Frailty and risk for heart failure in older adults: The health, aging, and body composition study

• Authors: Hassan Khan, University of Cambridge; Andreas Kalogeropoulos, Emory University; Vasiliki Georgiopoulou, Emory University; Anne B. Newman, University of Pittsburgh; Tamara B. Harris, National Institute on Aging; Nicolas Rodondi, Lausanne University Hospital; Douglas C. Bauer, University of California, San Francisco; Stephen B. Kritchevsky, Wake Forest University; Javed Butler, Emory University
• Journal Title: American Heart Journal
• Volume: Volume 166, Number 5
• Publisher: Elsevier: 12 months | 2013-11-01, Pages 887-894
• Type of Work: Article | Post-print: After Peer Review
• Publisher DOI: http://doi.org/10.1016/j.ahj.2013.07.032
• Subjects: Health Sciences, Medicine and Surgery; Health Sciences, Public Health
• Keywords: Science & Technology; Life Sciences & Biomedicine; Cardiac & Cardiovascular Systems; Cardiovascular System & Cardiology; LOWER-EXTREMITY PERFORMANCE; CARDIOVASCULAR-DISEASE; PHYSICAL FRAILTY; CONTROLLED TRIAL; EXERCISE; MORTALITY; ASSOCIATION; DISABILITY; PREDICTION; LEVEL

Abstract

Objective: The aim of this study was to assess the association between frailty and risk for heart failure (HF) in older adults. Background: Frailty is common in the elderly and is associated with adverse health outcomes. Impact of frailty on HF risk is not known. Methods: We assessed the association between frailty, using the Health ABC Short Physical Performance Battery (HABC Battery) and the Gill index, and incident HF in 2825 participants aged 70 to 79 years. Results: Mean age of participants was 74 ± 3 years; 48% were men and 59% were white. During a median follow up of 11.4 (7.1-11.7) years, 466 participants developed HF. Compared to non-frail participants, moderate (HR 1.36, 95% CI 1.08-1.71) and severe frailty (HR 1.88, 95% CI 1.02-3.47) by Gill index was associated with a higher risk for HF. HABC Battery score was linearly associated with HF risk after adjusting for the Health ABC HF Model (HR 1.24, 95% CI 1.13-1.36 per SD decrease in score) and remained significant when controlled for death as a competing risk (HR 1.30; 95% CI 1.00-1.55). Results were comparable across age, sex, and race, and in sub-groups based on diabetes mellitus or cardiovascular disease at baseline. Addition of HABC Battery scores to the Health ABC HF Risk Model improved discrimination (change in C-index, 0.014; 95% CI 0.018-0.010) and appropriately reclassified 13.4% (net-reclassification- improvement 0.073, 95% CI 0.021-0.125; P =.006) of participants (8.3% who developed HF and 5.1% who did not). Conclusions: Frailty is independently associated with risk of HF in older adults.