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Aging and disease    2018, Vol. 9 Issue (3) : 489-497     DOI: 10.14336/AD.2017.1125
Orginal Article |
Frailty in Older Adults with Cardiovascular Disease: Cause, Effect or Both?
Kleipool Emma EF.1, Hoogendijk Emiel O.2, Trappenburg Marijke C.1, Handoko M. Louis3, Huisman Martijn2,4, Peters Mike JL.1, Muller Majon1,*
1Department of Internal medicine and Geriatrics, VU University Medical Center, 1081 HV Amsterdam, The Netherlands
2Department of Epidemiology and Biostatistics, Amsterdam Public Health research institute, VU University Medical Center, 1007 MB Amsterdam, The Netherlands
3Department of Cardiology, VU University Medical Center, 1081 HV Amsterdam, The Netherlands
4Department of Sociology, VU University, 1081 HV Amsterdam, The Netherlands
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Abstract  

Cardiovascular disease (CVD) has been associated with an increased risk of frailty, but the direction of the association remains unclear. This study set out to examine the bidirectional longitudinal association between CVD and frailty over an extended period of time. Data are from 1432 older adults (aged 65-88yrs) of the Longitudinal Aging Study Amsterdam (LASA), who were followed for 17 years. At baseline and follow-up, CVD was assessed through self-report, medication use and medical records, and classified as angina pectoris, myocardial infarction, heart failure (HF), stroke, and peripheral artery disease. Throughout the study, frailty was assessed using Fried’s frailty criteria. Cox regression models showed that patients with HF had an increased frailty risk (HR 2.7; 95%CI: 1.5-5.1) after a median follow-up of 8.4 yrs. This finding was independent of potential confounders (age, sex, several comorbidities). Examinations of the reverse association revealed that frail older adults were not at risk of incident CVD. Of all older adults with CVD, those with HF have an increased risk of frailty and frail older adults do not have an increased risk of CVD. Our findings emphasize the need for cardiac rehabilitation programs evaluating the effect of physical exercise programs in order to prevent frailty and therewith improve quality of life and independence of care in CVD patients.

Keywords Frailty      older adults      cardiovascular disease      heart failure     
Corresponding Authors: Muller Majon   
About author:

Those authors contributed equally to this work.

Issue Date: 05 June 2018
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Kleipool Emma EF.
Hoogendijk Emiel O.
Trappenburg Marijke C.
Handoko M. Louis
Huisman Martijn
Peters Mike JL.
Muller Majon
Cite this article:   
Kleipool Emma EF.,Hoogendijk Emiel O.,Trappenburg Marijke C., et al. Frailty in Older Adults with Cardiovascular Disease: Cause, Effect or Both?[J]. Aging and disease, 2018, 9(3): 489-497.
URL:  
http://www.aginganddisease.org/EN/10.14336/AD.2017.1125     OR     http://www.aginganddisease.org/EN/Y2018/V9/I3/489
CVD
P-value
Yes
n=148
No
n=1284
Demographics
Age (yrs) a78.3 ± 5.975.4 ± 6.60.01
Sex (%female)47%52%0.28

Frailty score
Weight lossb32 (22%)218 (18%)0.14
Weak grip strengthc86 (56%)470 (36%)0.00
Exhaustiond46 (30%)196 (15%)0.00
Slow gait speede50 (35%)231 (18%)0.00
Low physical activityf50 (35%)253 (20%)0.00

Cardiovascular diseaseg
Angina pectoris83 (56%)
Myocardial infarction16 (11%)
Heart failure54 (37%)
Stroke14 (10%)
Peripheral artery disease14 (10%)

