PREVALENCE OF PRE-FRAILTY AND FRAILTY IN PATIENTS WITH MULTIVESSEL CORONARY ARTERY DISEASE

Highlights

The article is focused on one of the most urgent modern issues – the peculiarities of the diagnosis of pathological aging. Due to the absence of a “gold standard” of detection of frailty, attempts to assess its prevalence among the population of different age groups present fragmented and controversial data. In this study, for the first time, the prevalence of frailty in patients with multivessel coronary artery disease, characterized by extremely pronounced clinical complexity, was analyzed using six different diagnostic approaches, allowing us to obtain data on the sensitivity and specificity of these instruments.

Abstract

Aim. To study the prevalence of pre-frailty and frailty in patients with multivessel coronary artery disease.

Methods. The study included 387 patients with multivessel coronary artery disease scheduled for coronary artery bypass grafting. To detect pre-frailty and frailty, we have used various diagnostic approaches, such as the screening questionnaire “Age is not a drawback”, a multi-stage diagnostic framework based on the clinical recommendations on frailty developed by the “Russian Association of Gerontologists and Geriatricians” in 2020, the questionnaire “PRISMA-7”, the clinical frailty scale, the criteria of the Fried frailty phenotype, and the modified 5-item frailty index (mFI-5).

Results. The median age was 65 [59; 69] years, men were the majority (73.1%). Taking into account six diagnostic approaches, the prevalence of frailty in patients with multivessel coronary artery disease varied from 19.1% to 71.6%, the prevalence of pre-frailty varied from 15% to 58.2%. A high number of patients with frailty was detected using a multi-stage diagnostic framework based on the on the clinical recommendations on frailty developed by the “Russian Association of Gerontologists and Geriatricians” (46.8%), the clinical frailty scale (44.5%), the criteria of the Fried frailty phenotype (42.4%) and mFI-5 (71.6%), the lowest number of patients with frailty was detected using the questionnaire “PRISMA-7” (22.5%). The clinical frailty scale showed a higher level of sensitivity and specificity (67.8% and 80%, respectively) regarding the detection of pre-frailty, whereas a multi-stage diagnostic framework had a higher level of sensitivity and specificity (65.2% and 76.8%, respectively) regarding the detection of frailty.

Conclusions. The results of the study revealed a high prevalence of pre-frailty (15–58.2%) and frailty (19.1–71.6%) in patients with multivessel coronary artery disease, taking into account several diagnostic approaches. The clinical frailty scale and a multi-stage diagnostic framework based on the recommendations showed the highest sensitivity and specificity regarding the detection of frailty (clinical frailty scale – 67.8% and 80%, respectively; a multi-stage diagnostic framework – 65.2% and 76.8%, respectively).

1. Masnoon N., Shakib S., Kalisch-Ellett L., Caughey G.E. What is polypharmacy? A systematic review of definitions. BMC Geriatrics. 2017; 17 (1): 230. doi: 10.1186/s12877-017-0621-2

2. Payne R.A. The epidemiology of polypharmacy. Clinical medicine (London, England). 2016; 16 (5): 465-469. doi: 10.7861/clinmedicine.16-5-465

3. Tinetti M.E., Fried T. The end of the disease era. Am J Med. 2004; 116 (3): 179-185. doi: 10.1016/j.amjmed.2003.09.031

4. Cesari M., Calvani R., Marzetti E. Frailty in Older Persons. Clin Geriatr Med. 2017; 33 (3): 293-303. doi: 10.1016/j.cger.2017.02.002

5. Morley J.E., Vellas B., van Kan G.A., Anker S.D., Bauer J.M., Bernabei R., et al. Frailty consensus: a call to action. J Am Med Dir Assoc. 2013; 14 (6): 392-397. doi: 10.1016/j.jamda.2013.03.022

6. Collard R.M., Boter H., Schoevers R.A., Oude Voshaar R.C. Prevalence of frailty in community-dwelling older persons: a systematic review. J Am Geriatr Soc. 2012; 60: 1487-1492. doi: 10.1111/j.1532-5415.2012.04054.x

7. Searle S.D., Rockwood K. What proportion of older adults in hospital are frail? Lancet. 2018; 391 (10132): 1751-1752. doi: 10.1016/S0140-6736(18)30907-3

8. Atkins J.L., Delgado J., Pilling L.C., Bowman K., Masoli Jane A.H., Kuchel G.A., et al. Impact of Low Cardiovascular Risk Profiles on Geriatric Outcomes: Evidence From 421,000 Participants in Two Cohorts. The journals of gerontology. Series A, Biological sciences and medical sciences. 2019; 74 (3): 350-357. doi: 10.1093/gerona/gly083

9. Veronese N., Sigeirsdottir K., Eiriksdottir G., Marques E.A., Chalhoub D., Phillips C.L., et al. Frailty and Risk of Cardiovascular Diseases in Older Persons: The Age, Gene/Environment Susceptibility-Reykjavik Study. Rejuvenation Res. 2017; 20 (6): 517-524. doi: 10.1089/rej.2016.1905

10. Krivoshapova K.E., Vegner E.A., Terentyeva N.A., Masenko V.L., Grigoryeva I.I., Kokov A.N., et al. Frailty syndrome in patients with coronary artery disease. Medical alphabet. 2020; 1 (19): 6-10. doi: 10.33667/2078-5631-2020-19-6-10. (In Russ)

11. Krivoshapova K.E., Barbarash O.L., Vegner E.A., Zinets M.G., Ivanov S.V., Barbarash L.S. The patient with ischemic heart disease and frailty syndrome: characteristics of multimorbidity and in-hospital prognosis after coronary artery bypass surgery. Russian journal of thoracic and cardiovascular surgery. 2022; 64 (2): 161-168. doi: 10.24022/0236-2791-2022-64-2-161-168. (In Russ)

