Association Of Frailty Index Research Articles

Association of frailty index with all-cause and cardiovascular mortality with different diabetic status: NHANES 1999-2018.

The relationship between frailty and mortality among individuals with varying diabetic statuses represents a burgeoning area of concern and scholarly interest within the medical community. However, there are limited studies that explore the relationship between frailty and mortality, as well as cause-specific mortality among individuals with non-diabetes, prediabetes, and diabetes patients. Hence, this study aims to investigate the relationship between the frailty statues and all-cause mortality, as well as cause-specific mortality in individuals with varying diabetic statuses using the data in the NHANES database. The study utilized data from the National Health and Nutrition Examination Survey (NHANES) 1999-2018, incorporating a final sample size of 57, 098 participants. Both univariable and multivariable-adjusted logistic regression analyses, as well as Cox regression analysis were employed to examine the relationship between frailty index (FI) and mortality. This study, found a significant positive correlation between the frailty and the increased risk of all-cause mortality non-diabetic [OR 4.277, 95%CI (3.982, 4.594), P < 0.001], prediabetic [OR 2.312, 95%CI (2.133, 2.506), P < 0.001], and diabetic patients [OR 3.947, 95%CI (3.378, 4.611), P < 0.001]. This correlation still existed even after adjusting for confounding factors including age, sex, BMI, poverty, fasting insulin, education, smoke, alcohol drink, waist, hypertension, hyperlipidemia, fasting glucose, HbA1c, eGFR, creatinine and total bilirubin. Our result also suggested a significant positive correlation between the frailty index and the increased risk of CVD mortality among non-diabetic [OR 3.095, 95%CI (2.858, 3.352), P < 0.001] and prediabetic [OR 5.985, 95%CI (5.188, 6.904), P < 0.001] individuals. However, in patients with diabetes, the correlation between frailty and CVD mortality lost significance after adjusting for possible confounding factors [OR 1.139, 95%CI (0.794, 1.634), P > 0.05]. A nonlinear relationship has been identified between the FI and all-cause mortality, as well as CVD mortality in non-diabetic and pre-diabetic population. In diabetic patients, there was a significant positive correlation between the frailty and the increased risk of all-cause mortality, but not with CVD mortality. Renal function and liver function might potentially acted as an intermediary factor that elevated the risk of CVD mortality in frail patients with diabetes.

The prevalence of frailty and its effect on the outcome in cardiac resynchronization therapy patients.

Frailty is a complex clinical syndrome associated with aging and comorbidities, which correlates with unfavorable outcomes. However, in heart failure patients, frailty is very common, data is scarce about those, who are eligible for Cardiac Resynchronization Therapy (CRT) implantation. We investigated the incidence of frailty and the association of Frailty Index (FI) with the outcome. Thirty baseline clinical parameters were used by the Rockwood cumulative deficit method to determine patients' FI in our single-center cohort. Based on previous studies, patients with FI ≤ 0.210 were considered as non-frail, those with FI 0.10-0.210 were classified in Frail-1, with FI > 0.10 in Frail-2 groups, respectively. Echocardiographic response after 12months and all-cause mortality were investigated by frailty groups. Among 1004 included patients, 75 (7%) were considered Non-frail, 271 (27%) grouped in Frail-1, and 658 (66%) in Frail-2 with a median FI of 0.36 (0.28-0.43). Patients in Frail-2 group were older, with more comorbidities compared with non-frail patients or those in Group Frail-1. During the median follow-up time of 4.8years, 29 (39%) patients died in the Non-frail, 140 (52%) in Frail-1, and 471 (72%) in the Frail-2 groups (log-rank p < 0.001). Group Frail-2 showed an unfavorable outcome compared to the non-frail (HR 2.49, 95%CI 1.92-3.22; p < 0.001) and the Frail-1 group (1.83, 95%CI 1.55-2.16; p < 0.001). In our HFrEF patients eligible for CRT implantation, patients were exceedingly vulnerable with a high prevalence of frailty. The calculated frailty index was associated with outcome and proved to be prevalent in individual risk stratification.

Association of Frailty Index and Outcomes After Acute Limb Ischemia Revascularization in the VQI

Association of Frailty Index and Outcomes After Acute Limb Ischemia Revascularization in the VQI

Frailty index and risk of cardiovascular diseases: a mendelian randomization study.

BackgroundPrevious epidemiological evidence has suggested that frailty status might be associated with cardiovascular diseases (CVDs). However, the exact causality remains unestablished. In this study, we employed Mendelian randomization and sought to investigate the potential causality in association of frailty index (FI) with cardiovascular outcomes [coronary artery disease (CAD), myocardial infarction (MI), atrial fibrillation (AF), and heart failure (HF)].MethodsIndependent single nucleotide polymorphisms (SNPs) at genome-wide significance for FI were obtained from a recent genome-wide association study (GWAS) meta-analysis of European descent (n=175,226). The association of these SNPs with CVDs was examined in summary statistics from corresponding GWASs of European descent (CAD: 184,305 cases and 60,801 controls; MI: 184,305 cases and 43,676 controls; AF: 1,030,836 cases and 60,620 controls; and HF: 977,323 cases and 47,309 controls). Replication analyses were performed using GWAS datasets from FinnGen.ResultsIn the meta-analysis of inverse-variance weighted estimates from different data sources, genetically determined higher FI conferred an odds ratio (OR) of 1.46 [95% confidence interval (CI): 1.13 to 1.87; P=0.003] for CAD, 1.62 (95% CI: 1.21 to 2.17, P=0.001) for MI, and 1.46 (95% CI: 1.24 to 1.72; P=4.89×10−6) for HF. However, FI failed to be potentially influential on AF risk (OR, 1.43; 95% CI: 0.93 to 1.66; P=0.107). Several complementary analyses also received broadly concordant results.ConclusionsWe have provided genetic evidence of a causal association between FI and the risk of CAD, MI, and HF. Further studies are warranted to clarify whether FI is causally related to AF risk.