Cardiovascular risk factors
Nutritional statusg0.03
Low weight (BMIh <20)2 (1%)54 (4%)
Normal weight (BMI 20-25)35 (24%)396 (31%)
Overweight (BMI >25)111 (75%)834 (65%)
Systolic blood pressure (mmHg)a151 ± 28154 ± 260.18
Diastolic blood pressure (mmHg)a81 ± 1683 ± 130.03
Serum cholesterol (mmol/L)a
Total cholesterol5.6 ± 1.05.7 ± 1.00.50
LDL cholesterol3.6 ± 0.93.7 ± 1.00.43
HDL cholesterol1.2 ± 0.41.4 ± 0.40.00
Triglycerides1.7 ± 0.91.5 ± 0.70.00
Smokingg
Never Former Current

50 (34%) 77 (52%) 20 (14%)

459 (36%) 570 (44%) 254 (20%)
0.10
Alcohol useg
No Light Moderate/excessive

45 (31%) 71 (48%) 31 (21%)

311 (24%) 641 (50%) 330 (26%)
0.19
Chronic diseasesg
Chronic lung disease36 (24%)188 (15%)0.00
Arthritis57 (39%)602 (47%)0.38
Cancer19 (13%)156 (12%)0.81
Diabetes mellitus20 (14%)95 (7%)0.01
Urine incontinence54 (37%)332 (26%)0.01
Medicationg
No. of drugs taken 0 1 ≥ 2 Antihypertensive drugs Lipid lowering drugs

3 (2%) 5 (3%) 140 (95%) 126 (85%) 14 (10%)

351 (27%) 287 (23%) 646 (50%) 456 (36%) 51 (4%)

0.00 0.00 0.00
Table 1  Baseline characteristics in subjects with and without CVD (n=1432).
Odds ratio95% CIp-value
CVDa
Combinedb2.111.39-3.210.00
AP2.091.23-3.550.01
MI1.920.48-7.590.36
HF2.661.44-4.920.00
Stroke1.600.47-5.450.45
PAD3.501.01-12.120.05

CVDc
Combinedb1.771.13-2.750.01
AP1.650.94-2.890.08
MI2.430.57-10.390.23
HF2.131.15-4.080.02
Stroke1.790.51-6.320.37
PAD4.081.07-15.610.04

Chronic diseases
Lung disease1.851.26-2.720.00
Arthritis2.221.59-3.090.00
Cancer1.120.70-1.300.65
Diabetes1.490.91-2.440.11
Urine incontinence2.481.79-3.440.00

Polypharmacyd3.752.64-5.320.00
Table 2  Cross-sectional association of CVD, other co-morbidities, polypharmacy with frailty risk (n=1432).
Hazard ratio95% CIp-value
CVDa
Combinedb1.410.95-2.080.09
AP1.210.72-2.050.47
MI0.570.14-2.290.43
HF2.281.27-4.080.01
Stroke1.760.56-5.010.33
PAD1.590.39-6.400.52

CVDc
Combinedb1.360.92-2.000.12
AP1.180.70-1.990.54
MI0.580.14-2.320.44
HF2.091.14-3.830.02
Stroke1.870.59-5.560.28
PAD1.810.45-7.240.40

Chronic diseases
Lung disease1.401.01-1.930.04
Arthritis1.701.33-2.160.00
Cancer1.010.68-1.480.97
Diabetes1.751.14-2.680.01
Urine incontinence1.140.87-1.510.34

