Physical Frailty Phenotype and the Development of Geriatric Syndromes in Older Adults with Coronary Heart Disease

Published:November 23, 2020DOI:



      Frailty, a clinical state of vulnerability, is associated with subsequent adverse geriatric syndromes in the general population. We examined the long-term impact of frailty on geriatric outcomes among older patients with coronary heart disease.


      We used the National Health and Aging Trends Study, a prospective cohort study linked to a Medicare sample. Coronary heart disease was identified by self-report or International Classification of Diseases (ICD) codes 1-year prior to the baseline visit. Frailty was measured using the Fried physical frailty phenotype. Geriatric outcomes were assessed annually during a 6-year follow-up.


      Of the 4656 participants, 1213 (26%) had a history of coronary heart disease 1-year prior to their baseline visit. Compared to those without frailty, subjects with frailty were older (ages ≥75: 80.9% vs 68.9%, P < 0.001), more likely to be female, and belong to an ethnic minority. The prevalence of hypertension, stroke, falls, disability, anxiety/depression, and multimorbidity were much higher in the frail, than nonfrail, participants. In a discrete time survival model, the incidence of geriatric syndromes during 6-year follow-up including 1) dementia, 2) loss of independence, 3) activities of daily living disability, 4) instrumental activities of daily living disability, and 5) mobility disability were significantly higher in the frail than in the nonfrail older patients with coronary heart disease.


      In patients with coronary heart disease, frailty is a risk factor for the accelerated development of geriatric outcomes. Efforts to identify frailty in the context of coronary heart disease are needed, as well as interventions to limit or reverse frailty status for older patients with coronary heart disease.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to The American Journal of Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Damluji AA
        • Forman DE
        • van Diepen S
        • et al.
        Older adults in the cardiac intensive care unit: factoring geriatric syndromes in the management, prognosis, and process of care: a scientific statement from the American Heart Association.
        Circulation. 2020; 141: e6-e32
        • Walston J
        • Robinson TN
        • Zieman S
        • et al.
        Integrating frailty research into the medical specialties-report from a U13 conference.
        J Am Geriatr Soc. 2017; 65: 2134-2139
        • Walston J
        • Hadley EC
        • Ferrucci L
        Research agenda for frailty in older adults: toward a better understanding of physiology and etiology: summary from the American Geriatrics Society/National Institute on Aging Research Conference on Frailty in Older Adults.
        J Am Geriatr Soc. 2006; 54: 991-1001
        • Fried LP
        • Tangen CM
        • Walston J
        • et al.
        Frailty in older adults: evidence for a phenotype.
        J Gerontol A Biol Sci Med Sci. 2001; 56: M146-M156
        • Damluji AA
        • Huang J
        • Bandeen-Roche K
        • et al.
        Frailty among older adults with acute myocardial infarction and outcomes from percutaneous coronary interventions.
        J Am Heart Assoc. 2019; 8e013686
        • Purser JL
        • Kuchibhatla MN
        • Fillenbaum GG
        • Harding T
        • Peterson ED
        • Alexander KP
        Identifying frailty in hospitalized older adults with significant coronary artery disease.
        J Am Geriatr Soc. 2006; 54: 1674-1681
        • Gharacholou SM
        • Roger VL
        • Lennon RJ
        • et al.
        Comparison of frail patients versus nonfrail patients ≥65 years of age undergoing percutaneous coronary intervention.
        Am J Cardiol. 2012; 109: 1569-1575
        • Singh M
        • Rihal CS
        • Lennon RJ
        • Spertus JA
        • Nair KS
        • Roger VL
        Influence of frailty and health status on outcomes in patients with coronary disease undergoing percutaneous revascularization.
        Circ Cardiovasc Qual Outcomes. 2011; 4: 496-502
        • Bandeen-Roche K
        • Seplaki CL
        • Huang J
        • et al.
        Frailty in older adults: a nationally representative profile in the United States.
        J Gerontol A Biol Sci Med Sci. 2015; 70: 1427-1434
      1. Kasper JD, Freedman VA. National Health and Aging Trends Study User Guide: Rounds 1-8 Final Release. Baltimore, MD: Johns Hopkins University School of Public Health. Available at: Accessed January 13, 2020.

        • Rubin D
        Multiple imputation for nonresponse in surveys. multiple imputation for nonresponse in surveys.
        Wiley, New York, NY1987
        • Galvin JE
        • Roe CM
        • Powlishta KK
        • et al.
        The AD8: a brief informant interview to detect dementia.
        Neurology. 2005; 65: 559-564
        • Prentice RL
        • Gloeckler LA
        Regression analysis of grouped survival data with application to breast cancer data.
        Biometrics. 1978; 34: 57-67
        • Chaves PH
        • Semba RD
        • Leng SX
        • et al.
        Impact of anemia and cardiovascular disease on frailty status of community-dwelling older women: the Women's Health and Aging Studies I and II.
        J Gerontol A Biol Sci Med Sci. 2005; 60: 729-735
        • Newman AB
        • Simonsick EM
        • Naydeck BL
        • et al.
        Association of long-distance corridor walk performance with mortality, cardiovascular disease, mobility limitation, and disability.
        JAMA. 2006; 295: 2018-2026
        • Madhavan MV
        • Gersh BJ
        • Alexander KP
        • Granger CB
        • Stone GW
        Coronary artery disease in patients ≥80 years of age.
        J Am Coll Cardiol. 2018; 71: 2015-2040
        • Ahto M
        • Isoaho R
        • Puolijoki H
        • Laippala P
        • Romo M
        • Kivela SL
        Functional abilities of elderly coronary heart disease patients.
        Aging (Milano). 1998; 10: 127-136
        • Kleipool EE
        • Hoogendijk EO
        • Trappenburg MC
        • et al.
        Frailty in older adults with cardiovascular disease: cause, effect or both?.
        Aging Dis. 2018; 9: 489-497
        • Woods NF
        • LaCroix AZ
        • Gray SL
        • et al.
        Frailty: emergence and consequences in women aged 65 and older in the Women's Health Initiative Observational Study.
        J Am Geriatr Soc. 2005; 53: 1321-1330
        • Walston J
        • McBurnie MA
        • Newman A
        • et al.
        Frailty and activation of the inflammation and coagulation systems with and without clinical comorbidities: results from the Cardiovascular Health Study.
        Arch Intern Med. 2002; 162: 2333-2341
        • Gray SL
        • Anderson ML
        • Hubbard RA
        • et al.
        Frailty and incident dementia.
        J Gerontol A Biol Sci Med Sci. 2013; 68: 1083-1090
        • Vermeulen J
        • Neyens JC
        • van Rossum E
        • Spreeuwenberg MD
        • de Witte LP
        Predicting ADL disability in community-dwelling elderly people using physical frailty indicators: a systematic review.
        BMC Geriatr. 2011; 11: 33
        • Gobbens RJ
        • van Assen MA
        The prediction of ADL and IADL disability using six physical indicators of frailty: a longitudinal study in the Netherlands.
        Curr Gerontol Geriatr Res. 2014; 2014358137
        • Makizako H
        • Shimada H
        • Doi T
        • Tsutsumimoto K
        • Suzuki T
        Impact of physical frailty on disability in community-dwelling older adults: a prospective cohort study.
        BMJ Open. 2015; 5e008462