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Sami SZ. Letter to the Editor: The impact of patient-reported frailty on cardiovascular outcomes in elderly patients after non-ST-acute coronary syndrome. Int J Cardiol 2024; 414:132406. [PMID: 39089481 DOI: 10.1016/j.ijcard.2024.132406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2024] [Accepted: 07/26/2024] [Indexed: 08/04/2024]
Affiliation(s)
- Syeda Zuha Sami
- Shaheed Mohtarma Benazir Bhutto Medical College,Lyari Hospital Rd, Rangiwara Karachi, Karachi, Pakistan.
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Ko D, Evans PT, Lin KJ, Pande AN, Cervone A, Lee SB, Cheng S, Tsacogianis T, Glynn RJ, Kim DH. Frailty and Clinical Outcomes of Ticagrelor Versus Clopidogrel in Older Adults With Acute Myocardial Infarction. J Am Heart Assoc 2024; 13:e034529. [PMID: 39056329 DOI: 10.1161/jaha.124.034529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 07/02/2024] [Indexed: 07/28/2024]
Abstract
BACKGROUND Ticagrelor is recommended over clopidogrel in acute coronary syndrome based on the results of the PLATO (Study of Platelet Inhibition and Patient Outcomes) trial. We aimed to emulate PLATO in older adults with and without frailty and with acute coronary syndrome treated with percutaneous coronary intervention. METHODS AND RESULTS We created a new-user cohort of Medicare fee-for-service beneficiaries aged ≥65 years hospitalized for acute coronary syndrome from 2014 to 2018 and initiated ticagrelor or clopidogrel following percutaneous coronary intervention. Frailty was defined using a validated claims-based frailty index ≥0.25. Coprimary outcomes were major adverse cardiovascular events and major bleeding. Follow-up began on the date of first outpatient prescription for ticagrelor or clopidogrel and ended on the earliest date for an outcome event, death, discontinuation of the index drug, or disenrollment from Medicare. The study included 42 843 older adults; 23% were frail. After propensity score matching, the rates of major adverse cardiovascular events per 100 person-years comparing ticagrelor versus clopidogrel groups were 7.8 and 7.3 in the frail cohort (hazard ratio [HR], 1.07 [95% CI, 0.84-1.36]) and 3.7 and 4.2 in the nonfrail cohort (HR, 0.87 [95% CI, 0.75-1.02]). The corresponding rates of major bleeding were 4.3 and 3.8 in the frail cohort (HR, 1.12 95% CI, [0.80-1.56]) and 2.2 and 1.8 in the nonfrail cohort (HR, 1.22 [95% CI, 0.98-1.51]). CONCLUSIONS There was a trend toward a modest reduction in risk of major adverse cardiovascular events and a trend toward a modest increase in risk of major bleeding with ticagrelor compared with clopidogrel in the nonfrail cohort. There was insufficient evidence for the benefit of ticagrelor in frail older adults.
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Affiliation(s)
- Darae Ko
- Hinda and Arthur Marcus Institute for Aging Research Hebrew SeniorLife Boston MA
- Section of Cardiovascular Medicine Boston Medical Center Boston MA
| | - Peter T Evans
- Section of Cardiovascular Medicine Boston Medical Center Boston MA
| | - Kueiyu Joshua Lin
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine Brigham and Women's Hospital Boston MA
- Division of General Internal Medicine, Department of Medicine Massachusetts General Hospital Boston MA
| | - Ashvin N Pande
- Section of Cardiovascular Medicine Boston Medical Center Boston MA
| | - Alexander Cervone
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine Brigham and Women's Hospital Boston MA
| | - Su Been Lee
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine Brigham and Women's Hospital Boston MA
| | - Susan Cheng
- Department of Cardiology Cedars-Sinai Medical Center Los Angeles CA
| | - Theodore Tsacogianis
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine Brigham and Women's Hospital Boston MA
| | - Robert J Glynn
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine Brigham and Women's Hospital Boston MA
| | - Dae Hyun Kim
- Hinda and Arthur Marcus Institute for Aging Research Hebrew SeniorLife Boston MA
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine Brigham and Women's Hospital Boston MA
- Division of Gerontology, Department of Medicine Beth Israel Deaconess Medical Center Boston MA
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Hosseini F, Pitcher I, Kang M, Mackay M, Singer J, Lee T, Madden K, Cairns JA, Wong GC, Fordyce CB. Association of Frailty With In-hospital and Long-term Outcomes Among STEMI Patients Receiving Primary Percutaneous Coronary Intervention. CJC Open 2024; 6:1004-1012. [PMID: 39211750 PMCID: PMC11357769 DOI: 10.1016/j.cjco.2024.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2024] [Accepted: 04/21/2024] [Indexed: 09/04/2024] Open
Abstract
