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

Xu, Weihao; Cai, Yingying; Fan, Li; Wu, Chenkai

doi:10.1007/s00508-020-01650-9

Cited by 10 publications

(21 citation statements)

References 38 publications

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“…CGA-based frailty index (FI-CGA) was compiled based on the previously standardized CGA and population clinical trials, also in cardiology (44). The FI-CGA was associated with a higher risk of death and hospital readmissions (45)(46)(47). In our study population, the parts of the frailty assessment that deal with difficulties in everyday movements like kneeling, writing (Nagi score), walking up or down a flight of stairs, or doing heavy work around the house (Rosow-Breslau score) were not significant.…”

Section: Discussionmentioning

confidence: 99%

Preoperative nutritional state is associated with mid- and long-term mortality after cardiac surgery

Tóth¹,

Szabó²,

Nagy³

et al. 2021

Ann Palliat Med

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Background: The frailty score has been developed to determine physiological functioning capacity. The aim of our research was to explore the relationship between frailty factors and mortality in cardiac surgery patients.Methods: Our research is an observational, single-center, prospective cohort study (registered on ClinicalTrials.gov: NCT02224222), and we studied 69 patients who underwent elective cardiac surgery between 2014 and 2017. Thirty days before the surgery, they completed a questionnaire that contained questions related to social support, self-reported life quality-happiness, cognitive functions, anxiety and depression. Demographic, anthropometric and medical data were widely collected. The Geriatric Nutritional Risk Index (GNRI) and the Comprehensive Geriatric Assessment (CGA)-based frailty index were calculated as a sum and the domains, respectively. Cox regression and the Kaplan-Meier tests were applied to analyze survival and relative risk. The primary outcome was mid-term mortality.Results: The patients' mean age was 65.43 years [standard deviation (SD): 9.81 years]. The median followup was 1,656 days of survival [interquartile range (IQR), 1,336-2,081 years], during this period 14 patients died. The median of EuroSCORE II was 1.56 (1.00-2.58) points. The median preoperative albumin level was 32.80 g/L (IQR, 29.9-35.8 g/L). Major adverse cardiovascular and cerebral events (MACCEs) occurred 7 times during follow-up. The nutrition score of the CGA was significantly associated with worse long-term survival [score; hazard ratio (HR): 5.35; 95% CI: 1.10-25.91, P=0.037]. After adjustment for EuroSCORE II and postoperative complications the noncardiovascular CGA score was associated with overall mortality [adjusted hazard ratio (AHR): 1.44, 95% CI: 1.02-2.04, P=0.036]. In the multivariable Cox regression, GNRI <91 showed an increased risk for mortality (AHR: 4.76, 95% CI: 1.52-14.92, P=0.007). Conclusions:The CGA-based noncardiovascular score and nutritional status should be assessed before cardiac surgery prehabilitation and may help decrease long-term mortality.

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Section: Discussionmentioning

confidence: 99%

Preoperative nutritional state is associated with mid- and long-term mortality after cardiac surgery

Tóth¹,

Szabó²,

Nagy³

et al. 2021

Ann Palliat Med

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“…(43, 44) Negative clinical outcomes including death have been reported in frail older patients who were treated with percutaneous coronary intervention (PCI) [ 45 , 46 ]. Regarding elderly with ACS, frailty was found to be associated to higher all-cause mortality in three recent metanalyses [ 16 – 18 ]. Anyway, the pooled analyses were conducted without stratification for the different definitions of frailty of the single studies and the estimation could be partly biased.…”

Section: Discussionmentioning

confidence: 99%

“…There is increasing evidence – though sometimes contrasting – of a possible association between frailty and cardiovascular diseases such as hypertension, atrial fibrillation and heart failure [ 14 , 15 ]. To date, the available evidence on the association between frailty and ischemic heart disease (IHD) has only partly been summarized, regarding acute coronary syndrome (ACS), that is an acute manifestation of IHD [ 16 ] Since frailty is independently related to strong outcomes such as all-cause mortality [ 17 ] and readmissions [ 18 ] in elderly patients with ACS, its assessment should be integrated into the current existing management to help physicians to applicate appropriate management strategies. Still, there is no available evidence on the magnitude of the association between frailty and IHD.…”

Section: Introductionmentioning

confidence: 99%

Association between frailty and ischemic heart disease: a systematic review and meta-analysis

et al. 2021

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Background Frailty is increasingly reported among older adults with cardiovascular diseases and it has been demonstrated to increase negative health outcomes and mortality. To date, no systematic review of the evidence is available regarding the association between frailty and ischemic heart disease (IHD). We performed a systematic review of literature and a meta-analysis to assess the association between frailty and IHD. Methods We selected all the studies that provided information on the association between frailty and IHD, regardless of the study setting, study design, or definition of IHD and frailty. PubMed, Web of Science and Embase were searched for relevant papers. Studies that adopted the Fried definition for frailty were included in the meta-analyses. For each measure of interest (proportions and estimates of associations), a meta-analysis was performed if at least three studies used the same definition of frailty. Pooled estimates were obtained through random effect models and Mantel-Haenszel weighting. Results Thirty-seven studies were included. Of these, 22 adopted the Fried criteria to define frailty and provided estimates of prevalence and therefore they were included in meta-analyses. The pooled prevalence of IHD in frail individuals was 17% (95% Confidence Interval [95%CI] 11–23%) and the pooled prevalence of frailty in individuals with IHD was 19% (95% CI 15–24%). The prevalence of frailty among IHD patients ranged from 4 to 61%. Insufficient data were found to assess longitudinal association between frailty and IHD. Conclusions Frailty is quite common in older persons with IHD. The identification of frailty among older adults with IHD should be considered relevant to provide individualized strategies of cardiovascular prevention and care. Further research should specifically explore the association between frailty and IHD and investigate the potential common biological ground.

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“…People with cardiovascular diseases (CVD) have an even higher prevalence of frailty. Previous meta analyses have shown that the prevalence of frailty is approximately 17.9% in CVD patients and nearly 30% in patients with acute coronary syndrome (ACS) ( 3 , 4 ).…”

Section: Introductionmentioning

confidence: 99%

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

Bai

Hao

Meng

et al. 2022

Front. Cardiovasc. Med.

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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.

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

Cited by 10 publications

References 38 publications

Preoperative nutritional state is associated with mid- and long-term mortality after cardiac surgery

Preoperative nutritional state is associated with mid- and long-term mortality after cardiac surgery

Association between frailty and ischemic heart disease: a systematic review and meta-analysis

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

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