Polypharmacyd1.881.36-2.590.00
Table 3  Longitudinal association between CVD and frailty, excluding subject’s frail at baseline (n=1222).
[1] (2011). Prevalence of coronary heart disease--United States, 2006-2010. MMWR Morb Mortal Wkly Rep, 60: 1377-1381
[2] Roger VL, Jacobsen SJ, Weston SA, Bailey KR, Kottke TE, Frye RL (1999). Trends in heart disease deaths in Olmsted County, Minnesota, 1979-1994. Mayo Clin Proc, 74: 651-657
[3] Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, et al. (2001). Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci, 56: M146-156
[4] Rockwood K, Stadnyk K, MacKnight C, McDowell I, Hebert R, Hogan DB (1999). A brief clinical instrument to classify frailty in elderly people. Lancet, 353: 205-206
[5] Clegg A, Young J, Iliffe S, Rikkert MO, Rockwood K (2013). Frailty in elderly people. Lancet, 381: 752-762
[6] Song X, Mitnitski A, Rockwood K (2010). Prevalence and 10-year outcomes of frailty in older adults in relation to deficit accumulation. J Am Geriatr Soc, 58: 681-687
[7] Speechley M, Tinetti M (1991). Falls and injuries in frail and vigorous community elderly persons. J Am Geriatr Soc, 39: 46-52
[8] Gharacholou SM, Roger VL, Lennon RJ, Rihal CS, Sloan JA, Spertus JA, et al. (2012). Comparison of frail patients versus nonfrail patients >/=65 years of age undergoing percutaneous coronary intervention. Am J Cardiol, 109: 1569-1575
[9] Chaves PH, Semba RD, Leng SX, Woodman RC, Ferrucci L, Guralnik JM, et al. (2005). Impact of anemia and cardiovascular disease on frailty status of community-dwelling older women: the Women’s Health and Aging Studies I and II. J Gerontol A Biol Sci Med Sci, 60: 729-735
[10] Newman AB, Simonsick EM, Naydeck BL, Boudreau RM, Kritchevsky SB, Nevitt MC, et al. (2006). Association of long-distance corridor walk performance with mortality, cardiovascular disease, mobility limitation, and disability. JAMA, 295: 2018-2026
[11] Walston J, McBurnie MA, Newman A, Tracy RP, Kop WJ, Hirsch CH, et al. (2002). Frailty and activation of the inflammation and coagulation systems with and without clinical comorbidities: results from the Cardiovascular Health Study. Arch Intern Med, 162: 2333-2341
[12] Huisman M, Poppelaars J, van der Horst M, Beekman AT, Brug J, van Tilburg TG, et al. (2011). Cohort profile: the Longitudinal Aging Study Amsterdam. Int J Epidemiol, 40: 868-876
[13] Hoogendijk EO, Deeg DJ, Poppelaars J, van der Horst M, Broese van Groenou MI, Comijs HC, et al. (2016). The Longitudinal Aging Study Amsterdam: cohort update 2016 and major findings. Eur J Epidemiol, 31: 927-945
[14] Saum KU, Muller H, Stegmaier C, Hauer K, Raum E, Brenner H (2012). Development and evaluation of a modification of the Fried frailty criteria using population-independent cutpoints. J Am Geriatr Soc, 60: 2110-2115
[15] Hoogendijk EO, van Hout HP, van der Horst HE, Frijters DH, Dent E, Deeg DJ, et al. (2014). Do psychosocial resources modify the effects of frailty on functional decline and mortality? J Psychosom Res, 77: 547-551
[16] Gruenewald TL, Seeman TE, Karlamangla AS, Sarkisian CA (2009). Allostatic load and frailty in older adults. J Am Geriatr Soc, 57: 1525-1531
[17] Radloff L (1977). The CES-D scale: a self-report depression scale for research in the general population. Appl. Psychol. Meas., 1: 385-401
[18] Sanders JB, Bremmer MA, Deeg DJ, Beekman AT (2012). Do depressive symptoms and gait speed impairment predict each other’s incidence? A 16-year prospective study in the community. J Am Geriatr Soc, 60: 1673-1680
