TY - JOUR
T1 - Prefrailty, impairment in physical function, and risk of incident heart failure among older adults
AU - Segar, Matthew W.
AU - Singh, Sumitabh
AU - Goyal, Parag
AU - Hummel, Scott L.
AU - Maurer, Mathew S.
AU - Forman, Daniel E.
AU - Butler, Javed
AU - Pandey, Ambarish
N1 - Publisher Copyright:
© 2021 The American Geriatrics Society.
PY - 2021/9
Y1 - 2021/9
N2 - Objective: Evaluate the association between prefrailty and the risk of heart failure (HF) among older adults. Design, setting, and participants: This prospective, community-based cohort study included participants from the Atherosclerotic Risk in Communities study who underwent detailed frailty assessment using Fried Criteria and physical function assessment using the Short Performance Physical Battery (SPPB) score. Individuals with prevalent HF and frailty were excluded. Main outcomes and measures: Adjusted association between prefrailty (vs robust), physical function measures (SPPB score, grip strength, and gait speed), and incident HF (overall and HF subtypes, HF with reduced [HFrEF, EF < 50%] and preserved ejection fraction [HFpEF]) were assessed using Cox proportional hazards models. Results: Among 5210 participants (mean age 75 years, 58% women), 2565 (49.2%) were identified as prefrail. In cross-sectional analysis, prefrail individuals had a higher burden of chronic myocardial injury (troponin, Std β = 0.08 [0.05–0.10]) and neurohormonal stress (NT-ProBNP, Std β = 0.03 [0.02–0.05]) after adjustment for potential confounders. Over a median follow-up of 4.6 years, there were 232 (4.5%) HF events (HFrEF: 102; HFpEF: 97). Prefrailty was associated with an increased risk of HF after adjusting for potential clinical confounders and cardiac biomarkers (aHR [95% CI] = 1.65 [1.24–2.20]). Among HF subtypes, prefrailty was associated with an increased risk of HFpEF but not HFrEF (aHR [95% CI] = 1.73 [1.11–2.70] and 1.38 [0.90–2.10], respectively). A lower SPPB score was also associated with an increased risk of overall HF and HFpEF, but not HFrEF. Among individual components, increased gait speed were associated with a lower risk of HFpEF, but not HFrEF. Conclusions and relevance: Subtle abnormalities in physiological reserve (prefrailty) and impairment in physical function (SPPB) were both significantly associated with a higher risk of incident HF, particularly HFpEF. These findings highlight the potential role of routine assessment of geriatric syndromes for early identification of HF risk.
AB - Objective: Evaluate the association between prefrailty and the risk of heart failure (HF) among older adults. Design, setting, and participants: This prospective, community-based cohort study included participants from the Atherosclerotic Risk in Communities study who underwent detailed frailty assessment using Fried Criteria and physical function assessment using the Short Performance Physical Battery (SPPB) score. Individuals with prevalent HF and frailty were excluded. Main outcomes and measures: Adjusted association between prefrailty (vs robust), physical function measures (SPPB score, grip strength, and gait speed), and incident HF (overall and HF subtypes, HF with reduced [HFrEF, EF < 50%] and preserved ejection fraction [HFpEF]) were assessed using Cox proportional hazards models. Results: Among 5210 participants (mean age 75 years, 58% women), 2565 (49.2%) were identified as prefrail. In cross-sectional analysis, prefrail individuals had a higher burden of chronic myocardial injury (troponin, Std β = 0.08 [0.05–0.10]) and neurohormonal stress (NT-ProBNP, Std β = 0.03 [0.02–0.05]) after adjustment for potential confounders. Over a median follow-up of 4.6 years, there were 232 (4.5%) HF events (HFrEF: 102; HFpEF: 97). Prefrailty was associated with an increased risk of HF after adjusting for potential clinical confounders and cardiac biomarkers (aHR [95% CI] = 1.65 [1.24–2.20]). Among HF subtypes, prefrailty was associated with an increased risk of HFpEF but not HFrEF (aHR [95% CI] = 1.73 [1.11–2.70] and 1.38 [0.90–2.10], respectively). A lower SPPB score was also associated with an increased risk of overall HF and HFpEF, but not HFrEF. Among individual components, increased gait speed were associated with a lower risk of HFpEF, but not HFrEF. Conclusions and relevance: Subtle abnormalities in physiological reserve (prefrailty) and impairment in physical function (SPPB) were both significantly associated with a higher risk of incident HF, particularly HFpEF. These findings highlight the potential role of routine assessment of geriatric syndromes for early identification of HF risk.
KW - heart failure
KW - heart failure with preserved ejection fraction
KW - physical function
KW - prefrailty
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U2 - 10.1111/jgs.17218
DO - 10.1111/jgs.17218
M3 - Article
C2 - 34050919
AN - SCOPUS:85106981729
SN - 0002-8614
VL - 69
SP - 2486
EP - 2497
JO - Journal of the American Geriatrics Society
JF - Journal of the American Geriatrics Society
IS - 9
ER -