Prognostic impact of anemia according to frailty status in elderly patients with acute coronary syndromes

Abstract

Aims Anemia is associated with poorer outcomes in patients with acute coronary syndromes (ACS), but the magnitude of this association in elderly patients remains poorly understood. No study has assessed the prognostic impact of anemia according to frailty status in this setting. Methods The LONGEVO-SCA registry included unselected ACS patients aged at least 80 years. A geriatric assessment was performed during hospitalization, including frailty assessment using the FRAIL scale. Anemia was defined by the WHO criteria. We evaluated the impact of anemia on 6-month mortality according to the presence of frailty. Results A total of 517 patients were assessed. Mean age was 84.3 years, and a total of 236 patients (45.6%) had anemia. Patients with anemia had a higher prevalence of comorbidities and higher prevalence of frailty (30.6 vs. 22.3%, P = 0.007). A total of 60 patients (12.1%) died at 6 months [40 with anemia (17.5%) and 20 without anemia (7.5%), P = 0.001]. Anemia was independently associated with mortality at 6 months in the whole cohort (hazard ratio 2.28, 95% CI 1.13–457, P = 0.021). The association of anemia and mortality was different according to frailty status, being significant in patients without frailty (hazard ratio 3.94, 95% CI 1.84–8.45, P = 0.001), but not in frail patients (hazard ratio 1.17, 95% CI 0.53–2.57, P = 0.705), (P value for interaction = 0.035). Conclusion A high proportion of elderly patients with ACS have anemia, leading to a worse prognosis in the whole cohort. The association between anemia and mortality was especially significant in robust patients, whereas the poorer prognosis in frail patients was not modified by the presence of anemia.

Prevalence and prognostic value of the coexistence of anaemia and frailty in older patients with heart failure

“…More than 80% of hospitalized HF patients ≥65 years old had anaemia and/or frailty in the present study, which was a markedly high proportion compared with the rate of 57.6% reported previously in patients ≥80 years old with acute coronary syndromes 26 . Anaemia can be induced by HF via a number of related pathophysiological mechanisms, especially functional or absolute iron deficiency and erythropoietin synthesis and response 10 .…”

“…More than 80% of hospitalized HF patients ≥65 years old had anaemia and/or frailty in the present study, which was a markedly high proportion compared with the rate of 57.6% reported previously in patients ≥80 years old with acute coronary syndromes. 26 Anaemia can be induced by HF via a number of related pathophysiological mechanisms, especially functional or absolute iron deficiency and erythropoietin synthesis and response. 10 In addition, HF can result in frailty due to coordinated multisystem dysfunction as a result of its systemic nature, including systemic inflammation, high comorbidity burden, advanced age, and skeletal muscle abnormalities.…”

Clinical implications of assessing frailty in elderly patients treated with permanent cardiac pacing

“…4 There are mutual relationships between frailty and cardiovascular disease. 5 Among elderly patients with documented severe coronary artery disease or heart failure, the prevalence of frailty was found to be 50-54% in a metaanalysis and was associated with an increased risk of longterm mortality. 4 Balla et al 6 report on the long-term follow-up (median 46 months) of a group of 119 patients older than 70 years, admitted to hospital for pacemaker implantation and accurately evaluated with regard to frailty through the Short Physical Performance Battery (SPBB) test and handgrip test at discharge and 1-year follow-up.…”

“…There are mutual relationships between frailty and cardiovascular disease 5 . Among elderly patients with documented severe coronary artery disease or heart failure, the prevalence of frailty was found to be 50–54% in a meta-analysis and was associated with an increased risk of long-term mortality 4 …”

Sarcopenia detected by computed tomography: a simple tool for screening transcatheter aortic valve implantation candidates

“…2,7 Sarcopenia and frailty are strongly related and both are associated with poor outcomes in several cardiovascular settings. [8][9][10][11][12][13] The assessment of sarcopenia by psoas muscle area using computed tomography (CT) recently emerged as a possible tool for screening TAVI recipients. However, evidence regarding its prognostic impact diverges.…”