Background Frailty is generally a marker of worse prognosis. The impact of frailty on both in-hospital and long-term outcomes in ST-segment-elevation myocardial infarction (STEMI) patients has not been well described. Given this context, we aimed to determine the prevalence and impact of frailty on in-hospital and 1-year outcomes in STEMI patients undergoing primary percutaneous coronary intervention (pPCI). Methods This retrospective study reviewed STEMI patients aged ≥ 65 years who underwent pPCI at 1 of the 2 pPCI-capable hospitals at Vancouver Coastal Health. A frailty index (FI) was determined using a deficit-accumulation model, with those with an FI > 0.25 being defined as frail. The primary outcome was 1-year all-cause mortality. The secondary outcomes included in-hospital all-cause mortality, a composite of adverse in-hospital outcomes (all-cause mortality, cardiogenic shock, heart failure, reinfarction, major bleeding, or stroke), and the individual components of the composite. Results A total of 1579 patients were reviewed, of which 228 (14.4%) were determined to be frail. After multivariable adjustment, greater frailty (ie, increasing FI) was associated with increased in-hospital all-cause mortality (odds ratio [OR], 1.88; 95% confidence interval [CI], 1.50-2.35, P < 0.001), the composite adverse in-hospital outcome (OR, 1.46; 95% CI, 1.27-1.68, P < 0.001), and 1-year all-cause mortality (OR, 1.48; 95% CI, 1.10-2.00, P = 0.011). Conclusions In a contemporary STEMI cohort of older patients receiving pPCI, 1 in 7 patients were frail, with greater frailty being independently associated with increased in-hospital and long-term adverse outcomes. These findings highlight the need for the early recognition of frailty and implementation of an interdisciplinary approach toward the management of frail STEMI patients.
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Affiliation(s)
- Farshad Hosseini
- Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Ian Pitcher
- Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Mehima Kang
- Division of Internal Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Martha Mackay
- Centre for Health Evaluation and Outcome Sciences, University of British Columbia, Vancouver, British Columbia, Canada
- School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
| | - Joel Singer
- Centre for Health Evaluation and Outcome Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Terry Lee
- Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kenneth Madden
- Division of Geriatric Medicine, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Hip Health and Mobility, University of British Columbia, Vancouver, British Columbia, Canada
| | - John A. Cairns
- Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Cardiovascular Innovation, University of British Columbia, Vancouver, British Columbia, Canada
| | - Graham C. Wong
- Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Cardiovascular Innovation, University of British Columbia, Vancouver, British Columbia, Canada
| | - Christopher B. Fordyce
- Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Cardiovascular Innovation, University of British Columbia, Vancouver, British Columbia, Canada
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Capece U, Iacomini C, Mezza T, Cesario A, Masciocchi C, Patarnello S, Giaccari A, Di Giorgi N. Real-world evidence evaluation of LDL-C in hospitalized patients: a population-based observational study in the timeframe 2021-2022. Lipids Health Dis 2024; 23:224. [PMID: 39049007 PMCID: PMC11267803 DOI: 10.1186/s12944-024-02221-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Accepted: 07/17/2024] [Indexed: 07/27/2024] Open
Abstract
AIMS European registries and retrospective cohort studies have highlighted the failure to achieve low-density lipoprotein-cholesterol (LDL-C) targets in many very high-risk patients. Hospitalized patients are often frail, and frailty is associated with all-cause and cardiovascular mortality. The aim of this study is to evaluate LDL-C levels in a real-world inpatient setting, identifying cardiovascular risk categories and highlighting treatment gaps in the implementation of LDL-C management. METHODS This retrospective, observational study included all adult patients admitted to an Italian hospital between 2021 and 2022 with available LDL-C values during hospitalization. Disease-related real-world data were collected from Hospital Information System using automated data extraction strategies and through the implementation of a patient-centered data repository (the Dyslipidemia Data Mart). We performed assessment of cardiovascular risk profiles, LDL-C target achievement according to the 2019 ESC/EAS guidelines, and use of lipid-lowering therapies (LLT). RESULTS 13,834 patients were included: 17.15%, 13.72%, 16.82% and 49.76% were low (L), moderate (M), high (H) and very high-risk (VH) patients, respectively. The percentage of on-target patients was progressively lower towards the worst categories (78.79% in L, 58.38% in M, 33.3% in H and 21.37% in VH). Among LLT treated patients, 28.48% were on-target in VH category, 47.60% in H, 69.12% in M and 68.47% in L. We also analyzed the impact of monotherapies and combination therapies on target achievement. CONCLUSIONS We found relevant gaps in LDL-C management in the population of inpatients, especially in the VH category. Future efforts should be aimed at reducing cardiovascular risk in these subjects.
