An Easy Assessment of Frailty at Baseline Independently Predicts Prognosis in Very Elderly Patients With Acute Coronary Syndromes

Formiga, Francesç; Palau-Vendrel, Anna; Rivera, Angel Perez; Abu‐Assi, Emad; Cequier, Ángel; Alegre, Oriol; Arizá-Solé, Albert; Bañeras, Jordi; Rafecas, Agnès; Llibre, Cinta; Vives, Miquel; Sionís, Alessandro; Aboal, Jaime; Vilardell, Pau; Bardajı́, Alfredo; Tomás, Carlos; Macho, Oscar; Peraire, Manuel; Lacal, Ana; Palau, Anna; Martínez-García, Vanessa; Coma, Núria; Carol, Antoni; Campreciós, Marta; Herranz, Susana; Yun, Sergi; Orriols, Maria; Viguer, Josep Ma; Castillo, Juan Carlos; Becerra, Víctor; Cardila, Pilar; Corbi, Miguel; Díaz, Javier López; García-Pardo, Héctor; Pérez-Rivera, José Ángel; Merino, A; Martín-Herrero, Francisco; Garcimartin, Maria Isabel; Sanchís, Juan; Bonanad, Clara; Fabregat, O.; Pérez-Roselló, Vícto; López-Palop, Ramón; Rodríguez-Santamarta, Miguel; González-Salvado, Violeta; Villa, Bernardo García de la; Asmarats, Lluís; Maristany, Jaume; Torres, J. Girós; Gómez-Llorente, Marta; García-González, Martín J.; Pimienta, Raquel; Viana-Tejedor, Ana; Núñez‐Gil, Iván J.; Ruiz-García, Juan; Beringola, Alejandro Cortés; Bueno, Héctor; Martínez‐Sellés, Manuel; Vidán, María Teresa; Díez‐Villanueva, Pablo; Marı́n, Francisco; Munarriz, Aitziber; Salterain, N

doi:10.1016/j.jamda.2017.10.007

Cited by 67 publications

(30 citation statements)

References 33 publications

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“…The assessment tool of frailty among these studies are as follows: 4 studies [11, 12, 16, 19] used Canadian Study of Health and Aging Clinical Frailty Scale (CSHA-CFS); 4 studies [8, 9, 13, 14] used Survey of Health, Ageing and Retirement in Europe Frailty Index (SHARE-FI) tool; 2 studies [17, 18] from the same cohort used Green Score; 2 studies [10, 15] used Edmonton Frail Scale (EFS); one [20] used Fried Frailty score; and one [21] used FRAIL scale. One last study [22] determined frailty with the help of computer program “optimization of care in geriatrics, depending on the degree of frailty” on the basis of the specialized geriatric examination.…”

Section: Resultsmentioning

confidence: 99%

“…All the 15 studies [8–22] reported the prevalence rate of frailty among participants, ranged from 4.7 to 53.2%. Eight studies [8–10, 13–15, 20, 21] reported the rate of pre-frailty ranged from 23.0 to 38.5%.…”

Section: Resultsmentioning

confidence: 99%

“…These 15 included studies [8–22] were of relatively high methodological quality with their scores ranging from 5 to 9 (mean score = 7.4) (Table 2). Eight studies [9, 10, 12–15, 17, 20] were graded as good quality and the rest 7 studies [8, 11, 16, 18, 19, 21, 22] were graded as fair. The representativeness of the exposed cohort, fully adjusted in the analysis and follow-up time were considered to be the most important indicators for methodological quality.…”

Section: Resultsmentioning

confidence: 99%

“…The major bleeding in ACS is defined as patients who had in-hospital intracranial hemorrhage, retroperitoneal bleed, hematocrit drop ≥12%, or need of red blood cells transfusion. Crude data from 6 studies [8, 9, 14, 16, 20, 21] were enrolled in the meta-analysis. We noted that frailty in ACS was associated with the significantly increased risk of major bleeding (RR = 1.51; 95%CI: 1.14–1.99; I 2 = 13.2%, P = 0.33).…”

Section: Resultsmentioning

confidence: 99%

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Prognostic value of frailty in elderly patients with acute coronary syndrome: a systematic review and meta-analysis

Dou

Wang

et al. 2019

BMC Geriatr

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Background: Frailty is common and associated with poorer outcomes in the elderly, but its prognostic value in acute coronary syndromes (ACS) requires clarification. We thus undertook a systematic review and meta-analysis to evaluate the relationship between frailty and poor prognosis in patients with ACS. Methods: We systematically searched PubMed, Embase to find literatures which studied the prognostic value of frailty in elderly patients with ACS. Our main endpoints were the all-cause mortality, cardiovascular disease (CVD), major bleeding and readmissions. We pooled studies using random-effect generic inverse variance method, and conducted three pre-specified subgroup analyses. Results: Of 1216 identified studies, 15 studies were included in our analysis. Compared with the normal group, frailty (HR = 2.65; 95%CI: 1.81-3.89, I 2 = 60.2%) and pre-frailty (HR = 1.41; 95%CI: 1.19-1.66, I 2 = 0%) were characterized by a higher risk of mortality after adjustment. Frailty also was associated with increased risk of any-type CVD, major bleeding and hospital readmissions in elderly patients with ACS. The pooled effect sizes in frail patients were 1.54 (95%CI: 1.32-1.79), 1.51 (95%CI: 1.14-1.99) and 1.51 (95%CI: 1.09-2.10). Conclusions: Frailty provides quantifiable and significant prognostic value for mortality and adverse events in elderly ACS patients, helping doctors to appraise the comprehensive prognosis risk and to applicate appropriate management strategies.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 2 more Smart Citations

