Clinical relevance of frailty trajectory post myocardial infarction

Myers, Vicki; Drory, Yaacov; Gerber, Yariv

doi:10.1177/2047487312462828

Cited by 33 publications

(46 citation statements)

References 49 publications

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“…In addition to greater cardiac and noncardiac comorbidities, frail patients had greater deficits in cognition, mobility, and continence. Our findings demonstrating that frailty is not only associated with increased in‐hospital but also midterm all‐cause mortality and hospitalizations following MI are consistent with prior analyses 3, 4, 5, 6. Despite this higher risk, frail patients were managed less aggressively compared with their nonfrail counterparts.…”

Section: Discussionsupporting

confidence: 88%

“…Each participant received a score between 0 and 28, and the FI was defined as the frailty score divided by 28, ranging between 0 and 1. While frailty in the deficit accumulation model is a continuum, similar prior analyses3 have stratified patients into 2 groups: (1) frail , defined as a FI ≥0.25 (ie, frailty score ≥7) and (2) nonfrail , defined as a FI <0.25 (ie, frailty score <7).…”

Section: Methodsmentioning

confidence: 99%

“…However, in patients with significant cardiovascular disease, the prevalence may be as high as 60% 2. Frailty has been associated with increased major adverse cardiac events after myocardial infarction (MI) 3, 4, 5, 6. Mechanisms proposed for worse outcomes are likely multifactorial.…”

Section: Introductionmentioning

confidence: 99%

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Frailty and Outcomes After Myocardial Infarction: Insights From the CONCORDANCE Registry

Patel

Goodman

Yan

et al. 2018

JAHA

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BackgroundLittle is known about the prognostic implications of frailty, a state of susceptibility to stressors and poor recovery to homeostasis in older people, after myocardial infarction (MI).Methods and ResultsWe studied 3944 MI patients aged ≥65 years treated at 41 Australian hospitals from 2009 to 2016 in the CONCORDANCE (Australian Cooperative National Registry of Acute Coronary Care, Guideline Adherence and Clinical Events) registry. Frailty index (FI) was determined using the health deficit accumulation method. All‐cause and cardiac‐specific mortality at 6 months were compared between frail (FI >0.25) and nonfrail (FI ≤0.25) patients. Among 1275 patients with ST‐segment–elevation MI (STEMI), 192 (15%) were frail, and among 2669 non‐STEMI (NSTEMI) patients, 902 (34%) were frail. Compared with nonfrail counterparts, frail STEMI patients received 30% less reperfusion therapy and 22% less revascularization during index hospitalization; frail NSTEMI patients received 30% less diagnostic angiography and 39% less revascularization. Unadjusted 6‐month all‐cause mortality (STEMI: 13% versus 3%; NSTEMI: 13% versus 4%) and cardiac‐specific mortality (STEMI: 6% versus 1.4%, NSTEMI: 3.2% versus 1.2%) were higher among frail patients. After adjustment for known prognosticators, FI was significantly associated with higher 6‐month all‐cause (STEMI: odds ratio: 1.74 per 0.1 FI [95% confidence interval, 1.37–2.22], P<0.001; NSTEMI: odds ratio: 1.62 per 0.1 FI [95% confidence interval, 1.40–1.87], P<0.001) but not cardiac‐specific mortality (STEMI: P=0.99; NSTEMI: P=0.93).ConclusionsFrail patients receive lower rates of invasive cardiac care during MI hospitalization. Increased frailty was independently associated with increased postdischarge all‐cause mortality but not cardiac‐specific mortality. These findings inform identification of frailty during MI hospitalization as a potential opportunity to address competing risks for mortality in this high‐risk population.

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Section: Discussionsupporting

confidence: 88%

Section: Methodsmentioning

confidence: 99%

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Frailty and Outcomes After Myocardial Infarction: Insights From the CONCORDANCE Registry

Patel

Goodman

Yan

et al. 2018

JAHA

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“…There is also an aspect regarding the effectiveness of the measures implemented [46][47][48][49][50][51][52] and the different treatments [53][54][55]. Another investigated aspect concerns lifestyle, with regard to dietary habits, healthy lifestyle [56], comorbidities [43,57] (smoking and/or alcohol), but also environmental factors like atmospheric pollution.…”

Section: Discussionmentioning

confidence: 99%

“…cardiac or renal, but also to the various treatments and therapies. In response to Q5, T2 was thus related to research: in disease studies [30][31][32][33][34][35][36][37], to compare care and coding [38][39][40], but also in monitoring of patients over time and the survival rate [31,[41][42][43][44]. Survival rate forms part of a trajectory concept.…”

Section: Discussionmentioning

confidence: 99%

Patient healthcare trajectory. An essential monitoring tool: a systematic review

Pinaire

Azé

Bringay

et al. 2017

Health Inf Sci Syst

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Background: Patient healthcare trajectory is a recent emergent topic in the literature, encompassing broad concepts. However, the rationale for studying patients' trajectories, and how this trajectory concept is defined remains a public health challenge. Our research was focused on patients' trajectories based on disease management and care, while also considering medico-economic aspects of the associated management. We illustrated this concept with an example: a myocardial infarction (MI) occurring in a patient's hospital trajectory of care. The patient follow-up was traced via the prospective payment system. We applied a semi-automatic text mining process to conduct a comprehensive review of patient healthcare trajectory studies. This review investigated how the concept of trajectory is defined, studied and what it achieves.Methods: We performed a PubMed search to identify reports that had been published in peer-reviewed journals between January 1, 2000 and October 31, 2015. Fourteen search questions were formulated to guide our review. A semi-automatic text mining process based on a semantic approach was performed to conduct a comprehensive review of patient healthcare trajectory studies. Text mining techniques were used to explore the corpus in a semantic perspective in order to answer non-a priori questions. Complementary review methods on a selected subset were used to answer a priori questions.Results: Among the 33,514 publications initially selected for analysis, only 70 relevant articles were semi-automatically extracted and thoroughly analysed. Oncology is particularly prevalent due to its already well-established processes of care. For the trajectory thema, 80% of articles were distributed in 11 clusters. These clusters contain distinct semantic information, for example health outcomes (29%), care process (26%) and administrative and financial aspects (16%). Conclusion:This literature review highlights the recent interest in the trajectory concept. The approach is also gradually being used to monitor trajectories of care for chronic diseases such as diabetes, organ failure or coronary artery and MI trajectory of care, to improve care and reduce costs. Patient trajectory is undoubtedly an essential approach to be further explored in order to improve healthcare monitoring.

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Frailty as a predictor of all-cause mortality and readmission in older patients with acute coronary syndrome

Cai

Fan

et al. 2020

Wien Klin Wochenschr

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Clinical relevance of frailty trajectory post myocardial infarction

Abstract: Frailty, calculated via an index of deficits, was associated with mortality and hospitalizations following MI. Beyond predictive value, accurate identification of frailty may indicate which individuals will benefit most from preventive interventions.

Cited by 33 publications

References 49 publications

Frailty and Outcomes After Myocardial Infarction: Insights From the CONCORDANCE Registry

Frailty and Outcomes After Myocardial Infarction: Insights From the CONCORDANCE Registry

Patient healthcare trajectory. An essential monitoring tool: a systematic review

Frailty as a predictor of all-cause mortality and readmission in older patients with acute coronary syndrome

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