Interrelationships Among Frailty Indicators and Associated Factors in Older Adults with Cardiovascular Disease: A Network Analytical Approach

Aims The aim of this study was to investigate factors associated with frailty indicators in older adults with cardiovascular disease and to identify central indicators and key conditional associations within the network that may inform hypotheses for future management approaches. Design A cross-sectional analysis of nationally representative survey data. Methods All older adults aged 60 years and older with cardiovascular disease were selected from the 2015 wave of the China Health and Retirement Longitudinal Study using the Fried Frailty Phenotype to assess frailty indicators. Network analysis under a Mixed Graphical Model calculated strength, closeness, and betweenness centrality, complemented by bootstrap resampling (n=1,000) to assess stability. Results This study ultimately included a total of 2,748 older adults with CVD; 536 were identified as frail. Exhaustion and weakness demonstrated the highest strength centrality among the five frailty indicators. Strong positive associations were found between exhaustion and pain and poor sleep quality, and between weakness and depression; hemoglobin was negatively associated with exhaustion and slowed gait speed. Reduced social engagement showed negative expected influence, indicating conditional cross-sectional associations rather than protective causal effects. Conclusions Exhaustion and weakness were highly central nodes, followed by depression and pain-related distress. These exploratory findings, subject to multiple comparison considerations, suggest that assessment and management of these central indicators, with coordinated strategies addressing psychological status, pain, sleep quality, and social engagement, may warrant further longitudinal or interventional investigation.