12. Tkacheva O.N., Kotovskaya Yu.V., Runikhina N.K., Frolova E.V., Naumov A.V., Vorobyeva N.M., et al. Clinical guidelines on frailty. Russian Journal of Geriatric Medicine. 2020; (1): 11-46. doi: 10.37586/2686-8636-1-2020-11-46. (In Russ)

13. Raîche M., Hébert R., Dubois M.F. PRISMA-7: a case-finding tool to identify older adults with moderate to severe disabilities. Arch Gerontol Geriatr. 2008; 47 (1): 9-18. doi: 10.1016/j.archger.2007.06.004

14. Rockwood K., Song X., MacKnight C., Bergman H., Hogan D.B., McDowell I., et al. A global clinical measure of fitness and frailty in elderly people. CMAJ. 2005; 173 (5): 489-95. doi: 10.1503/cmaj.050051

15. Fried L.P., Tangen C.M., Walston J., Newman A.B., Hirsch C., Gottdiener J., et al. Cardiovascular Health Study Collaborative Research Group. Frailty in older adults: evidence for a phenotype. The journals of gerontology. Series A. Biological sciences and medical sciences. 2001; 56 (3): M146-56. doi: 10.1093/gerona/56.3.m146

16. Luo J., Carter G.C., Agarwal J.P., Kwok A.C. The 5-Factor Modified Frailty Index as a Predictor of 30-day Complications in Pressure Ulcer Repair. J Surg Res. 2021; 265: 21-26. doi: 10.1016/j.jss.2021.03.011

17. Santos-Eggimann B., Cuénoud P., Spagnoli J., Junod J. Prevalence of frailty in middle-aged and older community-dwelling Europeans living in 10 countries. J Gerontol A Biol Sci Med Sci. 2009; 64 (6): 675-681. doi: 10.1093/gerona/glp012

18. Gurina N.A., Frolova E.V., Degryse J.M. A roadmap of aging in Russia: the prevalence of frailty in community-dwelling older adults in the St. Petersburg district--the "Crystal" study. Journal of the American Geriatrics Society. 2011; 59 (6): 980-988. doi: 10.1111/j.1532-5415.2011.03448.x

19. Tkacheva O.N., Vorob’eva N.M., Kotovskaya Yu.V., Ostroumova O.D., Chernyaeva M.S., Silyutina M.V., et al. Prevalence of geriatric syndromes in persons over 65 years: the first results of the EVCALIPT study. Russian Journal of Cardiology. 2020; 25 (10): 3985. doi: 10.15829/1560-4071-2020-3985. (In Russ)

20. Hoffmann S., Wiben A., Kruse M., Jacobsen K.K., Lembeck M.A., Holm E.A. Predictive validity of PRISMA-7 as a screening instrument for frailty in a hospital setting. BMJ Open. 2020; 10 (10): e038768. doi: 10.1136/bmjopen-2020-038768

21. Hoogendijk E.O., van der Horst H.E., Deeg D.J., Frijters D.H., Prins B.A., Jansen A.P., et al. The identification of frail older adults in primary care: comparing the accuracy of five simple instruments. Age Ageing. 2013; 42 (2): 262-5. doi: 10.1093/ageing/afs163

22. Eredics K., Meyer C., Gschliesser T., Lodeta B., Heissler O., Kunit T., et al. Can a Simple Geriatric Assessment Predict the Outcome of TURP? Urol Int. 2020; 104 (5-6): 367-372. doi: 10.1159/000506717

23. Lewis E.T., Dent E., Alkhouri H., Kellett J., Williamson M., Asha S., et al. Which frailty scale for patients admitted via Emergency Department? A cohort study. Arch Gerontol Geriatr. 2019; 80: 104-114. doi: 10.1016/j.archger.2018.11.002

24. Ostapenko V.S., Runikhina N.K., Sharashkina N.V. Prevalence of frailty and its correlation with chronic non-infectious diseases among outpatients in Moscow. Russian Journal of Geriatric Medicine. 2020; (2): 131-137. doi: 10.37586/2686-8636-2-2020-131-137. (In Russ)

25. Damluji A.A., Huang J., Bandeen-Roche K., Forman D.E., Gerstenblith G., Moscucci M., et al. Frailty Among Older Adults With Acute Myocardial Infarction and Outcomes From Percutaneous Coronary Interventions. J Am Heart Assoc. 2019; 8 (17): e013686. doi: 10.1161/JAHA.119.013686

26. Bandeen-Roche K., Seplaki C.L., Huang J., Buta B., Kalyani R.R., Varadhan R., et al. Frailty in Older Adults: A Nationally Representative Profile in the United States. J Gerontol A Biol Sci Med Sci. 2015; 70 (11): 1427-34. doi: 10.1093/gerona/glv133

27. Gharacholou S.M., Roger V.L., Lennon R.J., Rihal C.S., Sloan J.A., Spertus J.A., et al. Comparison of frail patients versus nonfrail patients ≥65 years of age undergoing percutaneous coronary intervention. Am J Cardiol. 2012; 109 (11): 1569-75. doi: 10.1016/j.amjcard.2012.01.384

28. Vegner E.A., Krivoshapova K.E., Barbarash O.L. Challenges in diagnosing frailty syndrome in the elderly population of different countries. Complex Issues of Cardiovascular Diseases. 2020; 9 (4): 95-104. doi: 10.17802/2306-1278-2020-9- 4-95-104. (In Russ)