Elsevier

American Heart Journal

Volume 166, Issue 5, November 2013, Pages 887-894
American Heart Journal

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

https://doi.org/10.1016/j.ahj.2013.07.032Get rights and content

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.

Section snippets

Study population

The Health ABC Study enrolled 3075 well-functioning, community dwelling individuals aged 70 to 79 years from 1997 to 1998. Participants were identified from a random sample of white Medicare beneficiaries and all age eligible black community residents from Pittsburgh and Memphis. Participants with manifest or missing data on HF at baseline (n = 140) were excluded. Of the 2935 such participants, 2825 (96%) had data for the Gill criteria and HABC Battery and were included in this analysis.

Study definitions

Baseline participant characteristics

The mean age of participants was 74 ± 3 years; 48% were men and 59% were white. Median HABC Battery score was 2.3 (IQR 1.9-2.6). Table I presents the baseline characteristics. Frailty was present in 17.5% (moderate 16.2% and severe 1.3%) of participants by Gill criteria. Frail participants were older (74 ± 3 vs 73 ± 3 years, P < .001), more frequently women (60.1% vs 50.4%, P < .001), and black (53% vs 38%, P < .001). Frailty status by the 2 indexes was concordant in 1882 (66.7%) participants.

Discussion

In this cohort of community-based elderly, frailty was a significant predictor of incident HF. A unit decrease in HABC Battery score, signifying worsening frailty, was associated with 30% (10%-55%) increase in HF risk. These findings were consistent in both sexes, and in blacks and whites, and were independent of clinical risk factors, inflammatory markers, ankle arm index, incident CHD, and death as a competing event. These results highlight that frailty raises HF risk independent of other

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