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In this retrospective cohort study of 94 595 severe acute respiratory syndrome coronavirus 2–positive cases, we developed and validated an algorithm to assess the association between coronavirus disease 2019 (COVID-19) severity and long-term complications (stroke, myocardial infarction, pulmonary embolism/deep vein thrombosis, heart failure, and mortality). COVID-19 severity was associated with a greater risk of experiencing a long-term complication 31–120 days postinfection. Most incident events occurred 31–60 days postinfection and diminished after day 91, except heart failure for severe patients and death for moderate patients, which peaked on days 91–120. Understanding the differential impact of COVID-19 severity on long-term events provides insight into possible intervention modalities and critical prevention strategies.

Aims Frailty is associated with an increased risk of all-cause mortality and cardiovascular (CV) events. Limited data exist from the modern era of CV prevention on the relationship between frailty and CV mortality. We hypothesized that frailty is associated with an increased risk of CV mortality. Methods and results All US Veterans aged ≥65 years who were regular users of Veteran Affairs care from 2002 to 2017 were included. Frailty was defined using a 31-item previously validated frailty index, ranging from 0 to 1. The primary outcome was CV mortality with secondary analyses examining the relationship between frailty and CV events (myocardial infarction, stroke, revascularization). Survival analysis models were adjusted for age, sex, ethnicity, geographic region, smoking, hyperlipidaemia, statin use, and blood pressure medication use. There were 3 068 439 US Veterans included in the analysis. Mean age was 74.1 ± 5.8 years in 2002, 76.0 ± 8.3 years in 2014, 98% male, and 87.5% White. In 2002, the median (interquartile range) frailty score was 0.16 (0.10–0.23). This increased and stabilized to 0.19 (0.10–0.32) for 2006–14. The presence of frailty was associated with an increased risk of CV mortality at every stage of frailty. Frailty was associated with an increased risk of myocardial infarction and stroke, but not revascularization. Conclusion In this population, both the presence and severity of frailty are tightly correlated with CV death, independent of underlying CV disease. This study is the largest and most contemporary evaluation of the relationship between frailty and CV mortality to date. Further work is needed to understand how this risk can be diminished. Key Question Can an electronic frailty index identify adults aged 65 and older who are at risk of CV mortality and major CV events? Key Finding Among 3 068 439 US Veterans aged 65 and older, frailty was associated with an increased risk of CV mortality at every level of frailty. Frailty was also associated with an increased risk of myocardial infarction and stroke, but not revascularization. Take Home Message Both the presence and severity of frailty are associated with CV mortality and major CV events, independent of underlying CV disease.

Background Electronic frailty indices (eFIs) are increasingly used to identify patients at risk for morbidity and mortality. Whether eFIs capture the spectrum of frailty change, including decline, stability, and improvement, is unknown. Methods In a nationwide retrospective birth cohort of U.S. Veterans, a validated eFI, including 31 health deficits, was calculated annually using medical record and insurance claims data (2002–2012). K-means clustering was used to assign patients into frailty trajectories measured 5 years prior to death. Results There were 214 250 veterans born between 1927 and 1934 (mean [SD] age at death = 79.4 [2.8] years, 99.2% male, 90.3% White) with an annual eFI in the 5 years before death. Nine frailty trajectories were identified. Those starting at nonfrail or prefrail had 2 stable trajectories (nonfrail to prefrail, n = 29 786 and stable prefrail, n = 28 499) and 2 rapidly increasing trajectories (prefrail to moderately frail, n = 28 244 and prefrail to severely frail, n = 22 596). Those who were mildly frail at baseline included 1 gradually increasing trajectory (mildly to moderately frail, n = 33 806) and 1 rapidly increasing trajectory (mildly to severely frail, n = 15 253). Trajectories that started at moderately or severely frail included 2 gradually increasing trajectories (moderately to severely frail, n = 27 662 and progressing severely frail, n = 14 478) and 1 recovering trajectory (moderately frail to mildly frail, n = 13 926). Conclusions Nine frailty trajectories, including 1 recovering trajectory, were identified in this cohort of older U.S. Veterans. Future work is needed to understand whether prevention and treatment strategies can improve frailty trajectories and contribute to compression of morbidity toward the end of life.

Relatively little is known about if or how veteran status is related to pain and falls among community-dwelling older men. We investigated the association between pain and falls, and examined whether veterans status and combat experience might modify this association. The study sample included 2718 men from the Health and Retirement Study, a nationally representative sample of older Americans (mean age 76.6, range 68–99). The number of falls as the outcome was measured prospectively in 2012. Key independent variables, measured in 2010, included reporting trouble with pain, veteran status, and combat experience (fired a weapon in combat). Descriptive statistics include: 36% of the men fell during 2 years, 30% reported trouble with pain, 40% were non-veterans, and 14% and 46% were veterans with and without combat experiences, respectively. Multivariate Generalized Estimating Equation Poisson regression indicates that having trouble with pain increased the rate of experiencing a fall by 77% adjusting for age, race, marital status, education, income, alcohol consumption, physical activities, vision, depression, psychotropic medication, and comorbidities. There is an interaction between veteran status and pain on the risk of falls. Stratified analyses by veteran status and combat experiences show that having trouble with pain increased the rate of experiencing a fall by 80% and 97% in non-veterans and veterans without combat experience, respectively. There was no association between pain and falls among veterans with combat experience. Further research is recommended to understand how military experiences are related to the association between pain and falls in older adults.

The 1984-1988 dietary and cardiovascular disease risk factor profiles of the Framingham Offspring-Spouse population (n = 3787 Framingham males and females, 22-79 years) were compared to earlier estimates from the 1976-1980 NHANES II and 1977-1978 USDA Nationwide Food Consumption surveys. The goals were to assess whether differences exist among population estimates, to determine whether national population-based nutrition recommendations for cardiovascular disease risk reduction are appropriately targeted, and to identify focus areas for future preventive nutrition interventions. Overall, population mean levels of cardiovascular disease risk factors were high but mean total cholesterol and blood pressure levels and rates of dyslipidaemia were lower in Framingham men and women and hypertension appeared higher in Framingham compared with NHANES II. Severe overweight appeared more prevalent in Framingham men but similar in Framingham women in comparison with NHANES. Population estimates of total fat (36-41% of calories) and saturated fat (12.5-13.7% of calories) intakes were higher and carbohydrate intakes were lower (40-46% of calories) than current recommended levels. Dietary cholesterol and sodium intakes in Framingham women appeared to have reached recommended levels but were high in men. While the goals of current nutrition recommendations remain appropriate, future population-based preventive nutrition interventions to lower cardiovascular disease risk need to emphasize weight reduction, lowering intakes of foods rich in animal and plant fats, increases in dietary sources of complex carbohydrates, fibre and micronutrients, and lower sodium intakes, particularly in adult men.