Factors associated with change in frailty scores and long-term outcomes in older adults with coronary artery disease

OBJECTIVE Older adults with coronary artery disease (CAD) are at risk for frailty. However, little is known regarding transition in frailty measures over time or its impact on outcomes. We sought to determine the association of temporal change in frailty with long-term outcome in older adults with CAD. METHODS We re-assessed for phenotypic frailty using the Fried index (0 = not frail; 1-2 = pre-frail; >= 3 frail) in a cohort of CAD patients >= 65 years old at 2 time points 5 years apart. Factors associated with frailty worsening were assessed with scatterplots and outcomes estimated using the Kaplan-Meier method. Cox models were used to assess the risk of worsening frailty on outcome. RESULTS There were 45 subjects that completed both baseline and 5-year Fried frailty assessment. Mean age was 74.6 +/- 5.9 and 30 (67%) were men. Frailty incidence increased over time: baseline (3% frail, 37% pre-frail); 5 years (10% frail, 40% pre-frail). Baseline factors were not predictors of worsening frailty score, while both slower walk time (r = 0.46; P = 0.004) and diminishing grip strength (r = -0.39; P = 0.01) were associated with worsening frailty transitions. In follow-up (median 5.2 years), long-term major adverse cardiac event (MACE) free survival (P = 0.12) or hospitalization (P = 0.98) was not different for those with worsening frailty score (referent: improved/unchanged frailty). Frailty worsening had a trend towards increased risk of MACE (HR = 1.86; 95% CI: 0.65-5.27, P = 0.25). CONCLUSIONS Frailty transitions, specifically, declines in walk time and grip strength, were strongly associated with worsening frailty score in a cohort of older adults with CAD than were baseline indices, though frailty change status was not independently associated with MACE outcomes.