Identifying frailty in hospitalized older adults with significant coronary artery disease.

OBJECTIVES

To characterize physiological variation in hospitalized older adults with severe coronary artery disease (CAD) and evaluate the prevalence of frailty in this sample, to determine whether single-item performance measures are good indicators of multidimensional frailty, and to estimate the association between frailty and 6-month mortality.

DESIGN

Observational cohort study.

SETTING

Inpatient hospital cardiology ward.

PARTICIPANTS

Three hundred nine consecutive inpatients aged 70 and older admitted to a cardiology service (n = 309; 70% male, 84% white) with minimum two-vessel CAD determined using cardiac catheterization.

MEASUREMENTS

Two standard frailty phenotypes (Composite A and Composite B), usual gait speed, grip strength, chair stands, cardiology clinical variables, and 6-month mortality.

RESULTS

Prevalence of frailty was 27% for Composite A versus 63% for Composite B. Utility of single-item measures for identifying frailty was greatest for gait speed (receiver operating characteristic curve c statistic = 0.89 for Composite A, 0.70 for Composite B) followed by chair-stands (c = 0.83, 0.66) and grip strength (c = 0.78, 0.57). After adjustment, composite scores and single-item measures were individually associated with higher mortality at 6 months. Slow gait speed (< or =0.65 m/s) and poor grip strength (< or =25 kg) were stronger predictors of 6-month mortality than either composite score (gait speed odds ratio (OR)=3.8, 95% confidence interval (CI) = 1.1-13.1; grip strength OR = 2.7, 95% CI = 0.7-10.0; Composite A OR = 1.9, 95% CI = 0.60-6.1; chair-stand OR = 1.5, 95% CI = 0.5-5.1; Composite B OR = 1.3, 95% CI = 0.3-5.2).

CONCLUSION

Gait speed frailty was the strongest predictor of mortality in a population with CAD and may add to traditional risk assessments when predicting outcomes in this population.