title: Frailty Trajectories After Treatment for Coronary Artery Disease in Older Patients.
abstract: Frailty is an independent risk factor for cardiovascular outcomes. However, its trajectory after coronary artery disease treatment is unknown.
  
  
  
  Three hundred seventy-four patients undergoing nonemergent cardiac catheterization followed by treatment (ie, 128 coronary artery bypass graft [CABG], 150 percutaneous coronary intervention [PCI], 96 medical therapy only) were observed for 30 months. A frailty index (FI) score was calculated at baseline (before initial treatment) and 6, 12, and 30 months after treatment. Random-effects models compared FI score trajectories by sex, age, and treatment group. Mean baseline FI scores were 0.170, 0.154, and 0.154 for CABG, PCI, and medical therapy only, respectively. FI scores decreased (improved) 6 months after initial treatment, then increased (worsened) at 12 and 30 months (P<0.001 for differences over time). Women had nonsignificantly higher FI scores than men (P=0.097) but followed the same trajectory (P=0.352 for differences over time). In patients aged ≥75 years, FI scores increased postbaseline for CABG and medical therapy only and after 6 months for PCI patients. Patients <75 years assigned to PCI and CABG experienced a sustained frailty reduction, whereas those assigned to medical therapy only showed stable frailty over the 30-month follow-up period (P value for differences over time by age and treatment group=0.041).
  
  
  