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Affiliation(s)
- Umberto Capece
- Centro Malattie Endocrine e Metaboliche, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Chiara Iacomini
- Real World Data Facility, Gemelli Generator, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Teresa Mezza
- Centro Malattie Endocrine e Metaboliche, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy
- Pancreas Unit, Medicina Interna e Gastroenterologia, CEMAD Centro Malattie dell'Apparato Digerente, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Alfredo Cesario
- Gemelli Digital Medicine & Health, Rome, Italy
- Open Innovation Unit, Scientific Directorate, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Carlotta Masciocchi
- Real World Data Facility, Gemelli Generator, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Stefano Patarnello
- Real World Data Facility, Gemelli Generator, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Andrea Giaccari
- Centro Malattie Endocrine e Metaboliche, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.
- Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy.
| | - Nicoletta Di Giorgi
- Real World Data Facility, Gemelli Generator, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
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Lowry MTH, Kimenai DM, Doudesis D, Georgiev K, McDermott M, Bularga A, Taggart C, Wereski R, Ferry AV, Stewart SD, Tuck C, Newby DE, Mills NL, Anand A. The electronic frailty index and outcomes in patients with myocardial infarction. Age Ageing 2024; 53:afae150. [PMID: 39011637 PMCID: PMC11249914 DOI: 10.1093/ageing/afae150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 07/03/2024] [Indexed: 07/17/2024] Open
Abstract
BACKGROUND Frailty is increasingly present in patients with acute myocardial infarction. The electronic Frailty Index (eFI) is a validated method of identifying vulnerable older patients in the community from routine primary care data. Our aim was to assess the relationship between the eFI and outcomes in older patients hospitalised with acute myocardial infarction. STUDY DESIGN AND SETTING Retrospective cohort study using the DataLoch Heart Disease Registry comprising consecutive patients aged 65 years or over hospitalised with a myocardial infarction between October 2013 and March 2021. METHODS Patients were classified as fit, mild, moderate, or severely frail based on their eFI score. Cox-regression analysis was used to determine the association between frailty category and all-cause mortality. RESULTS In 4670 patients (median age 77 years [71-84], 43% female), 1865 (40%) were classified as fit, with 1699 (36%), 798 (17%) and 308 (7%) classified as mild, moderate and severely frail, respectively. In total, 1142 patients died within 12 months of which 248 (13%) and 147 (48%) were classified as fit and severely frail, respectively. After adjustment, any degree of frailty was associated with an increased risk of all-cause death with the risk greatest in the severely frail (reference = fit, adjusted hazard ratio 2.87 [95% confidence intervals 2.24 to 3.66]). CONCLUSION The eFI identified patients at high risk of death following myocardial infarction. Automatic calculation within administrative data is feasible and could provide a low-cost method of identifying vulnerable older patients on hospital presentation.
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Affiliation(s)
- Matthew T H Lowry
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Dorien M Kimenai
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Dimitrios Doudesis
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Konstantin Georgiev
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Michael McDermott
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Anda Bularga
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Caelan Taggart
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Ryan Wereski
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Amy V Ferry
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Stacey D Stewart
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Christopher Tuck
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - David E Newby
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Nicholas L Mills
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Atul Anand
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
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Kim DH, Park CM, Ko D, Lin KJ, Glynn RJ. Assessing the Benefits and Harms of Pharmacotherapy in Older Adults with Frailty: Insights from Pharmacoepidemiologic Studies of Routine Health Care Data. Drugs Aging 2024; 41:583-600. [PMID: 38954400 DOI: 10.1007/s40266-024-01121-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/07/2024] [Indexed: 07/04/2024]
Abstract
The objective of this review is to summarize and appraise the research methodology, emerging findings, and future directions in pharmacoepidemiologic studies assessing the benefits and harms of pharmacotherapies in older adults with different levels of frailty. Older adults living with frailty are at elevated risk for poor health outcomes and adverse effects from pharmacotherapy. However, current evidence is limited due to the under-enrollment of frail older adults and the lack of validated frailty assessments in clinical trials. Recent advancements in measuring frailty in administrative claims and electronic health records (database-derived frailty scores) have enabled researchers to identify patients with frailty and to evaluate the heterogeneity of treatment effects by patients' frailty levels using routine health care data. When selecting a database-derived frailty score, researchers must consider the type of data (e.g., different coding systems), the length of the predictor assessment period, the extent of validation against clinically validated frailty measures, and the possibility of surveillance bias arising from unequal access to care. We reviewed 13 pharmacoepidemiologic studies published on PubMed from 2013 to 2023 that evaluated the benefits and harms of cardiovascular medications, diabetes medications, anti-neoplastic agents, antipsychotic medications, and vaccines by frailty levels. These studies suggest that, while greater frailty is positively associated with adverse treatment outcomes, older adults with frailty can still benefit from pharmacotherapy. Therefore, we recommend routine frailty subgroup analyses in pharmacoepidemiologic studies. Despite data and design limitations, the findings from such studies may be informative to tailor pharmacotherapy for older adults across the frailty spectrum.
