Frailty is an independent prognostic marker in elderly patients with myocardial infarction

Salinas, Gonzalo Luis Alonso; Sanmartı́n, Marcelo; Izco, Marina Pascual; Rincón, Luis Miguel; Pueyo, Pablo Pastor; Castillo, A Marco Del; Guerrero, Alberto Garcia; Pérez, Pedro Caravaca; Recio-Mayoral, Alejandro; Camino, Asunción; Jiménez-Mena, Manuel; Zamorano, José Luís

doi:10.1002/clc.22749

Cited by 40 publications

(22 citation statements)

References 18 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%

“…Crude data from 7 studies [8, 9, 12, 14, 20–22] were used to examine the influence of frailty on any-type cardiovascular disease (CVD) risk (re-infarction and stroke/TIA) in ACS patients. The pooled RR demonstrated that ACS with frailty resulted in higher risk of any-type CVD risk during the follow-up (RR: 1.54; 95%CI: 1.32–1.79, I 2 = 1.7%, P = 0.425) (Fig.…”

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%

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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“…Possibly as a consequence, older patients are less likely to receive guideline indicated ACS care. 13 It remains unclear if invasive therapy is beneficial, when these preconditions are evident in patients with NSTEMI-ACS. Likewise, the decision-making process of the treating physician is not well elucidated.…”

Section: Introductionmentioning

confidence: 99%

<p>Impact of Different Geriatric Conditions on Choice of Therapy and In-Hospital Outcomes in Elderly Patients with Acute Coronary Syndrome</p>

Rittger¹,

Stadelmaier²,

Kieschnick³

et al. 2020

CIA

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Introduction: The clinical benefit of invasive therapy in elderly patients with acute coronary syndrome (ACS) remains unclear. Furthermore, the decision-making process to treat this growing patient group is also debatable. The purpose of this study was to assess the association between elderly ACS patients, the treatment choice and their in-hospital outcomes after non-ST-elevation (NSTE)-ACS in a consecutive series of patients >75 years of age. Methods and Results: Consecutive patients >75 years presenting with NSTE-ACS in our hospital between July 2017 and July 2018 were included during the first 2 days of hospital admission. Demographic data, prior medical history and present medical condition were documented. During day 0 and day 2, geriatric assessments (Clinical Frailty Scale [CFS], Barthel index, Charlson comorbidity index, "timed up and go" test [TUG], Mini-Mental Status Test [MMS], Geriatric Depression Scale [GDS], SF-36 for quality of life, instrumental activities of daily living [IADL], Killip-score, Grace-score and Euro-score) were conducted. After 6 months, patients were re-evaluated. In 106 patients (mean age 81.9±5.3 years, 57% male gender), 68 patients (64%) were treated interventionally, and 38 patients had conservative treatment (36%). Patients treated with intervention were significantly younger (80.9±4.7 years vs 83.5±6.0 years, p=0.015), had a lower rate of prior cerebral events (17.6% vs 26.3%; p=ns) and suffered more often from chronic obstructive pulmonary disease (17.6% vs 34.2%; p=0.050). All other demographic variables were comparable between both groups. The composite clinical endpoint (death, re-infarction, bleeding) was reached in 7 patients (10.3%) of the invasive and in 2 patients (5.3%) of the conservative group. They were not significantly different between both groups. A frailty index, consisting of commonly used parameters of functional impairment in elderly patients, namely, MMS ≤2 at baseline, IADL ≤7, CFS ≥7 and age ≥85 years, significantly predicted conservative treatment. Conclusion: Effective revascularization techniques are still underused in patients of older age in the case of ACS. For decision-making, geriatric tests alone may not predict treatment in those patients, but the combination of different tests may better predict treatment and perhaps the clinical outcomes in those patients. Furthermore, frail patients are at higher risk for not receiving guideline recommended therapy.

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“…Frailty can occur as a result of a range of diseases and medical conditions [1]. Frailty is associated with body mass index (BMI) and serum albumin level, which are reported to correlate with a poor prognosis in patients with acute coronary syndrome (ACS) [[2], [3], [4]]. There are several frailty scoring systems.…”

Section: Introductionmentioning

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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Frailty is an independent prognostic marker in elderly patients with myocardial infarction

Cited by 40 publications

References 18 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

<p>Impact of Different Geriatric Conditions on Choice of Therapy and In-Hospital Outcomes in Elderly Patients with Acute Coronary Syndrome</p>

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

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