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 - Funding Information:
Dr. Pandey has served on the advisory board of Roche Diagnostics and is supported Texas Health Resources Clinical Scholarship, Gilead Sciences Research Scholar Program, and the National Institute on Aging GEMSSTAR Grant (1R03AG067960-01). Dr. Maurer is supported by a K24AG036778 award from NIA. Dr. Goyal is supported by K76AG064428 from NIA and 20CDA35310455 from AHA. Dr. Hummel is supported by NIH grants R01AG062582 and R01HL139813, and CARA-009-16F9050. Dr. Forman is funded by NIH grants R01AG060499, R01AG058883, R01AG051376, and P30AG024827. Dr. Butler has been a Consultant to Abbott, Adrenomed, Arena Pharma, Array, Amgen, Applied Therapeutics, Astra Zeneca, Bayer, Boehringer Ingelheim, Cardior, CVRx, Eli Lilly, G3 Pharma, Imbria, Impulse Dynamics, Innolife, Janssen, LivaNova, Luitpold, Medtronic, Merck, Novartis, Novo Nordisk, Relypsa, Roche, Sequana Medical, V-Wave Limited, and Vifor. The remaining authors have nothing to disclose. The authors declare no conflicts of interest. Conceptualization: MWS, SS, AP. Formal analysis: MWS, AP. Writing-original draft: MWS, SS, AP. Writing review and editing: PG, SLH, MSM, DEF, JB. No funding source or sponsor had a role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; or preparation, review, or approval of the manuscript, and decision to submit the manuscript for publication.
Funding Information:
Dr. Pandey has served on the advisory board of Roche Diagnostics and is supported Texas Health Resources Clinical Scholarship, Gilead Sciences Research Scholar Program, and the National Institute on Aging GEMSSTAR Grant (1R03AG067960‐01). Dr. Maurer is supported by a K24AG036778 award from NIA. Dr. Goyal is supported by K76AG064428 from NIA and 20CDA35310455 from AHA. Dr. Hummel is supported by NIH grants R01AG062582 and R01HL139813, and CARA‐009‐16F9050. Dr. Forman is funded by NIH grants R01AG060499, R01AG058883, R01AG051376, and P30AG024827. Dr. Butler has been a Consultant to Abbott, Adrenomed, Arena Pharma, Array, Amgen, Applied Therapeutics, Astra Zeneca, Bayer, Boehringer Ingelheim, Cardior, CVRx, Eli Lilly, G3 Pharma, Imbria, Impulse Dynamics, Innolife, Janssen, LivaNova, Luitpold, Medtronic, Merck, Novartis, Novo Nordisk, Relypsa, Roche, Sequana Medical, V‐Wave Limited, and Vifor. The remaining authors have nothing to disclose.
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 -