Impact of Frailty and Functional Status on Outcomes in Elderly Patients With <scp>ST</scp>‐Segment Elevation Myocardial Infarction Undergoing Primary Angioplasty: Rationale and Design of the <scp>IFFANIAM</scp> Study

Arizá-Solé, Albert; Formiga, Francesç; Vidán, María Teresa; Bueno, Héctor; Curós, Antoni; Aboal, Jaime; Llibre, Cinta; Rueda, Ferran; Bernal, Eva; Cequier, Ángel

doi:10.1002/clc.22182

Cited by 32 publications

(17 citation statements)

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“…Frailty is an age‐associated biological syndrome characterized by a decline in overall function or biological reserve and response to situations that require rapid adaptive responses, resulting from the deterioration of multiple physiological systems. Frailty frequently coexists with cardiovascular diseases . Other studies have described that frailty is associated with increased mortality and health care utilization among community patients with HF, but its influence in prognosis after HF hospitalization is less well known.…”

Section: Discussionmentioning

confidence: 99%

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FRAIL‐HF, a Study to Evaluate the Clinical Complexity of Heart Failure in Nondependent Older Patients: Rationale, Methods and Baseline Characteristics

Vidán

Sánchez

Fernández-Avilés

et al. 2014

Clinical Cardiology

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The clinical scenario of heart failure (HF) in older hospitalized patients is complex and influenced by acute and chronic comorbidities, coexistent geriatric syndromes, the patient's ability for self-care after discharge, and degree of social support. The impact of all these factors on clinical outcomes or disability evolution is not sufficiently known. FRAIL-HF is a prospective observational cohort study designed to evaluate clinical outcomes (mortality and readmission), functional evolution, quality of life, and use of social resources at 1, 3, 6, and 12 months after admission in nondependent elderly patients hospitalized for HF. Clinical features, medical treatment, self-care ability, and health literacy were prospectively evaluated and a comprehensive geriatric assessment with special focus on frailty was systematically performed in hospital to assess interactions and relationships with postdischarge outcomes. Between May 2009 and May 2011, 450 consecutive patients with a mean age of 80 ± 6 years were enrolled. Comorbidity was high (mean Charlson index, 3.4 ± 2.9). Despite being nondependent, 118 (26%) had minor disability for basic activities of daily living, only 76 (16.2%) had no difficulty in walking 400 meters, and 340 (75.5%) were living alone or with another elderly person. In addition, 316 patients (70.2%) fulfilled frailty criteria. Even nondependent older patients hospitalized for HF show a high prevalence of clinical and nonclinical factors that may influence prognosis and are usually not considered in routine clinical practice. The results of FRAIL-HF will provide important information about the relationship between these factors and different postdischarge clinical, functional, and quality-of-life outcomes.

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Section: Discussionmentioning

confidence: 99%

“…Frailty frequently coexists with cardiovascular diseases. 45,46 Other studies have described that frailty is associated with increased mortality and health care utilization among community patients with HF, 12,47,48 but its influence in prognosis after HF hospitalization is less well known.…”

Section: Discussionmentioning

confidence: 99%

FRAIL‐HF, a Study to Evaluate the Clinical Complexity of Heart Failure in Nondependent Older Patients: Rationale, Methods and Baseline Characteristics

Vidán

Sánchez

Fernández-Avilés

et al. 2014

Clinical Cardiology

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“…An observational multicenter registry to assess the clinical impact of frailty in the elderly patients with STEMI has been planned. 20 A result of the study may bring any findings in the geriatrics field.…”

Section: Prognostic Impact Of the Barthel Index On Admission And Critmentioning

confidence: 97%

Barthel Index as a Predictor of 1‐Year Mortality in Very Elderly Patients Who Underwent Percutaneous Coronary Intervention for Acute Coronary Syndrome: Better Activities of Daily Living, Longer Life

