Associations and One-year Trends of Frailty, Cognition, Disability, and Quality of Life in Individuals with Chronic Limb-threatening Ischemia

Abstract Introduction This study aimed to describe the associations of frailty with cognition, disability, and quality of life (QoL) among individuals with chronic limb-threatening ischaemia (CLTI) over one-year following intervention. Methods Single-centre prospective cohort study. Patients aged ≥65 with CLTI and a planned intervention between May 2019 and May 2021 were eligible for inclusion. Patients underwent frailty, cognitive function, disability and QoL assessments before their procedure. Delirium screening was performed at 24- and 72-hours post-operatively. Frailty, disability and QoL assessments were repeated at three- and 12-months. Results Ninety-nine patients completed baseline assessments, of whom 45 (45%) were classified as frail by the Edmonton frail scale. Frailty was strongly associated with higher prevalence of cognitive impairment (52% vs 17%; p<.001). Eighty-seven patients underwent a procedure. Ten (11%) developed POD, of whom 8 had frailty (p=.003). Cognitive impairment (OR 8.52; 95%CI 1.12, 64.67; p=.038) was independently associated with POD. Frailty was associated with worse vascular quality of life questionnaire (VascuQoL) (p=.001) and EQ-5D-5L scores (p<.001) at all timepoints, however both those with and without frailty had modest improvement in VascuQoL and EQ-5D-5L scores at 12-months (p=.001). Barthel index (disability) scores were lower for those with frailty (p<.001) and decreased slightly over 12-months for both groups (p=.007). Five patients (12%) transitioned from frailty to non-frailty at 12-months (clinical frailty scale), however 10 patients (23%) transitioned from non-frailty to frailty. Conclusion CLTI patients with frailty have worse cognition, QoL and disability. Overall, individuals with CLTI demonstrate progression in frailty and disability at one-year post-intervention.