Progression of frailty and cardiovascular outcomes among Medicare beneficiaries

IF 4.3 2区医学 Q1 GERIATRICS & GERONTOLOGY Journal of the American Geriatrics Society Pub Date : 2024-08-01 DOI:10.1111/jgs.19116

Yusi Gong MD, Yang Song MSc, Jiaman Xu MPH, Huaying Dong MSc, Daniel B. Kramer MD, MPH, Ariela R. Orkaby MD, MPH, John A. Dodson MD, MPH, Jordan B. Strom MD, MSc

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Abstract

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.

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医疗保险受益人的虚弱程度和心血管疾病后果的进展。

背景：虚弱与心血管不良后果相关，与年龄和合并症无关：虚弱与不良心血管预后相关，与年龄和合并症无关，但虚弱进展对心血管预后的独立影响仍不确定：为了确定虚弱进展是否与不良心血管预后相关，而与基线虚弱和年龄无关，我们评估了所有在队列开始时年龄≥65 岁的联邦医疗保险付费服务受益人，他们在 2003 年至 2015 年期间连续参加了队列。根据基线虚弱程度和年龄进行调整后，使用线性混合效应模型来估算 5 年间基于索赔的有效虚弱指数（CFI）的变化。使用生存分析来检验虚弱程度的进展和不良健康后果的风险：共识别出 890 万名患者，平均年龄为 77.3 ± 7.2 岁，58.7% 为女性，10.9% 为非白人。在 2.4 年的中位随访中，60% 的患者体弱程度加深，40% 的患者体弱程度减轻。在调整年龄和基线 CFI 后，与体弱衰退者相比，体弱衰退者发生重大心脑血管不良事件 (MACCE) 的风险明显更高（危险比 [HR] 1.31，95% 置信区间 [CI] 1.31-1.31）、全因死亡率（HR 1.34，95% CI 1.34-1.34）、急性心肌梗死（HR 1.08，95% CI 1.07-1.09）、心衰加重（HR 1.30，95% CI 1.29-1.30）、缺血性中风（HR 1.14，95% CI 1.14-1.15）。与进展最慢的组别相比，进展较快的组别发生各种结果的风险也呈梯度增加，而且进展较快的组别在家中存活的天数（DAH）也明显较少（270.4 ± 112.3 对 308.6 ± 93.0 天，比率比为 0.88，95% CI 0.87-0.88，P 结论：这是一项全国性的大型样本研究，研究结果表明，与进展最慢的组别相比，进展较快的组别发生各种结果的风险也呈梯度增加：在这一大型的全国性老年医疗保险受益人样本中，与体弱衰退的受益人相比，体弱衰退与年龄和基线体弱无关，与较少的 DAH 以及 MACCE、全因死亡率、心肌梗死、心力衰竭和缺血性中风的分级风险相关。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of the American Geriatrics Society 医学-老年医学

CiteScore

10.00

自引率

6.30%

发文量

504

审稿时长

3-6 weeks

期刊介绍： Journal of the American Geriatrics Society (JAGS) is the go-to journal for clinical aging research. We provide a diverse, interprofessional community of healthcare professionals with the latest insights on geriatrics education, clinical practice, and public policy—all supporting the high-quality, person-centered care essential to our well-being as we age. Since the publication of our first edition in 1953, JAGS has remained one of the oldest and most impactful journals dedicated exclusively to gerontology and geriatrics.

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