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Affiliation(s)
- Dae Hyun Kim
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, 1200 Centre Street, Boston, MA, 02131, USA.
- Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.
- Harvard Medical School, Boston, MA, USA.
| | - Chan Mi Park
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, 1200 Centre Street, Boston, MA, 02131, USA
- Harvard Medical School, Boston, MA, USA
| | - Darae Ko
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, 1200 Centre Street, Boston, MA, 02131, USA
- Harvard Medical School, Boston, MA, USA
- Section of Cardiovascular Medicine, Boston Medical Center, Boston, MA, USA
- Richard A. and Susan F. Smith Center for Outcomes Research, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Kueiyu Joshua Lin
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Robert J Glynn
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Boston, MA, USA
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Leong DP, Bosch J, Bhatt DL, Avezum A, Yuan F, Yusuf S, Eikelboom JW. Impact of Frailty on the Benefits of Dual Pathway Inhibition for the Secondary Prevention of Cardiovascular Events in the COMPASS Randomised Trial. Can J Cardiol 2024:S0828-282X(24)00506-3. [PMID: 38914270 DOI: 10.1016/j.cjca.2024.06.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 06/15/2024] [Accepted: 06/18/2024] [Indexed: 06/26/2024] Open
Abstract
BACKGROUND Individuals with frailty are at higher risk of adverse cardiovascular outcomes and bleeding. The objective of this study was to determine whether the effects of 2.5 mg rivaroxaban twice daily in addition to low-dose aspirin are similar among frail compared with nonfrail patients with chronic atherosclerotic vascular disease. METHODS In the COMPASS trial (NCT01776424), patients with chronic atherosclerotic vascular disease were randomised to receive 100 mg aspirin daily, 100 mg aspirin daily plus 2.5 mg rivaroxaban twice daily, or 5 mg rivaroxaban twice daily. In this post hoc analysis, frailty was evaluated by constructing a cumulative deficit index from 37 diseases, signs, and symptoms. The frailty index for each participant was calculated as the proportion of the 37 deficits exhibited, with values > 0.2 considered to be frail. The primary outcome was the composite of cardiovascular death, myocardial infarction, or stroke. Hazard ratios (HRs) and 95% confidence intervals (CIs) are reported. RESULTS Frailty was present in 13% of the trial population. In nonfrail individuals, adding 2.5 mg rivaroxaban twice daily to aspirin reduced the primary outcome (HR 0.69, 95% CI 0.59-0.80) and mortality (HR 0.75, 95% CI 0.63-0.90), but increased major bleeding (HR 1.87, 95% CI 1.51-2.31); Among participants with frailty, its effects on the primary outcome (HR 1.06, 95% CI 0.79-1.42), mortality (HR 1.08, 0.80-1.46), and major bleeding (HR 1.10, 95% CI 0.71-1.70) were not evident (respective interaction P values 0.011, 0.049, and 0.032). CONCLUSIONS In adults with chronic atherosclerotic vascular disease, the benefit of adding 2.5 mg rivaroxaban twice daily to aspirin was not evident in patients with frailty. CLINICAL TRIAL REGISTRATION NCT01776424.
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Affiliation(s)
- Darryl P Leong
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Canada; Department of Medicine, McMaster University, Hamilton, Canada.
| | - Jackie Bosch
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Canada; Department of Rehabilitation Sciences, McMaster University, Hamilton, Canada
| | - Deepak L Bhatt
- Mount Sinai Fuster Heart Hospital, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Alvaro Avezum
- International Research Center, Hospital Alemão Oswaldo Cruz, São Paolo, São Paolo, Brazil
| | - Fei Yuan
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Canada
| | - Salim Yusuf
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Canada; Department of Medicine, McMaster University, Hamilton, Canada
| | - John W Eikelboom
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Canada; Department of Medicine, McMaster University, Hamilton, Canada
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van den Broek WWA, Gimbel ME, Hermanides RS, Runnett C, Storey RF, Knaapen P, Emans ME, Oemrawsingh RM, Cooke J, Galasko G, Walhout R, Stoel MG, von Birgelen C, van Bergen PFMM, Brinckman SL, Aksoy I, Liem A, Van't Hof AWJ, Jukema JW, Heestermans AACM, Nicastia D, Alber H, Austin D, Nasser A, Deneer V, Ten Berg JM. The impact of patient-reported frailty on cardiovascular outcomes in elderly patients after non-ST-acute coronary syndrome. Int J Cardiol 2024; 405:131940. [PMID: 38458385 DOI: 10.1016/j.ijcard.2024.131940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 02/20/2024] [Accepted: 03/05/2024] [Indexed: 03/10/2024]
Abstract
BACKGROUND 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). METHODS 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. RESULTS 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. CONCLUSIONS 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.
