Frailty, Cognition, and Depression in Older Subjects with Coronary Artery Disease

Date
2015-09-28
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Abstract
Frailty is an area of increasing interest for researchers in cardiovascular health, as health providers look for ways to improve patient resiliency and outcomes. However, little is known about the behavior of frailty or frailty components, particularly cognitive and emotional vulnerability, over time and which groups are more at risk of decline in resiliency after a coronary intervention. The Calgary Cardiac and Cognition (3C) study is a prospective, longitudinal cohort study of patients undergoing coronary angiography who subsequently received a revascularization procedure or only medical treatment. Using the 3C data, three separate but related studies were completed. First, the independent associations of baseline potential frailty criteria with 12-month decline in activities of daily living (ADL) were compared. Those categorized as frail in the best multivariable model had 9.0 times the risk of ADL decline and 3.8 times the risk of health-related quality of life (HQRL) decline compared to those categorized as robust. In the second study, the association over time between two frailty criteria, depression and cognition, was further investigated. Persistent depressive symptoms were more strongly associated with cognitive decline after coronary intervention than depressive symptoms measured only at baseline. Executive function scores for those with persistent depression in the first year, declined by 0.3 to 0.5 standard deviations in the subsequent 18 months. In the third study, frailty scores on average formed a U-shaped curve with frailty declining from baseline (pre-procedure) to 6 and 12 months, and increasing again by 30 months. Women had higher scores than men, but not significantly so. Frailty trajectory by initial treatment plan differed by age group as those aged 75 and older did not decline (improve) in frailty after the intervention for some treatment types. A better understanding of the nature of frailty and frailty components, provided by this research, may help researchers plan and interpret future intervention studies aimed at preventing worsened frailty or better supporting frail persons in follow up to coronary intervention. It lays the groundwork for more studies designed to better anticipate and address the loss of resilience, functional decline, and quality of life in patients after coronary intervention.
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Epidemiology
Citation
Freiheit, E. A. (2015). Frailty, Cognition, and Depression in Older Subjects with Coronary Artery Disease (Doctoral thesis, University of Calgary, Calgary, Canada). Retrieved from https://prism.ucalgary.ca. doi:10.11575/PRISM/26222