Frailty and other geriatric conditions for risk stratification of older patients with acute coronary syndrome

Sanchís, Juan; Bonanad, Clara; Ruíz, Vicente; Fernández, Julio; García‐Blas, Sergio; Mainar, Luis; Ventura, Silvia Mastrolembo; Rodríguez-Borja, Enrique; Chorro, Francisco J.; Hermenegildo, Carlos; Bertomeu-González, Vicente; Núñez, Eduardo; Núñez, Julio

doi:10.1016/j.ahj.2014.07.022

Cited by 148 publications

(126 citation statements)

References 25 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%

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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%

“…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%

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

Patel

Goodman

Yan

et al. 2018

JAHA

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“…In the face of the advanced and novel techniques currently available for the treatment of coronary atherosclerosis and consequent heart failure, it seems valuable to better assess the frailty status of stable CHD patients. 11,12 We took the opportunity to reaffirm our assumptions regarding the value of low ALT levels as a prognostic marker in this important patient population.…”

Section: Introductionmentioning

confidence: 96%

Low ALT Levels Independently Associated with 22-Year All-Cause Mortality Among Coronary Heart Disease Patients

et al. 2015

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BACKGROUND: Low alanine aminotransferase (ALT) blood levels are known to be associated with frailty and increased risk of long-term mortality in certain populations. However, the contribution of this marker to longterm outcome has not been assessed in patients with chronic coronary heart disease. OBJECTIVE: The aim of the current study was to assess the association between low ALT values and long-term, 22.8-year, all-cause mortality in this population. PARTICIPANTS: We examined the association of low ALT (<17 IU/l) with long-term all-cause mortality in the Bezafibrate Infarction Prevention (BIP) Registry population. KEY RESULTS: Appropriate laboratory and survival data were available for 6,575 patients, without known liver pathology, included in the BIP registry, with a median follow-up period of 22.8 years. The cumulative probability of all-cause mortality was significantly higher in the low ALT group compared with patients with higher ALT levels (65.6 % vs. 58.4 %; log-rank p<0.001). Consistently, multivariate analysis, adjusted for multiple established predictors of mortality in this population, demonstrated that low ALT is independently associated with 11 % greater long-term (22.8 years) mortality risk [HR 1.11 (95 % confidence interval: 1.03-1.19; adjusted p<0.01)]. CONCLUSIONS: Low ALT levels are associated with increased long-term mortality among middle-aged patients with stable coronary heart disease. This association remained statistically significant after adjustment for other well-established risk factors for mortality in this population.

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“…23 In this setting frailty ranged from 10% to 48%, and higher levels of frailty were associated with worse outcomes (Table 5). 47,[49][50][51][52][53][54][55] These studies showed an independent added prognostic value of frailty assessment, and although larger studies are needed to refine risk prediction models, it is suggested that clinicians and researchers should consider how they can embed frailty measurement into clinical practice.…”

Section: Frailty In Cardiologymentioning

confidence: 99%

“…In general, even as a sole prognostic indicator and with the above limitations, instruments describing a frailty status in several populations of cardiac patients have outscored other more usually adopted prognostic indicators. [46][47][48] Frailty in elderly patients with acute coronary syndrome or percutaneous transluminal coronary angioplasty…”

Section: Frailty In Cardiologymentioning

confidence: 99%

Frailty and cardiac rehabilitation: A call to action from the EAPC Cardiac Rehabilitation Section

Vigorito

Abreu

Ambrosetti³

et al. 2016

Eur J Prev Cardiolog

165

133

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Frailty is a geriatric syndrome characterised by a vulnerability status associated with declining function of multiple physiological systems and loss of physiological reserves. Two main models of frailty have been advanced: the phenotypic model (primary frailty) or deficits accumulation model (secondary frailty), and different instruments have been proposed and validated to measure frailty. However measured, frailty correlates to medical outcomes in the elderly, and has been shown to have prognostic value for patients in different clinical settings, such as in patients with coronary artery disease, after cardiac surgery or transvalvular aortic valve replacement, in patients with chronic heart failure or after left ventricular assist device implantation. The prevalence, clinical and prognostic relevance of frailty in a cardiac rehabilitation setting has not yet been well characterised, despite the increasing frequency of elderly patients in cardiac rehabilitation, where frailty is likely to influence the onset, type and intensity of the exercise training programme and the design of tailored rehabilitative interventions for these patients. Therefore, we need to start looking for frailty in elderly patients entering cardiac rehabilitation programmes and become more familiar with some of the tools to recognise and evaluate the severity of this condition. Furthermore, we need to better understand whether exercise-based cardiac rehabilitation may change the course and the prognosis of frailty in cardiovascular patients.

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Frailty and other geriatric conditions for risk stratification of older patients with acute coronary syndrome

Cited by 148 publications

References 25 publications

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

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

Low ALT Levels Independently Associated with 22-Year All-Cause Mortality Among Coronary Heart Disease Patients

Frailty and cardiac rehabilitation: A call to action from the EAPC Cardiac Rehabilitation Section

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