Physical function frailty trajectory before and after cardiovascular event among older adults in three multinational cohorts.

OBJECTIVES

To capture temporal pattern of physical function frailty before and after cardiovascular disease (CVD), including heart disease and stroke incidence event, among older adults.

METHODS

A total of 23,307 participants aged over 50 years from three cohorts: English Longitudinal Study of Ageing (ELSA), and Health and Retirement Study (HRS) and China Health and Retirement Longitudinal Study (CHARLS) were studied. Physical function frailty was assessed by mobility and daily function scores. Higher scores indicated more severe physical function frailty. CVD was ascertained by self-reported physician-diagnosed heart disease or stroke. Four subtypes of heart disease including angina, heart attack, coronary heart disease and heart failure were also assessed.

RESULTS

In participants who experienced a CVD event, physical function frailty (measured by the mobility and daily function scores) were already present prior to the event and worsened thereafter. Short-term increase of mobility scores following the CVD diagnosis were observed (ELSA: β = 4.40, 95% CI 3.34, 5.45; HRS: β = 4.73, 95% CI 3.95, 5.50; CHARLS: β = 3.08, 95% CI 1.01, 5.14). The post-annual increase of physical function frailty after the event was significantly faster than that before the event. These patterns were consistent for both heart disease and stroke incidence events, as well as for the four subtypes of heart disease.

CONCLUSIONS

Prior to CVD onset, participants who developed CVD exhibited higher levels of physical function frailty at baseline compared with CVD-free participants. Following the incidence of CVD, participants experienced a short-term increase and a faster annual rate of increase in physical function frailty. We recommend that integrating routine screening for physical function frailty into primary care for older adults to identify high-risk individuals for targeted CVD prevention. Tailored cardiac rehabilitation programs should be developed for CVD survivors.