Identifying Frailty in Hospitalized Older Adults with Significant Coronary Artery Disease

Authors

  • Jama L. Purser PT, PhD,

    1. From the *Division of Geriatrics, Department of Medicine, Physical Therapy Division, Department of Community and Family Medicine, Center for the Study of Aging and Human Development, §Department of Biostatistics and Bioinformatics, Division of Medical Psychology, Department of Psychiatry and Behavioral Sciences, Geriatric Research, Education and Clinical Center, Veterans' Affairs Medical Center, #Duke Clinical Research Institute, and **Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, North Carolina.
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  • Maragatha N. Kuchibhatla PhD,

    1. From the *Division of Geriatrics, Department of Medicine, Physical Therapy Division, Department of Community and Family Medicine, Center for the Study of Aging and Human Development, §Department of Biostatistics and Bioinformatics, Division of Medical Psychology, Department of Psychiatry and Behavioral Sciences, Geriatric Research, Education and Clinical Center, Veterans' Affairs Medical Center, #Duke Clinical Research Institute, and **Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, North Carolina.
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  • Gerda G. Fillenbaum PhD,

    1. From the *Division of Geriatrics, Department of Medicine, Physical Therapy Division, Department of Community and Family Medicine, Center for the Study of Aging and Human Development, §Department of Biostatistics and Bioinformatics, Division of Medical Psychology, Department of Psychiatry and Behavioral Sciences, Geriatric Research, Education and Clinical Center, Veterans' Affairs Medical Center, #Duke Clinical Research Institute, and **Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, North Carolina.
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  • Tina Harding RN,

    1. From the *Division of Geriatrics, Department of Medicine, Physical Therapy Division, Department of Community and Family Medicine, Center for the Study of Aging and Human Development, §Department of Biostatistics and Bioinformatics, Division of Medical Psychology, Department of Psychiatry and Behavioral Sciences, Geriatric Research, Education and Clinical Center, Veterans' Affairs Medical Center, #Duke Clinical Research Institute, and **Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, North Carolina.
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  • Eric D. Peterson MD,

    1. From the *Division of Geriatrics, Department of Medicine, Physical Therapy Division, Department of Community and Family Medicine, Center for the Study of Aging and Human Development, §Department of Biostatistics and Bioinformatics, Division of Medical Psychology, Department of Psychiatry and Behavioral Sciences, Geriatric Research, Education and Clinical Center, Veterans' Affairs Medical Center, #Duke Clinical Research Institute, and **Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, North Carolina.
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  • Karen P. Alexander MD

    1. From the *Division of Geriatrics, Department of Medicine, Physical Therapy Division, Department of Community and Family Medicine, Center for the Study of Aging and Human Development, §Department of Biostatistics and Bioinformatics, Division of Medical Psychology, Department of Psychiatry and Behavioral Sciences, Geriatric Research, Education and Clinical Center, Veterans' Affairs Medical Center, #Duke Clinical Research Institute, and **Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, North Carolina.
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  • A poster on this topic was presented at the 2005 Annual Scientific Meeting of the Gerontological Society of America, for which Dr. Purser received the Research Award from the Clinical Medicine Section.

Address correspondence to Jama L. Purser, PT, PhD, Box 3003, Rm 0512 Blue Zone, Duke University Medical Center, Durham, NC 27710. E-mail: jama.purser@duke.edu

Abstract

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.

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