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Affiliation(s)
- W W A van den Broek
- St. Antonius Hospital, Department of Cardiology, Nieuwegein, the Netherlands
| | - M E Gimbel
- St. Antonius Hospital, Department of Cardiology, Nieuwegein, the Netherlands
| | - R S Hermanides
- Isala Hospital, Department of Cardiology, Zwolle, the Netherlands
| | - C Runnett
- Northumbria Healthcare NHS Foundation Trust, Department of Cardiology, Newcastle, United Kingdom
| | - R F Storey
- University of Sheffield, Division of Clinical Medicine, Sheffield, United Kingdom
| | - P Knaapen
- Amsterdam University Medical Centre, Department of Cardiology, Amsterdam, the Netherlands
| | - M E Emans
- Ikazia Hospital, Department of Cardiology, Rotterdam, the Netherlands
| | - R M Oemrawsingh
- Albert Schweitzer Hospital, Department of Cardiology, Dordrecht, the Netherlands
| | - J Cooke
- Chesterfield Royal Hospital NHS Foundation Trust, Department of Cardiology, Chesterfield, United Kingdom
| | - G Galasko
- Blackpool Teaching Hospital NHS Foundation Trust, Department of Cardiology, Blackpool, United Kingdom
| | - R Walhout
- Gelderse Vallei Hospital, Department of Cardiology, Ede, the Netherlands
| | - M G Stoel
- Medisch Spectrum Twente, Department of Cardiology, Enschede, the Netherlands
| | - C von Birgelen
- Medisch Spectrum Twente, Department of Cardiology, Enschede, the Netherlands; University of Twente, Department of Health Technology and Services Research, Technical Medical Centre, Enschede, the Netherlands
| | - Paul F M M van Bergen
- Dijklander Hospital, Department of Cardiology, Maelsonstraat 3, 1624 NP Hoorn, the Netherlands
| | - S L Brinckman
- Department of Cardiology, Tergooi MC, Blaricum, the Netherlands
| | - I Aksoy
- Admiraal de Ruyter Hospital, Department of Cardiology, Goes, the Netherlands
| | - A Liem
- Franciscus Gasthuis, Department of Cardiology, Rotterdam, the Netherlands
| | - A W J Van't Hof
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht, the Netherlands; Zuyderland Medical Centre, Department of Cardiology, Heerlen, the Netherlands
| | - J W Jukema
- Leids University Medical Centre, Department of Cardiology, Leiden, the Netherlands
| | - A A C M Heestermans
- Department of Cardiology, Noordwest Hospital Group, Alkmaar, the Netherlands
| | - D Nicastia
- Department of Cardiology, Gelre Hospital, Apeldoorn, the Netherlands
| | - H Alber
- KABEG Klinikum, Department for Internal Medicine and Cardiology, Klagenfurt am Wörthersee, Austria
| | - D Austin
- The James Cook University Hospital, Academic Cardiovascular Unit, Middlesbrough, United Kingdom
| | - A Nasser
- South Tyneside and Sunderland NHS Foundation Trust, Department of Cardiology, South Shields, United Kingdom
| | - V Deneer
- Department of Clinical Pharmacy, Division of Laboratories, Pharmacy, and Biomedical Genetics, University Medical Center Utrecht, Utrecht, the Netherlands; Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, the Netherlands
| | - J M Ten Berg
- St. Antonius Hospital, Department of Cardiology, Nieuwegein, the Netherlands; Cardiovascular Research Institute Maastricht (CARIM), Maastricht, the Netherlands.
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Jamil Y, Park DY, Rao SV, Ahmad Y, Sikand NV, Bosworth HB, Coles T, Damluji AA, Nanna MG, Samsky MD. Association Between Frailty and Management and Outcomes of Acute Myocardial Infarction Complicated by Cardiogenic Shock. JACC. ADVANCES 2024; 3:100949. [PMID: 38938859 PMCID: PMC11198471 DOI: 10.1016/j.jacadv.2024.100949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 11/27/2023] [Accepted: 01/23/2024] [Indexed: 06/29/2024]
Abstract
Background Cardiogenic shock (CS) in the setting of acute myocardial infarction (AMI) is associated with high morbidity and mortality. Frailty is a common comorbidity in patients with cardiovascular disease and is also associated with adverse outcomes. The impact of preexisting frailty at the time of CS diagnosis following AMI has not been studied. Objectives The purpose of this study was to examine the prevalence of frailty in patients admitted with AMI complicated by CS (AMI-CS) hospitalizations and its associations with in-hospital outcomes. Methods We retrospectively analyzed the National Inpatient Sample from 2016 to 2020 and identified all hospitalizations for AMI-CS. We classified them into frail and nonfrail groups according to the hospital frailty risk score cut-off of 5 and compared in-hospital outcomes. Results A total of 283,700 hospitalizations for AMI-CS were identified. Most (70.8%) occurred in the frail. Those with frailty had higher odds of in-hospital mortality (adjusted OR [aOR]: 2.17, 95% CI: 2.07 to 2.26, P < 0.001), do-not-resuscitate status, and discharge to a skilled nursing facility compared with those without frailty. They also had higher odds of in-hospital adverse events, including intracranial hemorrhage, gastrointestinal hemorrhage, acute kidney injury, and delirium. Importantly, AMI-CS hospitalizations in the frail had lower odds of coronary revascularization (aOR: 0.55, 95% CI: 0.53-0.58, P < 0.001) or mechanical circulatory support (aOR: 0.89, 95% CI: 0.85-0.93, P < 0.001). Lastly, hospitalizations for AMI-CS showed an overall increase from 53,210 in 2016 to 57,065 in 2020 (P trend <0.001), with this trend driven by a rise in the frail. Conclusions A high proportion of hospitalizations for AMI-CS had concomitant frailty. Hospitalizations with AMI-CS and frailty had higher rates of in-hospital morbidity and mortality compared to those without frailty.
