Abstract 12446: Trajectories of Frailty and Cardiovascular Outcomes Among Medicare Beneficiaries, 2003-2015

Abstract

Background: Frailty is associated with adverse cardiovascular outcomes independent of age and comorbidities, yet the independent role of frailty progression on health outcomes remains uncertain. Methods: In Medicare Fee-for-Service beneficiaries ≥ 65 years with continuous enrollment from 2003-2015, we calculated frailty progression or regression, using a continuous, validated Fried phenotype-based frailty index in years 1-5. We used linear mixed effects models and Cox proportional hazards models, adjusting for baseline frailty, to evaluate the influence of frailty trajectory on the risk of adverse health outcomes (death, HF, MI, ischemic stroke, MACE, and days at home [DAH] within the calendar year). Results: Among 26,414,887 individuals (mean age 75.4 ± 7.0 years, 57% female, 13% non-white race), 20.4% had frailty progression and 13.6% had frailty regression. Compared to frailty regressors, progressors had a greater risk of mortality (HR 1.59, 95% CI 1.58-1.59) and all cardiovascular outcomes. With increasing quartile of frailty progression and adjusting for baseline frailty, there was a graded risk in mortality (quartile 4 vs. 1, HR 2.21, 95% CI 2.21-2.23, p < 0.001) and all adverse cardiovascular outcomes (Figure). Compared to those in the lowest frailty progression quartile, those in the highest quartile had significantly fewer DAH (270.4 ± 112.3 vs. 308.6 ± 93.0, RR 0.88, 95% CI 0.87-0.88, p < 0.001). Conclusions: In this large, nationwide sample of older Medicare beneficiaries, the degree of frailty progression, independent of baseline frailty, was associated with increased risk of all-cause mortality, HF, MI, ischemic stroke, and MACE, and fewer DAH. Frailty progression therefore identifies patients at high risk for adverse outcomes and increased health services utilization.