The impact of patient-reported frailty on cardiovascular outcomes in elderly patients after non-ST-acute coronary syndrome

• Published in: International journal of cardiology Vol. 405; p. 131940
• Main Authors: van den Broek, W.W.A., Gimbel, M.E., Hermanides, R.S., Runnett, C., Storey, R.F., Knaapen, P., Emans, M.E., Oemrawsingh, R.M., Cooke, J., Galasko, G., Walhout, R., Stoel, M.G., von Birgelen, C., van Bergen, Paul F.M.M., Brinckman, S.L., Aksoy, I., Liem, A., van't Hof, A.W.J., Jukema, J.W., Heestermans, A.A.C.M., Nicastia, D., Alber, H., Austin, D., Nasser, A., Deneer, V., ten Berg, J.M.
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 15.06.2024
• Subjects: Acute Coronary Syndrome - epidemiology; Aged; Aged, 80 and over; Antiplatelet therapy; Cardiovascular outcomes; Coronary artery disease; Elderly; Female; Follow-Up Studies; Frail Elderly - statistics & numerical data; Frailty; Frailty - diagnosis; Frailty - epidemiology; Humans; Male; Non-ST Elevated Myocardial Infarction - epidemiology; Non-ST Elevated Myocardial Infarction - mortality; Non-ST-elevation acute coronary syndrome; Patient Reported Outcome Measures; Prospective Studies; Registries; Treatment Outcome; EQ-5D; PCS; NSTE-ACS; SF-12; GFI; Coronary artery disease; Cardiovascular outcomes; Antiplatelet therapy; ACS; Non-ST-elevation acute coronary syndrome; MACE; PCI; Frailty; MCS; Elderly; DAPT
• ISSN: 0167-5273; 1874-1754
• DOI: 10.1016/j.ijcard.2024.131940

As life expectancy increases, the population of older individuals with coronary artery disease and frailty is growing. We aimed to assess the impact of patient-reported frailty on the treatment and prognosis of elderly early survivors of non-ST-elevation acute coronary syndrome (NSTE-ACS). Frailty data were obtained from two prospective trials, POPular Age and the POPular Age Registry, which both assessed elderly NSTE-ACS patients. Frailty was assessed one month after admission with the Groningen Frailty Indicator (GFI) and was defined as a GFI-score of 4 or higher. In these early survivors of NSTE-ACS, we assessed differences in treatment and 1-year outcomes between frail and non-frail patients, considering major adverse cardiovascular events (MACE, including cardiovascular mortality, myocardial infarction, and stroke) and major bleeding. The total study population consisted of 2192 NSTE-ACS patients, aged ≥70 years. The GFI-score was available in 1320 patients (79 ± 5 years, 37% women), of whom 712 (54%) were considered frail. Frail patients were at higher risk for MACE than non-frail patients (9.7% vs. 5.1%, adjusted hazard ratio [HR] 1.57, 95% confidence interval [CI] 1.01–2.43, p = 0.04), but not for major bleeding (3.7% vs. 2.8%, adjusted HR 1.23, 95% CI 0.65–2.32, p = 0.53). Cubic spline analysis showed a gradual increase of the risk for clinical outcomes with higher GFI-scores. In elderly NSTE-ACS patients who survived 1-month follow-up, patient-reported frailty was independently associated with a higher risk for 1-year MACE, but not with major bleeding. These findings emphasize the importance of frailty screening for risk stratification in elderly NSTE-ACS patients. [Display omitted] •Frailty is common in elderly patients with non-ST-acute coronary syndrome.•Patient-reported frailty was independently associated with ischemic events.•Higher frailty scores were associated with increased risk of adverse events.•Clinicians should consider frailty assessment for a more comprehensive risk evaluation.