Identifying frailty in hospitalized older adults with significant coronary artery disease.
OBJECTIVE
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.


METHODS
Observational cohort study.


METHODS
Inpatient hospital cardiology ward.


METHODS
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.


METHODS
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 (< or =0.65 m/s) and poor grip strength (< or =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).


CONCLUSIONS
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.
Purser
Jama L
JL
Division of Geriatrics, Department of Medicine, Duke University Medical Center, Durham, North Carolina 27710, USA. jama.purser@duke.edu
Kuchibhatla
Maragatha N
MN
Fillenbaum
Gerda G
GG
Harding
Tina
T
Peterson
Eric D
ED
Alexander
Karen P
KP
D000368:Aged; D019540:Area Under Curve; D015331:Cohort Studies; D003324:Coronary Artery Disease / Q000401:mortality / Q000503:physiopathology*; D005260:Female; D016330:Frail Elderly / Q000706:statistics & numerical data*; D005684:Gait / Q000502:physiology*; D018737:Hand Strength / Q000502:physiology*; D006760:Hospitalization; D006801:Humans; D016015:Logistic Models; D008297:Male; D011379:Prognosis; D012680:Sensitivity and Specificity