  With coronary artery disease treatment, frailty generally follows a U-shaped trajectory, but the pattern may differ by age and treatment. Further investigation is needed to confirm these observations and determine whether patients might benefit from consideration of frailty status.
authors.affiliation: From the Department of Community Health Sciences (E.A.F., D.B.H., S.B.P., W.A.G., C.J.M.), Department of Medicine (D.B.H., T.A., W.A.G., M.K.), Department of Psychiatry (S.B.P.), Department of Cardiac Sciences (T.A.), Department of General Internal Medicine (W.A.G.), Mathison Centre for Mental Health Research and Education (S.B.P.), and Libin Cardiovascular Institute of Alberta (T.A., W.A.G., M.K.), University of Calgary, Calgary, Alberta, Canada; Department of Anesthesia, University of Toronto, Toronto, Ontario, Canada (H.W.); Department of Critical Care Medicine, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada (H.W.); the Schools of Pharmacy and Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada (C.J.M.); and the Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada (C.J.M.). elizfreiheit@gmail.com.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Freiheit
authors.affiliation: From the Department of Community Health Sciences (E.A.F., D.B.H., S.B.P., W.A.G., C.J.M.), Department of Medicine (D.B.H., T.A., W.A.G., M.K.), Department of Psychiatry (S.B.P.), Department of Cardiac Sciences (T.A.), Department of General Internal Medicine (W.A.G.), Mathison Centre for Mental Health Research and Education (S.B.P.), and Libin Cardiovascular Institute of Alberta (T.A., W.A.G., M.K.), University of Calgary, Calgary, Alberta, Canada; Department of Anesthesia, University of Toronto, Toronto, Ontario, Canada (H.W.); Department of Critical Care Medicine, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada (H.W.); the Schools of Pharmacy and Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada (C.J.M.); and the Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada (C.J.M.).
authors.forename: David B
authors.initials: DB
authors.lastname: Hogan
authors.affiliation: From the Department of Community Health Sciences (E.A.F., D.B.H., S.B.P., W.A.G., C.J.M.), Department of Medicine (D.B.H., T.A., W.A.G., M.K.), Department of Psychiatry (S.B.P.), Department of Cardiac Sciences (T.A.), Department of General Internal Medicine (W.A.G.), Mathison Centre for Mental Health Research and Education (S.B.P.), and Libin Cardiovascular Institute of Alberta (T.A., W.A.G., M.K.), University of Calgary, Calgary, Alberta, Canada; Department of Anesthesia, University of Toronto, Toronto, Ontario, Canada (H.W.); Department of Critical Care Medicine, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada (H.W.); the Schools of Pharmacy and Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada (C.J.M.); and the Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada (C.J.M.).
authors.forename: Scott B
authors.initials: SB
authors.lastname: Patten
authors.affiliation: From the Department of Community Health Sciences (E.A.F., D.B.H., S.B.P., W.A.G., C.J.M.), Department of Medicine (D.B.H., T.A., W.A.G., M.K.), Department of Psychiatry (S.B.P.), Department of Cardiac Sciences (T.A.), Department of General Internal Medicine (W.A.G.), Mathison Centre for Mental Health Research and Education (S.B.P.), and Libin Cardiovascular Institute of Alberta (T.A., W.A.G., M.K.), University of Calgary, Calgary, Alberta, Canada; Department of Anesthesia, University of Toronto, Toronto, Ontario, Canada (H.W.); Department of Critical Care Medicine, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada (H.W.); the Schools of Pharmacy and Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada (C.J.M.); and the Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada (C.J.M.).
authors.forename: Hannah
authors.initials: H
authors.lastname: Wunsch
authors.affiliation: From the Department of Community Health Sciences (E.A.F., D.B.H., S.B.P., W.A.G., C.J.M.), Department of Medicine (D.B.H., T.A., W.A.G., M.K.), Department of Psychiatry (S.B.P.), Department of Cardiac Sciences (T.A.), Department of General Internal Medicine (W.A.G.), Mathison Centre for Mental Health Research and Education (S.B.P.), and Libin Cardiovascular Institute of Alberta (T.A., W.A.G., M.K.), University of Calgary, Calgary, Alberta, Canada; Department of Anesthesia, University of Toronto, Toronto, Ontario, Canada (H.W.); Department of Critical Care Medicine, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada (H.W.); the Schools of Pharmacy and Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada (C.J.M.); and the Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada (C.J.M.).
authors.forename: Todd
authors.initials: T
authors.lastname: Anderson
authors.affiliation: From the Department of Community Health Sciences (E.A.F., D.B.H., S.B.P., W.A.G., C.J.M.), Department of Medicine (D.B.H., T.A., W.A.G., M.K.), Department of Psychiatry (S.B.P.), Department of Cardiac Sciences (T.A.), Department of General Internal Medicine (W.A.G.), Mathison Centre for Mental Health Research and Education (S.B.P.), and Libin Cardiovascular Institute of Alberta (T.A., W.A.G., M.K.), University of Calgary, Calgary, Alberta, Canada; Department of Anesthesia, University of Toronto, Toronto, Ontario, Canada (H.W.); Department of Critical Care Medicine, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada (H.W.); the Schools of Pharmacy and Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada (C.J.M.); and the Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada (C.J.M.).
authors.forename: William A
authors.initials: WA
authors.lastname: Ghali
authors.affiliation: From the Department of Community Health Sciences (E.A.F., D.B.H., S.B.P., W.A.G., C.J.M.), Department of Medicine (D.B.H., T.A., W.A.G., M.K.), Department of Psychiatry (S.B.P.), Department of Cardiac Sciences (T.A.), Department of General Internal Medicine (W.A.G.), Mathison Centre for Mental Health Research and Education (S.B.P.), and Libin Cardiovascular Institute of Alberta (T.A., W.A.G., M.K.), University of Calgary, Calgary, Alberta, Canada; Department of Anesthesia, University of Toronto, Toronto, Ontario, Canada (H.W.); Department of Critical Care Medicine, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada (H.W.); the Schools of Pharmacy and Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada (C.J.M.); and the Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada (C.J.M.).
authors.forename: Merril
authors.initials: M
authors.lastname: Knudtson
authors.affiliation: From the Department of Community Health Sciences (E.A.F., D.B.H., S.B.P., W.A.G., C.J.M.), Department of Medicine (D.B.H., T.A., W.A.G., M.K.), Department of Psychiatry (S.B.P.), Department of Cardiac Sciences (T.A.), Department of General Internal Medicine (W.A.G.), Mathison Centre for Mental Health Research and Education (S.B.P.), and Libin Cardiovascular Institute of Alberta (T.A., W.A.G., M.K.), University of Calgary, Calgary, Alberta, Canada; Department of Anesthesia, University of Toronto, Toronto, Ontario, Canada (H.W.); Department of Critical Care Medicine, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada (H.W.); the Schools of Pharmacy and Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada (C.J.M.); and the Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada (C.J.M.).
authors.forename: Colleen J
authors.initials: CJ
authors.lastname: Maxwell
mesh_terms: D000367:Age Factors; D000368:Aged; D000416:Alberta; D002317:Cardiovascular Agents / Q000009:adverse effects / Q000627:therapeutic use*; D017023:Coronary Angiography; D001026:Coronary Artery Bypass / Q000009:adverse effects; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000628:therapy*; D005260:Female; D016330:Frail Elderly; D015577:Geriatric Assessment; D006801:Humans; D008297:Male; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012737:Sex Factors; D062606:Tertiary Care Centers; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D002317:Cardiovascular Agents
keywords: aging; coronary artery disease; follow-up studies; frailty