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Affiliation(s)
- Yasser Jamil
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Dae Yong Park
- Department of Medicine, Cook County Health, Chicago, Illinois, USA
| | - Sunil V. Rao
- Grossman School of Medicine, New York University Langone Health System, New York University, New York, New York, USA
| | - Yousif Ahmad
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Nikhil V. Sikand
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Hayden B. Bosworth
- Division of General Internal Medicine, Department of Medicine, Duke University, Durham, North Carolina, USA
- Department of Psychiatry and Behavioral Health Sciences, Duke University School of Nursing, Durham, North Carolina, USA
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Theresa Coles
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Abdulla A. Damluji
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Inova Center of Outcomes Research, Falls Church, Virginia, USA
| | - Michael G. Nanna
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Marc D. Samsky
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, Connecticut, USA
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Alonso Salinas GL, Cepas-Guillén P, León AM, Jiménez-Méndez C, Lozano-Vicario L, Martínez-Avial M, Díez-Villanueva P. The Impact of Geriatric Conditions in Elderly Patients with Coronary Heart Disease: A State-of-the-Art Review. J Clin Med 2024; 13:1891. [PMID: 38610656 PMCID: PMC11012545 DOI: 10.3390/jcm13071891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Revised: 03/18/2024] [Accepted: 03/22/2024] [Indexed: 04/14/2024] Open
Abstract
The growing geriatric population presenting with coronary artery disease poses a primary challenge for healthcare services. This is a highly heterogeneous population, often underrepresented in studies and clinical trials, with distinctive characteristics that render them particularly vulnerable to standard management/approaches. In this review, we aim to summarize the available evidence on the treatment of acute coronary syndrome in the elderly. Additionally, we contextualize frailty, comorbidity, sarcopenia, and cognitive impairment, common in these patients, within the realm of coronary artery disease, proposing strategies for each case that may assist in therapeutic approaches.
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Affiliation(s)
- Gonzalo Luis Alonso Salinas
- Cardiology Department, Hospital Universitario de Navarra (HUN-NOU), Calle de Irunlarrea, 3, 31008 Pamplona, Spain;
- Navarrabiomed (Miguel Servet Foundation), IdiSNA, 31008 Pamplona, Spain;
- Heath Sciences Department, Universidad Pública de Navarra (UPNA-NUP), 31006 Pamplona, Spain
| | - Pedro Cepas-Guillén
- Quebec Heart and Lung Institute, Laval University, 2725 Ch Ste-Foy, Quebec, QC G1V 4G5, Canada;
| | - Amaia Martínez León
- Cardiology Department, Hospital Universitario de Navarra (HUN-NOU), Calle de Irunlarrea, 3, 31008 Pamplona, Spain;
- Navarrabiomed (Miguel Servet Foundation), IdiSNA, 31008 Pamplona, Spain;
| | - César Jiménez-Méndez
- Cardiology Department, Hospital Universitario Puerta del Mar, Avda Ana de Viya 21, 11009 Cádiz, Spain;
| | - Lucia Lozano-Vicario
- Navarrabiomed (Miguel Servet Foundation), IdiSNA, 31008 Pamplona, Spain;
- Geriatric Medicine Department, Hospital Universitario de Navarra (HUN-NOU), Calle de Irunlarrea, 3, 31008 Pamplona, Spain
| | - María Martínez-Avial
- Cardiology Department, Hospital Universitario La Princesa, Calle Diego de León 62, 28006 Madrid, Spain; (M.M.-A.); (P.D.-V.)
| | - Pablo Díez-Villanueva
- Cardiology Department, Hospital Universitario La Princesa, Calle Diego de León 62, 28006 Madrid, Spain; (M.M.-A.); (P.D.-V.)
