The Connection Between Frailty and Heart Disease

Studies measuring the frailty of aging patients and the risk of heart failure were found to have a significant association which perhaps is not too surprising. However, the study found that simple exercise and other intervention could improve the physical function of at-risk seniors, lowering the risk of heart disease and improving the quality of life for those found to be categorized as medically frail. Taking fish oil supplements may help support overall heart health as well.

Study Participants

The Health Aging and Body Composition Study (Health ABC) measured the frailty and health of a random sample of individuals aged between 70 and 79 years of age. 48% of the study group were male and 59% were white. The follow-up covered a period of 11.4 years.

The 2935 participants had full data to meet the Gill Criteria and HABC Battery. Information was collected on smoking history, diabetes, calories used in weekly exercise, hypertension and coronary heart disease (CHD) which was defined as a history of angina, stroke, myocardial infarction of electrocardiographic evidence.

How to Measure Frailty

Frailty of the participants was based on the Gill Index which measures mobility using two tests. Patients were defined as having severe frailty if they were unable to stand up from a chair without the assistance of chair arms and were unable to walk at a speed of 0.6 meters per second (m/s) or more. Those with one of the two criteria present, either standing up unaided or walking slower than 0.6 m/s were considered to have moderate frailty. Those with neither problem were classed as non-frail.

Frailty was also measured by the Health ABC physical performance battery which evaluates individuals using an extended series of tests including five repeated chair stands, standing balance, balance on one leg for 30 seconds, a 6-meter walk to check speed and ability to walk between two lines 20cm apart.

These tests gave the study participants a scale of frailty from 0 to 4. At the start of the study frailty was present in 17.5% of participants (16.2% with moderate frailty and 1.3% with severe frailty). Frailty was most common in older women and black patients.

In a cross-section of the general population of individuals aged 65 to 75 years, 3-7% are found to be frail while up to 26% of octogenarians and 33% of those over the age of 90 suffer from frailty, as measured by the Gill Index and Health ABC Battery tests. Other studies showed 25-50% of those with frailty also had cardiovascular disease and were at higher risk of mortality from heart disease.

The Relationship Between Frailty and Heart Failure in the Elderly

During the study a total of 466 participants developed heart failure. It was found that those deemed to have severe frailty or moderate frailty were at higher risk of developing heart failure. The risks were the same across different ages, sex and race and in subgroups of those suffering from diabetes or cardiovascular disease at the start of the study.

Overall the study concluded that frailty is a precursor to heart failure and is independently associated with an increased risk of heart failure in older adults.

Although more detailed study needs to be done into the correlation between frailty in the elderly and heart failure, one key element that was shown to improve the outcome and quality of life for the elderly was exercise. Introducing physical activity was found to have a positive effect on patients, including those deemed frail. Exercise was associated with a decrease in inflammation and improvement in insulin resistance which can all help reduce debility in the elderly.


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