Frailty shows strong positive association with depression in older adults with coronary heart disease.
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Key Takeaway
Note high heterogeneity and cross-sectional bias when interpreting frailty-depression association in older adults with CHD.
This systematic review and meta-analysis examined the association between frailty and depression in a population of 2,628 older adults with coronary heart disease, with a mean or median age of at least 60 years. The study design included both cross-sectional and cohort studies, though prospective data were limited. No specific medications were analyzed as the primary exposure was the presence of frailty compared to depression status.
The pooled analysis demonstrated a significant positive association between frailty and depression, yielding an odds ratio of 2.45 (95% CI: 1.22–4.92). When stratified by study design, the association appeared more pronounced in cohort studies with an odds ratio of 3.92 (95% CI: 1.66–9.27), compared to cross-sectional studies which reported an odds ratio of 1.91 (95% CI: 1.02–3.58). Absolute numbers for specific outcomes were not reported in the source data.
Safety and tolerability data, including adverse events or discontinuations, were not reported. Key limitations include a predominance of cross-sectional data, which prevents establishing temporality, and substantial heterogeneity across studies (I² = 90% overall). Additional heterogeneity was noted in cross-sectional (I² = 74%) and cohort (I² = 71%) subsets. Funding sources and potential conflicts of interest were not reported.
The practice relevance supports integrated screening approaches for both conditions. However, prospective studies are needed to establish temporality and better inform causal inference. The high heterogeneity and observational nature of the evidence preclude definitive causal conclusions regarding frailty as a risk factor for depression in this population.
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View Original Abstract ↓
BackgroundFrailty and depression frequently co-occur in older patients with coronary heart disease (CHD) and are each associated with adverse outcomes. However, the strength and nature of their association in this population have not been systematically quantified.MethodsWe systematically searched PubMed, Embase, and Web of Science and other major databases from inception to April 2025 for observational studies examining the association between frailty and depression in adults with CHD. Two reviewers independently screened studies, extracted data, and assessed quality using the Newcastle-Ottawa Scale for cohort studies and the AHRQ checklist for cross-sectional studies. Both cross-sectional and cohort studies were eligible. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using a random-effects model, prioritizing adjusted estimates where available. Heterogeneity was quantified using the I2 statistic. Subgroup analyses were planned by region, study design and assessment tool.ResultsOf 2,160 records screened, 6 studies met the inclusion criteria, comprising 2,628 patients with CHD. All included studies focused on older adults (mean/median age ≥60 years), reflecting the current evidence base in this population. Meta-analysis showed a significant positive association between frailty and depression (pooled OR = 2.45; 95% CI: 1.22–4.92), with substantial heterogeneity (I2 = 90%). When analyzed by study design, the association appeared more pronounced in cohort studies (OR = 3.92; 95% CI: 1.66–9.27; I2 = 71%) than in cross-sectional studies (OR = 1.91; 95% CI: 1.02–3.58; I2 = 74%).ConclusionFrailty and depression are significantly associated in older adults with CHD, supporting integrated screening approaches. However, given the predominance of cross-sectional data, high heterogeneity, and limited cohort evidence, prospective studies are needed to establish temporality and better inform causal inference.Systematic review registrationhttps://www.crd.york.ac.uk/PROSPERO/view/CRD420251036929, PROSPERO (CRD420Ò51036929).
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