CHANGES IN INDICATORS OF FRAILTY IN PATIENTS AFTER DIRECT MYOCARDIAL REVASCULARIZATION

Highlights

• In the era of rapid population aging, frailty has become one of the most significant public health concerns because of the increased risk of adverse outcomes, such as functional decline, greater medical resource utilization, and higher mortality rates.
• In low- and middle-income countries, there is a growing need to identify and monitor the dynamics of frailty in order to develop measures to maintain a high quality of life for ageing populations.

Aim. To study the changes in indicators of pre-frailty and frailty syndrome in patients within three years after primary elective coronary artery bypass grafting.

Methods. The study included 387 patients with multivessel coronary artery disease before undergoing direct myocardial revascularization. Various diagnostic approaches were used to identify pre-frailty and frailty syndrome, such as a multi-stage diagnostic algorithm from the frailty recommendations of the Russian Public Organization «Russian Association of Gerontologists and Geriatricians» (2020), the «PRISMA-7» questionnaire, the criteria for the Fried frailty phenotype, and the 5-factor modified frailty index (mFI-5). Statistical processing of the results was carried out using the IBM SPSS Statistics 26.0.0 software.

Results. The results of the analysis of the clinical and anamnestic characteristics of the sample revealed a classic portrait of patients with multivessel coronary artery disease, the majority of patients were men (73.1%), the median age was 65 [59; 69] years. The incidence of pre-frailty among patients with coronary artery disease ranged from 15.0 to 42.4%, and the incidence of frailty syndrome ranged from 22.5 to 71.6%. Within three years after elective coronary bypass surgery, according to several diagnostic approaches, the manifestations of pathological aging of the body can increase by an average of 5.0–10.0%, whereas using European «PRISMA-7» questionnaire revealed significant differences (p = 0.045).

Conclusions. The progression of frailty in patients with coronary artery disease three years after direct myocardial revascularization varies on average from 5.0 to 10.0% according to the results of the study.

1. Hoogendijk E.O., Afilalo J., Ensrud K.E., Kowal P., Onder G., Fried L.P. Frailty: implications for clinical practice and public health. Lancet. 2019; 394 (10206): 1365-75. doi:10.1016/S0140-6736(19)31786-6

2. Walston J., Bandeen-Roche K., Buta B., Bergman H., Gill T.M., Morley J.E., et al. Moving Frailty Toward Clinical Practice: NIA Intramural Frailty Science Symposium Summary. J Am Geriatr Soc. 2019; 67 (8): 1559-64. doi:10.1111/jgs.15928

3. Mitnitski A.B., Song X., Rockwood K. The estimation of relative fitness and frailty in community-dwelling older adults using self-report data. J Gerontol A Biol Sci Med Sci. 2004; 59 (6): M627-32. doi:10.1093/gerona/59.6.m627

4. Ayers E., Barzilai N., Crandall J.P., Milman S., Verghese J. Association of Family History of Exceptional Longevity With Decline in Physical Function in Aging. J Gerontol A Biol Sci Med Sci. 2017; 72 (12): 1649-55. doi:10.1093/gerona/glx053

5. Welstead M., Jenkins N.D., Russ T.C., Luciano M., Muniz-Terrera G. A Systematic Review of Frailty Trajectories: Their Shape and Influencing Factors. Gerontologist. 2021; 61 (8): e463-e475. doi:10.1093/geront/gnaa061

6. Stow D., Matthews F.E., Hanratty B. Frailty trajectories to identify end of life: a longitudinal population-based study. BMC Med. 2018; 16 (1): 171. doi:10.1186/s12916-018-1148-x

7. O’Caoimh R., Galluzzo L., Rodríguez-Laso Á., Van der Heyden J., Ranhoff A.H., Carcaillon-Bentata L., et al. Transitions and trajectories in frailty states over time: a systematic review of the European Joint Action ADVANTAGE. Ann Ist Super Sanita. 2018; 54 (3): 246-52. doi:10.4415/ANN_18_03_12

8. Loecker C., Schmaderer M., Zimmerman L. Frailty in Young and Middle-Aged Adults: An Integrative Review. J Frailty Aging. 2021; 10 (4): 327-333. doi:10.14283/jfa.2021.14

9. Crea F. The Atlas of cardiovascular disease in Europe and a focus on frailty and cardiovascular risk. Eur Heart J. 2022; 43 (8): 703-705. doi:10.1093/eurheartj/ehac066

10. Damluji A.A., Cohen M.G. The influence of frailty on cardiovascular disease: the time for a «Frailty Academic Research Consortium» is now! Circ Cardiovasc Interv. 2022; 15: e011669. doi:10.1161/circinterventions.121.011669