[19] Stel VS, Smit JH, Pluijm SM, Visser M, Deeg DJ, Lips P (2004). Comparison of the LASA Physical Activity Questionnaire with a 7-day diary and pedometer. J Clin Epidemiol, 57: 252-258
[20] Kriegsman DM, Penninx BW, van Eijk JT, Boeke AJ, Deeg DJ (1996). Self-reports and general practitioner information on the presence of chronic diseases in community dwelling elderly. A study on the accuracy of patients’ self-reports and on determinants of inaccuracy. J Clin Epidemiol, 49: 1407-1417
[21] (1989) Central Bureau of Statistics (CBS).Health Interview Questionnaire. The Hague, the Netherlands
[22] Garretsen H (1983). Problem drinkers. Lisse: Swets & Zeitlinger
[23] Pahor M, Chrischilles EA, Guralnik JM, Brown SL, Wallace RB, Carbonin P (1994). Drug data coding and analysis in epidemiologic studies. Eur J Epidemiol, 10: 405-411
[24] Boyd CM, Darer J, Boult C, Fried LP, Boult L, Wu AW (2005). Clinical practice guidelines and quality of care for older patients with multiple comorbid diseases: implications for pay for performance. JAMA, 294: 716-724
[25] Woods NF, LaCroix AZ, Gray SL, Aragaki A, Cochrane BB, Brunner RL, et al. (2005). Frailty: emergence and consequences in women aged 65 and older in the Women’s Health Initiative Observational Study. J Am Geriatr Soc, 53: 1321-1330
[26] Maddocks M, Kon SS, Canavan JL, Jones SE, Nolan CM, Labey A, et al. (2016). Physical frailty and pulmonary rehabilitation in COPD: a prospective cohort study. Thorax, 71: 988-995
[27] Andrews JS, Trupin L, Yelin EH, Hough CL, Covinsky KE, Katz PP (2017). Frailty and reduced physical function go hand in hand in adults with rheumatoid arthritis: a US observational cohort study. Clin Rheumatol
[28] Wise BL, Parimi N, Zhang Y, Cawthon PM, Barrett-Connor E, Ensrud KE, et al. (2014). Frailty and hip osteoarthritis in men in the MrOS cohort. J Gerontol A Biol Sci Med Sci, 69: 602-608
[29] Handforth C, Clegg A, Young C, Simpkins S, Seymour MT, Selby PJ, et al. (2015). The prevalence and outcomes of frailty in older cancer patients: a systematic review. Ann Oncol, 26: 1091-1101
[30] DuBeau CE, Kuchel GA, Johnson T2nd, Palmer MH, Wagg A, Fourth International Consultation on I (2010). Incontinence in the frail elderly: report from the 4th International Consultation on Incontinence. Neurourol Urodyn, 29: 165-178
[31] Ng TP, Feng L, Nyunt MS, Larbi A, Yap KB (2014). Frailty in older persons: multisystem risk factors and the Frailty Risk Index (FRI). J Am Med Dir Assoc, 15: 635-642
[32] Cacciatore F, Abete P, Mazzella F, Viati L, Della Morte D, D’Ambrosio D, et al. (2005). Frailty predicts long-term mortality in elderly subjects with chronic heart failure. Eur J Clin Invest, 35: 723-730
[33] Purser JL, Kuchibhatla MN, Fillenbaum GG, Harding T, Peterson ED, Alexander KP (2006). Identifying frailty in hospitalized older adults with significant coronary artery disease. J Am Geriatr Soc, 54: 1674-1681
[34] Jha SR, Ha HS, Hickman LD, Hannu M, Davidson PM, Macdonald PS, et al. (2015). Frailty in advanced heart failure: a systematic review. Heart Fail Rev, 20: 553-560
[35] Denfeld QE, Winters-Stone K, Mudd JO, Gelow JM, Kurdi S, Lee CS (2017). The prevalence of frailty in heart failure: A systematic review and meta-analysis. Int J Cardiol, 236: 283-289
[36] Blom J, den Elzen W, van Houwelingen AH, Heijmans M, Stijnen T, Van den Hout W, et al. (2016). Effectiveness and cost-effectiveness of a proactive, goal-oriented, integrated care model in general practice for older people. A cluster randomised controlled trial: Integrated Systematic Care for older People--the ISCOPE study. Age Ageing, 45: 30-41
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