Accumulation of Deficits as a Key Risk Factor for Cardiovascular Morbidity and Mortality: A Pooled Analysis of 154 000 Individuals
Journal Articles
Overview
Research
Identity
Additional Document Info
View All
Overview
abstract
Background
Frailty is associated with higher mortality in individuals at high cardiovascular disease (
CVD
) risk. We hypothesize that frailty is a more important prognostic factor than
CVD
risk factors and aim to determine the prognostic value of a cumulative deficit frailty index in patients with or at high risk for
CVD
.
Methods and Results
We conducted an individual‐level pooled analysis of participants with or at risk for
CVD
, recruited in 14 multicenter clinical trials. The cumulative deficit index was calculated as the proportion of 26 deficits exhibited. Individuals were categorized as nonfrail, prefrail, or frail if they had indexes of ≤0.1, >0.1 to 0.21, or >0.21, respectively.
CVD
risk was assessed using the Framingham score. Outcomes included
CVD
event (new or recurrent myocardial infarction, stroke, or heart failure) and mortality. We studied 154 696 patients (mean age, 70.8 years; 63% men) with median follow‐up of 3.2 years. There were 17 535
CVD
events and 15 067 deaths. The frail group (n=13 872) had higher risk of a
CVD
event (incidence rate ratio, 1.97; 95%
CI
, 1.85–2.08), all‐cause mortality (hazard ratio, 1.91; 95%
CI
, 1.79–2.03), and
CVD
mortality (hazard ratio, 1.91; 95%
CI
, 1.77–2.05) than the nonfrail group (n=101 343). Associations remained unchanged after adjusting for
CVD
risk factors. The index statistically outperformed the Framingham score in its ability to discriminate
CVD
events (C‐statistic, 0.60 [95%
CI
, 0.60–0.61] versus 0.58 [95%
CI
, 0.57–0.58], respectively;
P
<0.001).
Conclusions
In individuals with or at high risk of developing
CVD
, the cumulative deficit index is associated with increased
CVD
events and mortality, independent of
CVD
risk factors, and adds incremental prognostic value.
