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 (≤0.65 m/s) and poor grip strength (≤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.