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11
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Chad T, Koulouroudias M, Layton GR, Fashina O, Sze S, Roman M, Murphy GJ. Frailty in acute coronary syndromes. A systematic review and narrative synthesis of frailty assessment tools and interventions from randomised controlled trials. Int J Cardiol 2024; 399:131764. [PMID: 38211672 DOI: 10.1016/j.ijcard.2024.131764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 12/19/2023] [Accepted: 01/07/2024] [Indexed: 01/13/2024]
Abstract
AIM We aimed to review all randomised controlled trial (RCT) data to explore optimal identification and treatment strategies of frail patients with Acute Coronary Syndromes (ACS). METHODS The protocol was preregistered (PROSPERO - CRD42021250235). We performed a systematic review including RCT's that 1; used at least one frailty assessment tool to assess frailty and its impact on outcomes in patients diagnosed with ACS and 2; used at least one intervention where change in frailty was measured in patients diagnosed with ACS. The Cochrane Central Register of Controlled Trials, MEDLINE and EMBASE were searched on the 1st April 2021 and updated on 4th July 2023. Owing to low search output results are presented as a narrative synthesis of available evidence. RESULTS A single RCT used a frailty assessment tool. A single RCT specifically targeted frailty with their intervention. This precluded further quantitative analysis. There was indication of selection bias against frail participants, and a signal of value for physical activity measurement in frail ACS patients. There was a high level of uncertainty and low level of robustness of this evidence. CONCLUSIONS Data from RCT's alone is inadequate in answering the reviews question. Future RCT's need to address ways to incorporate frail participants, whilst mitigating selection biases. Physical performance aspects of the frailty syndrome appear to be high yield modifiable targets that improve outcomes. Intervention trials should consider using change in frailty status as an outcome measure. Any trials that include frail participants should present data specifically attributable to this group.
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Affiliation(s)
- Thomas Chad
- Department of Cardiovascular Sciences, University of Leicester, UK.
| | | | - Georgia R Layton
- Department of Cardiac Surgery, University Hospitals of Leicester NHS trust, UK
| | | | - Shirley Sze
- Department of Cardiovascular Sciences, University of Leicester, UK
| | - Marius Roman
- Department of Cardiovascular Sciences, University of Leicester, UK
| | - Gavin J Murphy
- Department of Cardiovascular Sciences, University of Leicester, UK
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12
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Doody H, Livori A, Ayre J, Ademi Z, Bell JS, Morton JI. Guideline concordant prescribing following myocardial infarction in people who are frail: A systematic review. Arch Gerontol Geriatr 2023; 114:105106. [PMID: 37356114 DOI: 10.1016/j.archger.2023.105106] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 06/15/2023] [Accepted: 06/16/2023] [Indexed: 06/27/2023]
Abstract
AIMS The risk-to-benefit ratio of cardioprotective medications in frail older adults is uncertain. The objective was to systematically review prescribing of guideline-recommended cardioprotective medications following myocardial infarction (MI) in people who are frail. DATA SOURCES Ovid Medline, PubMed and Cochrane were searched from inception to October 2022 for studies that reported prescribing of one or more cardioprotective medication classes post-MI or acute coronary syndromes in people with frailty. STUDY SELECTION We included observational studies that reported prescribing of cardioprotective medications post-MI stratified by frailty status. RESULTS Overall, 16 cohort studies published from 2013 to 2022 that used seven different frailty scales were included. Prescribing of all cardioprotective medication classes following MI was lower in frail compared to non-frail people, with absolute rates of prescribing varying substantially across studies. Median prescribing in frail and non-frail people, respectively, was 88.9% (IQR 81.5-96.2) and 93.1% (IQR 92.0-98.9) for aspirin; 68.1% (IQR 61.9-91.2) and 86.7% (IQR 79.5-92.8) for P2Y12-inhibitors; 83.1% (IQR 76.9-91.3) and 94.0% (IQR 87.1-95.9) for lipid-lowering therapy; 67.9% (IQR 60.6-74.0) and 74.7% (IQR 71.3-84.5) for angiotensin-converting enzyme inhibitor/angiotensin II receptor blockers; and 74.1% (IQR 69.2-79) and 77.6% (IQR 71.8-85.9) for beta-blockers. CONCLUSION People who were frail were less likely to be prescribed guideline recommended medication classes post-MI than those who were non-frail. Further research is needed into treatment benefits and risks in frail people to avoid unnecessarily withholding treatment in this high-risk population, while also minimising potential for medication related harm.
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Affiliation(s)
- Hannah Doody
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Australia; Pharmacy Department, Launceston General Hospital, Tasmania, Australia
| | - Adam Livori
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Australia; Grampians Health, Ballarat, Victoria, Australia
| | - Justine Ayre
- Pharmacy Department, Launceston General Hospital, Tasmania, Australia
| | - Zanfina Ademi
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Australia; School of Public Health and Preventive Medicine, Monash University, Australia
| | - J Simon Bell
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Australia
| | - Jedidiah I Morton
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Australia.