Higuchi

Kabeya

Matsushita

et al. 2015

Clinical Cardiology

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Background: Percutaneous coronary intervention (PCI) is safe and effective in very elderly patients, defined as those who are age ≥85 years, with acute coronary syndrome (ACS). However, the prognostic factors remain unknown. The association between activities of daily living (ADL) and the prognosis after PCI has not yet been investigated. Hypothesis: Better ADL is associated with better 1-year prognosis. Methods: This retrospective study included 91 consecutive very elderly patients with ACS. We calculated the Barthel Index (BI) as an indicator for ADL. Patients were classified into 2 groups according to BI: high BI (≥85) and low BI (<85). The BI was assessed both on admission (pre-BI) and at discharge (post-BI). Results: In the 91 patients (mean age, 88.2 ± 3.0 years, 52% male), 1-year mortality was 33%. The Cox regression model demonstrated that low pre-BI was not a risk factor for 1-year mortality (hazard ratio: 0.73, 95% confidence interval [CI]: 0.30-1.78, P = 0.490). However, post-BI was significantly associated with 1-year mortality (hazard ratio: 0.25, 95% CI: 0.11-0.57, P = 0.001). The 1-year mortality of the high and the low post-BI group was estimated as 21% (95% CI: 12%-35%) and 62% (95% CI: 42%-82%), respectively. A 5-unit decrease in post-BI was related to a 1.10-fold increased risk for 1-year mortality (95% CI: 1.05-1.15, P < 0.001). Conclusions: Activities of daily living at discharge, although not before admission, may be a useful predictor for 1-year mortality in very elderly patients undergoing PCI for ACS. IntroductionIn elderly patients who are affected by comorbidities, primary percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS) seems to be a promising strategy. 1 As PCI has become a safer and less invasive procedure, the very elderly population-defined as those age ≥85 years-is increasingly being referred for PCI, particularly in the setting of ACS. Although evidence on ACS in very elderly patients is scarce, a few studies have reported clinical outcomes related to this topic. A retrospective cohort study reported that long-term survival of patients age ≥90 years who underwent PCI was not inferior to those who were included in a Minnesota cohort matched by age and sex.2 Other studies have also reportedThe authors have no funding, financial relationships, or conflicts of interest to disclose.that PCI for patients with ACS who were ≥85 years was safe, feasible, and effective. 3,4 However, most patients with advanced age have disabilities such as dementia, cerebral infarction sequelae, and muscle weakness, all of which can influence their prognosis. This study aimed to confirm the hypothesis that better activities of daily living (ADL) is associated with better prognosis in very elderly patients with ACS who underwent PCI. Methods Study DesignThis study retrospectively included 91 consecutive patients, age ≥85 years, who were admitted to our hospital for ACS and underwent primary PCI between January 2007 and January 2014. We reviewed the medical records of all patients ...

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“…They concluded that frailty status was an independent predictor of in-hospital mortality in this population. Other studies have been designed in STEMI but have not been published yet [16]. Several studies also suggest an association between frailty status and in-hospital mortality [17, 18].…”

Section: Discussionmentioning

confidence: 99%

The Role of Frailty in Acute Coronary Syndromes in the Elderly

et al. 2018

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Background: Myocardial infarction (MI) patients are increasingly older, and common risk scores include chronological age, but do not consider chronic comorbidity or biological age. Frailty status reflects these variables and may be independently correlated with prognosis in this setting. Objective: This study investigated the impact of frailty on the prognosis of elderly patients admitted due to MI. Methods: This prospective and observational study included patients ≥75 years admitted to three tertiary hospitals in Spain due to MI. Frailty assessment was performed at admission using the Survey of Health, Ageing and Retirement in Europe Frailty Index (SHARE-FI) tool. The primary endpoint was the composite of death or non-fatal reinfarction during a follow-up of 1 year. Overall mortality, reinfarction, the composite of death, reinfarction and stroke, major bleeding, and readmission rates were also explored. Results: A total of 285 patients were enrolled. Frail patients (109, 38.2%) were older, with a higher score in the Charlson Comorbidity Index and with a higher risk score addressed in the GRACE and CRUSADE indexes. On multivariate analysis including GRACE, CRUSADE, maximum creatinine level, culprit lesion revascularization, complete revascularization, and dual antiplatelet therapy at discharge, frailty was an independent predictor of the composite of death and reinfarction (2.81, 95% CI 1.16–6.78) and overall mortality (3.07, 95% CI 1.35–6.98). Conclusion: Frailty is an independent prognostic marker of the composite of mortality and reinfarction and of overall mortality in patients aged ≥75 years admitted due to MI.

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Impact of Frailty and Functional Status on Outcomes in Elderly Patients With ST‐Segment Elevation Myocardial Infarction Undergoing Primary Angioplasty: Rationale and Design of the IFFANIAM Study

Cited by 32 publications

References 34 publications

FRAIL‐HF, a Study to Evaluate the Clinical Complexity of Heart Failure in Nondependent Older Patients: Rationale, Methods and Baseline Characteristics

FRAIL‐HF, a Study to Evaluate the Clinical Complexity of Heart Failure in Nondependent Older Patients: Rationale, Methods and Baseline Characteristics

Barthel Index as a Predictor of 1‐Year Mortality in Very Elderly Patients Who Underwent Percutaneous Coronary Intervention for Acute Coronary Syndrome: Better Activities of Daily Living, Longer Life

The Role of Frailty in Acute Coronary Syndromes in the Elderly

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