Dr. Ariela R. Orkaby completed an Internal Medicine residency at Boston Medical Center, a Geriatrics fellowship at Beth Israel Deaconess Medical Center, and a Masters of Public Health degree at Harvard T.H. Chan School of Public Health after graduating from MSIH. She has worked as an Assistant Professor of Medicine at Harvard Medical School since 2016. In this podcast Dr. Orkaby speaks on the Frailty and cardiovascular mortality in more than 3 million US Veterans.
Frailty is linked to an increased risk of death from any cause as well as cardiovascular (CV) events. The link between frailty and CV mortality is poorly understood in the present era of CV prophylaxis. Frailty, we hypothesized, is linked to an elevated risk of CV mortality.
Methods and outcomes
From 2002 to 2017, all US Veterans over the age of 65 who used Veteran Affairs services on a regular basis were included. A 31-item previously validated frailty measure, ranging from 0 to 1, was used to define frailty. The primary outcome was cardiovascular death, with supplementary analyses looking into the link between frailty and cardiovascular events (myocardial infarction, stroke, revascularization). Age, sex, ethnicity, geographic region, smoking, hyperlipidemia, statin use, and blood pressure medication use were all factored into the survival analysis models. In total, 3 068 439 US veterans were involved in the study. In 2002, the average age was 74.1 5.8 years, rising to 76.0 8.3 years in 2014, with 98 percent of men and 87.5 percent of whites. In 2002, the median frailty score (interquartile range) was 0.16 (0.10–0.23). For the years 2006–14, this grew and then stabilized at 0.19 (0.10–0.32). At every stage of frailty, the presence of frailty was linked to an elevated risk of CV mortality. Frailty was linked to an increased risk of heart attack and stroke, but not of revascularization.
Both the presence and severity of frailty are strongly linked to CV death in this cohort, regardless of underlying CV disease. This research is the most comprehensive and up-to-date examination of the link between frailty and CV mortality to date. More research is needed to determine how this danger can be reduced.
The Crucial Question
Is it possible to use an electronic frailty index to identify persons aged 65 and up who are at risk of cardiovascular death and catastrophic events?
The Most Important Finding
Frailty was linked to an elevated risk of CV mortality in 3 068 439 US Veterans aged 65 and older at all levels of frailty. Frailty was linked to a higher risk of myocardial infarction and stroke, but not of revascularization.
Message to Recipients
Independent of underlying CV disease, both the presence and severity of frailty are linked to CV mortality and major CV events.