Frailty Confers High Mortality Risk across Different Populations: Evidence from an Overview of Systematic Reviews and Meta-Analyses

Abstract

We performed an overview of systematic reviews and meta-analyses to summarize available data regarding the association between frailty and all-cause mortality. Medline, Embase, CINAHL, Web of Science, PsycINFO, and AMED (Allied and Complementary Medicine) databases were searched until February 2020 for meta-analyses examining the association between frailty and all-cause mortality. The AMSTAR2 checklist was used to evaluate methodological quality. Frailty exposure and the risk of all-cause mortality (hazard ratio [HR] or relative risk [RR]) were displayed in forest plots. We included 25 meta-analyses that pooled data from between 3 and 20 studies. The number of participants included in these meta-analyses ranged between <2000 and >500,000. Overall, 56%, 32%, and 12% of studies were rated as of moderate, low, and critically low quality, respectively. Frailty was associated with increased risk of all-cause mortality in 24/24 studies where the HR/RRs ranged from 1.35 [95% confidence interval (CI) 1.05-1.74] (patients with diabetes) to 7.95 [95% CI 4.88-12.96] (hospitalized patients). The median HR/RR across different meta-analyses was 1.98 (interquartile range 1.65-2.67). Pre-frailty was associated with a significantly increased risk of all-cause mortality in 7/7 studies with the HR/RR ranging from 1.09 to 3.65 (median 1.51, IQR 1.38-1.73). These data suggest that interventions to prevent frailty and pre-frailty are needed.

Keywords: evidence synthesis; frailty; meta-analyses; mortality; umbrella review.

Figure 1

Flow chart of studies’ selection process.

Figure 2

Forest plot showing the reported HR/RR of the association between frailty and all-cause mortality across the included meta-analyses. HF = heart failure; ACS = acute coronary syndrome; PCI = percutaneous coronary intervention; TAVI = TAVI = transcatheter aortic valve implantation patients; TAVR = transcatheter aortic valve replacement, LVAD = left ventricular assist device implantation; ICU = intensive care unit.

Figure 3

Forest plot showing the reported HR/RR of the association between pre-frailty and all-cause mortality across the included meta-analyses. ACS = acute coronary syndrome; HF = heart failure.