverse cardiac and cerebral events, and post-stroke disability at 3 months. These results highlight the crucial role of screening and evaluating frailty status in improving short-term prognosis for adult stroke patients. Interventions should be developed to address baseline frailty and mitigate the short-term prognosis of stroke.

TWEETABLE ABSTRACT

Baseline frailty predicts non-elective readmission, major adverse cardiac and cerebral events, and post-stroke disability in adult stroke patients. @haiyanhexyyy.

Associations between information and communication technology use and frailty in community-dwelling old-old adults: results from the ILSA-J

OBJECTIVES

Frailty is a significant cause of adverse health events including long-term care and hospitalization. Although information and communication technology (ICT) has become an integral part of modern life, it remains unclear whether ICT use is associated with frailty.

DESIGN

A cross-sectional study (Integrated Longitudinal Studies on Aging in Japan, ILSA-J).

SETTING AND PARTICIPANTS

Aged 75 and older data from the ILSA-J in 2017 (n = 2893).

METHODS

ICT use was measured using the technology usage sub-items of the Japan Science and Technology Agency Index of Competence. Specifically, the use of mobile phones, ATMs, DVD players, and sending e-mails were rated as "yes" (able to do) or "no" (unable to do), with the first quintile (≤1 point) defined as ICT non-users. Frailty was assessed using the Japanese version of the Cardiovascular Health Study criteria based on the phenotype model (e.g., weight loss, slowness, weakness, exhaustion, and low activity). Further, multivariate logistic regression analysis analyzed its association with ICT use. Subgroup analyses were stratified according to gender, years of education, and living arrangements.

RESULTS

Higher ICT use was not associated with frailty after adjusting for covariates (odds ratio [OR]: 0.53; 95%CI 0.39-0.73). Similar associations were found in the sub-groups of women (OR 0.45, 95%CI 0.30-0.66), <13 years of education (OR 0.48, 95%CI 0.34-0.67), living alone (OR 0.46, 95%CI 0.27-0.79), and living together (OR 0.57, 95%CI 0.38-0.85). No association existed between using ICT and frailty in the sub-groups of men and ≥13 years of education.

CONCLUSIONS AND IMPLICATIONS

Higher ICT use is associated with the absence of frailty in individuals 75 years and older. Such benefits may be particularly pronounced in women, those with lower levels of education, and older adults living alone or with others.

Impact of frailty in patients with non-valvular atrial fibrillation undergoing catheter ablation

Background

The relationships between frailty and clinical outcomes in elderly Japanese patients with non-valvular atrial fibrillation (NVAF) after catheter ablation (CA) have not been established. We evaluated the frailty rate of patients undergoing CA for NVAF, examined whether CA for NVAF improves frailty, and analyzed the CA outcomes of patients with and without frailty.

Methods

Elderly Japanese patients (≥65 years; mean age: 72.8 years) who participated in the real-world ablation therapy with anti-coagulants in management of atrial fibrillation registry and who responded to the frailty screening index survey were included (n = 213). Frailty and AF recurrence were assessed preoperatively and at 3 and 6 months after CA.

Results

Twenty-six patients (12.8%) were frail, 109 (53.7%) were pre-frail, and 68 (33.5%) were robust. Cardiovascular (frailty: 0.5%/person-year; pre-frailty: 0.1%/person-year; robust: 0.1%/person-year) and cardiac (frailty: 0.5%/person-year; pre-frailty: 0.1%/person-year; robust: 0.1%/person-year) events, as well as major bleeding (frailty: 0.3%/person-year; pre-frailty: 0.1%/person-year; robust: 0.1%/person-year), were numerically more frequent in the frailty group. No deaths from cardiovascular or stroke/systemic thromboembolic events occurred. A large proportion of patients did not experience 3-month (frailty: 96.2%; pre-frailty: 96.3%; robust: 88.2%) or 6-month (frailty: 88.5%; pre-frailty: 91.7%; robust: 86.8%) AF recurrence after CA. Weight loss, walking speed, and fatigue improved in the frailty and pre-frailty groups after CA.

Conclusion

Japanese patients aged ≥65 years with frailty or pre-frailty had improved frailty screening index components, such as weight loss, walking speed and fatigue, after CA. Therefore, elderly patients with frailty or pre-frailty may benefit from CA for NVAF.

Metabolic Syndrome and Positive Frailty Screening: A Cross-Sectional Study with Community-Dwelling Older Adults

Background

Metabolic Syndrome is a set of disorders that characterized by the association of three or more risk factors, like the obesity central, dyslipidemia, borderline blood pressure, hyperglycemia, and the increase of triglycerides. However, these factors also can be associated with pathophysiology of frailty.

Objectives

verifying whether the metabolic syndrome is associated to the positive frailty screening in the older people.

Design

Cross-sectional study. Participants: 443 older people living in Rio Branco, Brazil.

Setting

Data collection was carried out in two stages: a personal interview and blood collection.

Measurements

The diagnosis of metabolic syndrome was based on the criteria of the Third Report of the National Cholesterol Education Program Expert Panel on Detection, Evaluation and Treatment of High Blood Cholesterol in Adults. The frailty screening was performed using subjective questions validated in a previous study. Descriptive statistics and multinomial logistic regression were used for data analyses.

Results

There was a predominance of female older people (69.07%), aged between 60 and 79 years (87.13%), with an income greater than or equal to one minimum wage (72.09%), no cognitive decline (75.94%) and depressive symptoms (63.31%), independent for BADL (86.46%) and dependent for IADL (51.69%). From the total sample, 56.88% of the older people were identified as frail, 34.09% pre-frail and 9.03% non frail. The prevalence of metabolic syndrome was 51.69%. After adjusting by the independent variables, an association between metabolic syndrome and pre-frailty was observed, and older people with metabolic syndrome were more likely to be prefrail (RRR=2.36; 95%CI=1.08-5.18).

Conclusion

The metabolic syndrome was associated to the increase chance of screening for prefrailty in the older people evaluated, which reinforces the needy to establish preventive measures in relation to the metabolic syndrome to avoid frailty in the older people.