Measuring Frailty Using Self-Report or Automated Tools to Identify Risk of Cardiovascular Events and Mortality: The Million Veteran Program

• Published in: Journal of the American Heart Association 2024-08, Vol.13 (16), p.e033111
• Main Authors: Qazi, Saadia, Seligman, Benjamin, Preis, Sarah R, Rane, Manas, Djousse, Luc, Gagnon, David R, Wilson, Peter W F, Gaziano, J Michael, Driver, MD, MPH, Jane A, Cho, Kelly, Orkaby, Ariela R
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; cardiovascular disease; Cardiovascular Diseases - diagnosis; Cardiovascular Diseases - epidemiology; Cardiovascular Diseases - mortality; Female; Frail Elderly - statistics & numerical data; frailty; Frailty - diagnosis; Frailty - epidemiology; Frailty - mortality; Geriatric Assessment - methods; Humans; Male; Middle Aged; Prospective Studies; Risk Assessment - methods; Risk Factors; risk stratification; Self Report; United States - epidemiology; Veterans - statistics & numerical data
• ISSN: 2047-9980; 2047-9980
• DOI: 10.1161/JAHA.123.033111

Frailty, a syndrome of physiologic vulnerability, increases cardiovascular disease (CVD) risk. Whether in person or automated frailty tools are ideal for identifying CVD risk remains unclear. We calculated 3 distinct frailty scores and examined their associations with mortality and CVD events in the Million Veteran Program, a prospective cohort of nearly 1 million US veterans. Veterans aged ≥50 years and enrolled from 2011 to 2018 were included. Two frailty indices (FI) based on the deficit accumulation theory were calculated: the questionnaire-based 36-item Million Veteran Program-FI and 31-item Veterans Affairs-FI using claims data. We calculated Fried physical frailty using the self-reported, 3-item Study of Osteoporotic Fractures. Multivariable-adjusted Cox models examined the association of frailty by each score with primary (all-cause and CVD mortality) and secondary (myocardial infarction, stroke, and heart failure) outcomes. In 190 688 veterans (69±9 years, 94% male, 85% White), 33, 233 (17%) all-cause and 10 115 (5%) CVD deaths occurred. Using Million Veteran Program-FI, 29% were robust, 42% pre-frail, and 29% frail. Frailty prevalence increased by age group (27% in 50-59 to 42% in ≥90 years). Using the Million Veteran Program-FI, over 6±2 years, frail veterans had a higher hazard of all-cause (hazard ratio [HR], 3.05 [95% CI, 2.95-3.16]) and CVD mortality (HR, 3.65 [95% CI, 3.43-3.90]). Findings were concordant for the Veterans Affairs-FI and Study of Osteoporotic Fractures frailty definitions, and remained significant even among younger veterans aged 50-59 years. Irrespective of frailty measure, frailty is associated with a higher risk of all-cause mortality and adverse CVD events. Further study of frailty in veterans aged