11. Orkaby A.R. Moving beyond chronological age: frailty as an important risk factor for cardiovascular disease. Eur Heart J. 2021; 42 (37): 3866-3868. doi:10.1093/eurheartj/ehab481

12. Ijaz N., Buta B., Xue Q.L., Mohess D.T., Bushan A., Tran H., et al. Interventions for frailty among older adults with cardiovascular disease: JACC state-of-the-art review. J Am Coll Cardiol. 2022; 79: 482-503. doi:10.1016/j.jacc.2021.11.029

13. Shrauner W., Lord E.M., Nguyen X.T., Song R.J., Galloway A., Gagnon D.R., et al. Frailty and cardiovascular mortality in more than 3 million US veterans. Eur Heart J. 2022; 43: 818-26. doi:10.1093/eurheartj/ehab850

14. Chen L., Li X., Lv Y., Tan X., Zhong V.W., Rong S., et al. Physical frailty, adherence to ideal cardiovascular health and risk of cardiovascular disease: a prospective cohort study. Age Ageing. 2023; 52 (1): afac311. doi:10.1093/ageing/afac311

15. Travers J., Romero-Ortuno R., Langan J., MacNamara F., McCormack D., McDermott C., et al. Building resilience and reversing frailty: a randomised controlled trial of a primary care intervention for older adults. Age Ageing. 2023; 52 (2): afad012. doi:10.1093/ ageing/afad012

16. Quach J., Theou O., Pérez-Zepeda M.U., Godin J., Rockwood K., Kehler D.S. Effect of a physical activity intervention and frailty on frailty trajectory and major mobility disability. J Am Geriatr Soc. 2022; 70 (10): 2915-2924. doi:10.1111/jgs.17941

17. 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)

18. 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)

19. 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)

20. 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

21. 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

22. 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

23. Krivoshapova K.E., Tsygankov D.A., Tsygankova D.P., Barbarash O.L. Prevalence of pre-frailty and frailty in patients with multivessel coronary artery disease. Complex Issues of Cardiovascular Diseases. 2023; 12 (4S): 25-33. doi:10.17802/2306-1278-2023-12-4S-25-33. (In Russ)

24. Fogg C., Fraser S.D.S., Roderick P., de Lusignan S., Clegg A., Brailsford S., et al. The dynamics of frailty development and progression in older adults in primary care in England (2006-2017): a retrospective cohort profile. BMC Geriatr. 2022; 22 (1): 30. doi:10.1186/s12877-021-02684-y

25. Yoshizawa Y., Tanaka T., Takahashi K., Fujisaki-Sueda-Sakai M., Son B.K., Iijima K. Impact of Health Literacy on the Progression of Frailty after 4 Years among Community-Dwelling Older Adults. Int J Environ Res Public Health. 2021; 19 (1): 394. doi:10.3390/ijerph19010394

26. Xue Q.L., Bandeen-Roche K., Tian J., Kasper J.D., Fried L.P. Progression of Physical Frailty and the Risk of All-Cause Mortality: Is There a Point of No Return? J Am Geriatr Soc. 2021; 69 (4): 908-915. doi:10.1111/jgs.16976

27. Goodman-Palmer D., Greig C., Agyapong-Badu S., Witham M.D., Payne C.F., Bountogo M., et al. Frailty progression in adults aged 40 years and older in rural Burkina Faso: a longitudinal, population-based study. Lancet Healthy Longev. 2024; 5 (7): e493-e502. doi:10.1016/S2666-7568(24)00096-5

28. Ye B., Li Y., Bao Z., Gao J. Psychological Resilience and Frailty Progression in Older Adults. JAMA Netw Open. 2024; 7 (11): e2447605. doi:10.1001/jamanetworkopen.2024.47605

29. He D., Wang Z., Li J., Yu K., He Y., He X., et al. Changes in frailty and incident cardiovascular disease in three prospective cohorts. Eur Heart J. 2024; 45 (12): 1058-1068. doi:10.1093/eurheartj/ehad885

30. Gong Y., Song Y., Xu J., Dong H., Kramer D.B., Orkaby A.R., et al. Progression of frailty and cardiovascular outcomes among Medicare beneficiaries. J Am Geriatr Soc. 2024; 72 (10): 3129-3139. doi:10.1111/jgs.19116

31. Howrey B.T., Al Snih S., Middleton J.A., Ottenbacher K.J. Trajectories of Frailty and Cognitive Decline Among Older Mexican Americans. J Gerontol A Biol Sci Med Sci. 2020; 75 (8): 1551-1557. doi:10.1093/gerona/glz295

32. Ke Z., Wen H., Huang R., Xu X., Yang K., Liu W., et al. Long-term insulin resistance is associated with frailty, frailty progression, and cardiovascular disease. J Cachexia Sarcopenia Muscle. 2024; 15 (4): 1578-1586. doi:10.1002/jcsm.13516