Worsening frailty linked with poorer outcomes compared with improving frailty

Frailty progression was associated with fewer days alive at home (DAH), regardless of age or frailty level at baseline, a new study shows. Compared with people with frailty regression, people with frailty progression also had a higher risk of major adverse cardiovascular and cerebrovascular events (MACCE), all-cause mortality, myocardial infarction, heart failure and ischemic stroke.

Researchers reported their findings in an Aug. 1 report in Journal of the American Geriatrics Society.

The team assessed Medicare Fee-for-Service beneficiaries who were age 65 and up, and continuously enrolled from 2003 to 2015. About 8.9 million people were included, with an average age of 77.3 years. Of them, 58.7% were female and 10.9% weren’t white.

Sixty percent of patients had frailty progression (frailty getting worse) and 40% experienced frailty regression (frailty improving) over a median follow-up period of 2.4 years.  

During that time, 50.9% of those with frailty progression experienced MACCE, 39.7% of those with frailty progression died; more specifically, 6% of those with frailty progression had acute myocardial infarction, 12.7% experienced an acute heart failure exacerbation, and 10.7% had an ischemic stroke.

People with increasing frailty progression spent fewer DAH, and those with the fastest rates of progression spent 38 fewer days alive at home than those with the slowest rates of progression.

Data showed a graded increase in risk of each outcome with more rapid progression, as well as significantly fewer DAH with more rapid progression compared to the slowest progression group. 

Overall, people with frailty progression had a 1.31-fold increased risk for having a MACCE. They were 1.34 times more likely to die from any cause, 1.08 times more likely to experience acute myocardial infarction, 1.3 times to have worsening heart failure, and 1.14 times more likely to have an ischemic stroke. 

“Our results indicate that both the severity of frailty and the degree of frailty progression may help to identify those at high risk for adverse outcomes and increased health services utilization,” the authors wrote. They say frailty testing is imperative to guide decision making and pinpoint high-risk individuals for cardiovascular interventions, and it should be a part of future studies.