title: Identifying frailty in hospitalized older adults with significant coronary artery disease.
abstract: 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.
authors.affiliation: Division of Geriatrics, Department of Medicine, Duke University Medical Center, Durham, North Carolina 27710, USA. jama.purser@duke.edu
authors.forename: Jama L
authors.initials: JL
authors.lastname: Purser
authors.forename: Maragatha N
authors.initials: MN
authors.lastname: Kuchibhatla
authors.forename: Gerda G
authors.initials: GG
authors.lastname: Fillenbaum
authors.forename: Tina
authors.initials: T
authors.lastname: Harding
authors.forename: Eric D
authors.initials: ED
authors.lastname: Peterson
authors.forename: Karen P
authors.initials: KP
authors.lastname: Alexander
mesh_terms: 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