Association of Frailty Index with Clinical BPH Progression and Serious Adverse Events: the MTOPS Trial

Lower urinary tract symptoms due to suspected benign prostatic hyperplasia (BPH) are increasingly treated with medications targeting obstruction among older men, but frailty may represent a novel risk factor for this condition. Our objective was to assess the associations between frailty and clinical BPH progression or serious adverse events (SAE) among 3047 men, age 50-89 years, enrolled in the Medical Therapy of Prostatic Symptoms Study, a placebo-controlled RCT of doxazosin, finasteride, or combination therapy on clinical BPH progression. We created a frailty index using 69 items collected at baseline and categorized men as fit (0-0.1), less fit (0.1-<0.25), or frail (0.25-1.0). The primary outcomes were time to 1) first composite event of clinical BPH progression, and 2) SAE requiring hospitalization. Cox proportional hazards models were adjusted for demographics, intervention, BPH surrogates, and comorbidities. At baseline, 28% men were fit, 58% were less fit, and 14% were frail. During follow-up (mean 4.5 years), the incidence rate of clinical BPH progression was 2.2/100p-y among fit, 3.0/100p-y among less fit (HR =1.28, 95% CI 0.98, 1.67), and 4.1/100p-y among frail men (HR=1.60, 95% CI 1.13, 2.26). Among men randomized to combination therapy, the SAE incidence rate was 3.4/100p-y for fit men versus 12.7/100p-y for frail men (HR=5.98, 95% CI 3.76, 9.52). In conclusion, frailty is independently associated with greater risk of both clinical BPH progression and SAE. The decision to initiate medical therapy for BPH among frail men should therefore include a discussion of both benefits and risks via shared decision making.

THE ASSOCIATION OF A FRAILTY INDEX AND INCIDENT DELIRIUM IN HOSPITALIZED VETERANS

Frailty is an accumulation of deficits that helps identify patients who are vulnerable to stressors. Acute illness and hospitalization are stressors that may result in delirium. Delirium is significant in older adults, resulting in increased hospital stays, institutionalization, morbidity, and mortality. This study aimed to determine if a frailty index (FI), calculated on hospital admission, was associated with the development of incident delirium. An FI was built on an accumulation of deficits model which included assessments of cognition, physical function, and medical comorbidities for a cohort of 218 patients admitted to a Veteran Affairs medical facility. The FI was calculated as a proportion of possible deficits (range 0-1; higher scores indicate increased frailty). Delirium was assessed daily by expert clinician interview. Participants were, on average, 71 years (SD=9.53), white (92.7%), and male (91.7%). Participants were grouped using FI ranges as non-frail (FI<0.25; 26%), pre-frail (FI=0.25-0.35; 39%), and frail (FI>0.35; 35%). Incident delirium was more likely to occur in those who were frail (29.3%, p=0.001), compared to those who were pre-frail (20.9%) or non-frail (3.6%). The association of FI and incident delirium remained after adjustment for age, education, and other demographics (pre-frail: adjusted OR=5.64, 95%CI; 1.23, 25.99; frail: adjusted OR=6.80, 95%CI; 1.38, 33.45). Continued data analysis will include an AUC model to demonstrate robustness of the FI. The results from this study support the use of frailty assessments at hospital admission to identify patients at high risk of delirium and in need of additional clinical support and interdisciplinary resources.

Association of frailty index with perioperative mortality and in-hospital morbidity after elective lower extremity bypass

ObjectiveThe frailty index has been linked to adverse outcomes after surgical procedures. In this study, we evaluated the association between frailty index and outcomes after elective lower extremity bypass (LEB) for lower extremity ischemia. MethodsThe American College of Surgeons National Surgical Quality Improvement Program data set (2005-2012) was used to identify patients who underwent elective LEB using diagnostic and procedure Current Procedural Terminology codes. Modified frailty index (mFI) scores, derived from the Canadian Study of Health and Aging, were categorized into three groups: low, medium, and high. Association of mFI with 30-day postoperative death (POD), myocardial infarction (MI), cardiopulmonary events (CPEs), deep tissue surgical site infection (SSI), and graft failure (GF) was evaluated. Both univariate and multivariable regression analyses—adjusted for age, sex, American Society of Anesthesiologists class, body mass index, and creatinine levels—were used to assess the effect of frailty on each outcome. ResultsOf 12,677 patients (mean age, 67.7 ± 11.1 years) identified who underwent elective LEB, POD occurred in 265 (2.1% overall). Postoperative MI, SSI, CPEs, and GF occurred in 1.6%, 2.5%, 3.1%, and 4.3%, respectively. The mean mFI of the entire sample was 0.3 ± 0.1. Adjusted odds ratio for development of any morbidity in the group with the highest mFI was 1.36 (95% confidence interval, 1.08-1.72; P = .010) compared with the low frailty group. Patients with higher mFI were more likely to develop MI and CPEs but not SSI or GF. Univariate and multivariable analyses showed a significantly increased risk of POD among those in the highest mFI tertile. Female sex and age, increased American Society of Anesthesiologists class and creatinine levels, and decreased body mass index independently predicted increased mortality. The addition of categorical mFI improved models with these variables. ConclusionsHigher mFI is independently associated with higher mortality and morbidity. Preoperative mFI assessment may be considered an additional screening tool for risk stratification among patients undergoing LEB.