Prognostic value of frailty in elderly patients with acute coronary syndrome: a systematic review and meta-analysis

Dou

Wang

et al. 2019

BMC Geriatr

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“…For ACS, Matsuzawa et al reported that slow gait speed (as a marker of frailty) was significantly associated with an increased risk of cardiovascular events in 472 patients with STEMI [14]. Furthermore, White et al showed the correlation between frailty and worse outcomes in 9326 patients with ACS [15] and Alegre et al reported that another frailty assessment tool, the FRAIL scale, was a significant predictor of mortality in ACS patients [16]. Corresponding with previous reports, our study indicated that CFS is independently associated with poor mid-term outcomes in patients with STEMI.…”

Section: Discussionmentioning

confidence: 99%

Impact of the clinical frailty scale on mid-term mortality in patients with ST-elevated myocardial infarction

Yoshioka

Takagi

Morita

et al. 2019

IJC Heart & Vasculature

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Background “Frailty” is associated with poor prognosis in ST-elevated myocardial infarction (STEMI). However, there is little data regarding the impact of the Canadian Study of Health and Aging Clinical Frailty Scale (CFS), a simple and semiquantitative tool for assessing frailty, on mid-term mortality in STEMI patients. Methods A total of 354 consecutive STEMI patients (mean age 69.8 ± 12.4 years; male 76.6%) who underwent percutaneous intervention between July 2014 and March 2017 were retrospectively reviewed. The study endpoint was mid-term mortality according to the CFS classification. Furthermore, in order to clarify the impact of CFS upon admission on mid-term mortality, the independent predictors of all-cause death were evaluated. Results Patients were categorized into three groups (CFS 1–3, n = 281; CFS 4–5, n = 62; and CFS 6–7, n = 11). During the study period (median 474 days), all-cause death was observed in 39 patients. After multivariate Cox regression analysis, higher CFS (adjusted hazard ratio [HR] 2.34, 95% confidence interval [CI] 1.43–3.85, p < 0.001), higher Killip score (adjusted HR 2.46, 95%CI 1.30–5.78, p = 0.002), and lower serum albumin level (adjusted HR 4.29, 95%CI 2.16–8.51, p < 0.001) were significantly associated with an increased risk of all-cause death. Conclusion In conclusion, severe frailty was associated with mid-term mortality in STEMI patients who underwent PCI.

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Effect of Routine Invasive vs Conservative Strategy in Older Adults With Frailty and Non–ST-Segment Elevation Acute Myocardial Infarction

et al. 2023

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ImportanceTo our knowledge, no randomized clinical trial has compared the invasive and conservative strategies in frail, older patients with non–ST-segment elevation acute myocardial infarction (NSTEMI).ObjectiveTo compare outcomes of invasive and conservative strategies in frail, older patients with NSTEMI at 1 year.Design, Setting, and ParticipantsThis multicenter randomized clinical trial was conducted at 13 Spanish hospitals between July 7, 2017, and January 9, 2021, and included 167 older adult (≥70 years) patients with frailty (Clinical Frailty Scale score ≥4) and NSTEMI. Data analysis was performed from April 2022 to June 2022.InterventionsPatients were randomized to routine invasive (coronary angiography and revascularization if feasible; n = 84) or conservative (medical treatment with coronary angiography for recurrent ischemia; n = 83) strategy.Main Outcomes and MeasuresThe primary end point was the number of days alive and out of the hospital (DAOH) from discharge to 1 year. The coprimary end point was the composite of cardiac death, reinfarction, or postdischarge revascularization.ResultsThe study was prematurely stopped due to the COVID-19 pandemic when 95% of the calculated sample size had been enrolled. Among the 167 patients included, the mean (SD) age was 86 (5) years, and mean (SD) Clinical Frailty Scale score was 5 (1). While not statistically different, DAOH were about 1 month (28 days; 95% CI, −7 to 62) greater for patients managed conservatively (312 days; 95% CI, 289 to 335) vs patients managed invasively (284 days; 95% CI, 255 to 311; P = .12). A sensitivity analysis stratified by sex did not show differences. In addition, we found no differences in all-cause mortality (hazard ratio, 1.45; 95% CI, 0.74-2.85; P = .28). There was a 28-day shorter survival in the invasive vs conservatively managed group (95% CI, −63 to 7 days; restricted mean survival time analysis). Noncardiac reasons accounted for 56% of the readmissions. There were no differences in the number of readmissions or days spent in the hospital after discharge between groups. Neither were there differences in the coprimary end point of ischemic cardiac events (subdistribution hazard ratio, 0.92; 95% CI, 0.54-1.57; P = .78).Conclusions and RelevanceIn this randomized clinical trial of NSTEMI in frail older patients, there was no benefit to a routine invasive strategy in DAOH during the first year. Based on these findings, a policy of medical management and watchful observation is recommended for older patients with frailty and NSTEMI.Trial RegistrationClinicalTrials.gov Identifier: NCT03208153

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An Easy Assessment of Frailty at Baseline Independently Predicts Prognosis in Very Elderly Patients With Acute Coronary Syndromes

Cited by 67 publications

References 33 publications

Prognostic value of frailty in elderly patients with acute coronary syndrome: a systematic review and meta-analysis

Prognostic value of frailty in elderly patients with acute coronary syndrome: a systematic review and meta-analysis

Impact of the clinical frailty scale on mid-term mortality in patients with ST-elevated myocardial infarction

Effect of Routine Invasive vs Conservative Strategy in Older Adults With Frailty and Non–ST-Segment Elevation Acute Myocardial Infarction

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