Association between frailty and short- and long-term mortality in patients with critical acute myocardial infarction: Results from MIMIC-IV

Abstract

BackgroundFrailty has been recognized as an important prognostic indicator in patients with acute myocardial infarction (AMI). However, no study has focused on critical AMI patients. We aimed to determine the impact of frailty on short- and long-term mortality risk in critical AMI patients.MethodsData from the Medical Information Mart for Intensive Care (MIMIC)-IV database was used. Frailty was assessed using the Hospital Frailty Risk Score (HFRS). Outcomes were in-hospital mortality and 1-year mortality. Logistic regression and Cox proportional-hazards models were used to investigate the association between frailty and outcomes.ResultsAmong 5,003 critical AMI patients, 2,176 were non-frail (43.5%), 2,355 were pre-frail (47.1%), and 472 were frail (9.4%). The in-hospital mortality rate was 13.8%, and the 1-year mortality rate was 29.5%. In our multivariable model, frailty was significantly associated with in-hospital mortality [odds ratio (OR) = 1.30, 95% confidence interval (CI): 1.20–1.41] and 1-year mortality [hazard ratio (HR) = 1.29, 95% CI: 1.24–1.35] as a continuous variable (per five-score increase). When assessed as categorical variables, pre-frailty and frailty were both associated with in-hospital mortality (OR = 2.80, 95% CI: 2.19–3.59 and OR = 2.69, 95% CI: 1.93–3.73, respectively) and 1-year mortality (HR = 2.32, 95% CI: 2.00–2.69 and HR = 2.81, 95% CI: 2.33–3.39, respectively) after adjustment for confounders. Subgroup analysis showed that frailty was only associated with in-hospital mortality in critically ill patients with non-ST-segment elevation myocardial infarction (STEMI) but not STEMI (p for interaction = 0.012). In addition, frailty was associated with 1-year mortality in both STEMI and non-STEMI patients (p for interaction = 0.447). The addition of frailty produced the incremental value over the initial model generated by baseline characteristics for both in-hospital and 1-year mortality.ConclusionFrailty, as assessed by the HFRS, was associated with both in-hospital and 1-year mortality in critical AMI patients. Frailty improves the prediction of short- and long-term mortality in critical AMI patients and may have potential clinical applications.

Association of Frailty with Adverse Outcomes in Patients with Critical Acute Myocardial Infarction: A Retrospective Cohort Study

“…11 The prevalence of frailty assessed by the FRAIL scale was 19.7% in patients with STEMI aged ≥75 years or older undergoing percutaneous coronary intervention and frailty was independently associated with in-hospital mortality. 10 In our previous research, 18 we reported on another frailty assessment method based on electronic medical record data called the Hospital Frailty Risk Score (HFRS), 23 and its association with in-hospital and one-year mortality in the same population. The results showed that frailty, as assessed by the HFRS, was significantly associated with both in- However, frailty assessment methods based on self-report and/or objective measures such as the FRAIL scale, 24 Edmonton Frail Scale 25 and FFP 26 may not be feasible in the ICU setting, which are limited by patients' state of consciousness and mobility.…”

“…We considered all patients diagnosed with AMI during the analysis period, the same as in our previous study. 18 We excluded patients with one or more of the following criteria: age <18 years; survival time <24 h or organ donors; pregnant patients or those with puerperal illness; and those missing key variables (demographic data, AMI type, Sequential Organ Failure Assessment [SOFA] score, 19 items to construct the MFI, and vital status at hospital discharge and one year after ICU admission). For patients with more than one ICU stay, only the first ICU stay was included for analysis.…”

Frailty as a Key Predictor of Malnutrition among Older Adults with Swallowing Problems

“…Several studies have shown that frailty is associated with in-hospital, post-discharge care needs, postoperative complications, postoperative delirium, and prolonged length of hospital stay in hospitalized older people. 6,7 In addition, a previous study has demonstrated that pre-frail and frail older adults tend to have poor nutritional status or develop severe malnutrition. 8 However, malnutrition due to difficulty swallowing is a significant clinical problem often overlooked among older people.…”

Comment on: Benefit of primary and secondary prophylactic implantable cardioverter defibrillator in elderly patients

“…6 Finally, frailty is associated with a significantly higher risk of all-cause mortality and readmission in patients with acute ACS. 7,8 In our view, subanalysis of the current trial in frail and nonfrail cohorts should be performed if it is possible.…”

“… 6 Finally, frailty is associated with a significantly higher risk of all‐cause mortality and readmission in patients with acute ACS. 7 , 8 …”