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13
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Kim DH, Zhong L, Rich MW. Frailty-Guided Management of Cardiovascular Disease-From Clinical Trials to Clinical Practice. JAMA Cardiol 2023; 8:897-898. [PMID: 37647048 PMCID: PMC10805234 DOI: 10.1001/jamacardio.2023.1634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
This Viewpoint discusses pitfalls in measurement and interpretation of post hoc frailty scores and proposes standardized frailty assessment in randomized clinical trials.
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Affiliation(s)
- Dae Hyun Kim
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA
| | - Lily Zhong
- University of Connecticut School of Medicine, Farmington, CT
| | - Michael W. Rich
- Division of Cardiology, Department of Internal Medicine, Washington University School of Medicine, St. Louis, MO
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14
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Pan Y, Xu M, Mei Y, Wang Y, Zhang Q. Activities of daily living predict periprocedural myocardial infarction and injury following percutaneous coronary intervention: a cross-sectional study. BMC Cardiovasc Disord 2023; 23:427. [PMID: 37644419 PMCID: PMC10466711 DOI: 10.1186/s12872-023-03468-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 08/22/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND In recent years, there has been growing interest in exploring the relationship between activities of daily living (ADL) and cardiovascular diseases. This retrospective cross-sectional study aimed to investigate the association of ADL measured by Barthel index (BI) with periprocedural myocardial infarction (PMI) and injury following percutaneous coronary intervention (PCI). METHODS Enrolled patients were stratified into impaired and unimpaired ADL groups according to their BI scores. Logistic regressions were conducted to explore the association of ADL on admission with periprocedural myocardial injury and infarction. Restricted cubic spline (RCS) curve and subgroup analysis were also performed. RESULTS Totally, 16.4% of patients suffered from PMI; the mean age was 65.8 ± 10.4 years old. RCS analysis showed that the morbidity of periprocedural myocardial infarction and injury showed a downward tendency with increasing BI scores. Multivariable logistic regression analysis demonstrated that impaired ADL was an independent risk factor for periprocedural myocardial infarction (OR = 1.190, 95% CI [1.041, 1.360], P = 0.011) and injury (OR = 1.131, 95% CI [1.017, 1.257], P = 0.023). Subgroup analysis showed that the association between ADL and PMI was founded in several subgroups, while the association between ADL and periprocedural myocardial injury was founded only in BMI ≥ 24 kg/m2 subgroup. CONCLUSION Impaired ADL at hospital admission was an independent risk factor for periprocedural myocardial infarction and injury among patients following PCI.
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Affiliation(s)
- Yifan Pan
- Department of Cardiology, Yongkang People's Hospital, Yongkang, Zhejiang, 321300, China
| | - Min Xu
- Department of Cardiology, Yongkang People's Hospital, Yongkang, Zhejiang, 321300, China
| | - Yaosheng Mei
- Department of Cardiology, Yongkang People's Hospital, Yongkang, Zhejiang, 321300, China
| | - Yunxiang Wang
- Department of Cardiology, Yongkang People's Hospital, Yongkang, Zhejiang, 321300, China
| | - Qiongli Zhang
- Department of Cardiology, Yongkang Hospital, Yongkang, Zhejiang, 321300, China.
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15
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Pham HM, Nguyen AP, Nguyen HTT, Nguyen TN, Nguyen TX, Nguyen TTH, Nguyen HTT, Nguyen AT, Nguyen QN, Tran GS, Vu HTT. The Frail Scale - A Risk Stratification in Older Patients with Acute Coronary Syndrome. J Multidiscip Healthc 2023; 16:1521-1529. [PMID: 37274424 PMCID: PMC10239255 DOI: 10.2147/jmdh.s409535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 05/22/2023] [Indexed: 06/06/2023] Open
Abstract
Purpose The aim of this study was to explore the impact of frailty on in-hospital adverse outcomes and net adverse clinical events (NACE) in older patients with acute coronary syndrome. Patients and Methods This observational study included elderly patients (≥60 years old), diagnosed with acute coronary syndrome (ACS) at admission from February 2021 to August 2021. The primary outcome was net adverse clinical events (NACE) defined as a composite of all-cause mortality, stroke, and major bleeding. Secondary outcome was in-hospital adverse outcomes including arrhythmia, acquired pneumonia, stroke, major bleeding, and all-cause mortality. Frailty was assessed using the Frail scale (FS). Data about socio-demographics, comorbidities, body mass index, ACS type, coronary angiography, left ventricular ejection fraction, and length of hospital stay were also collected. Univariate and multivariate logistic regressions were employed to identify the potential association between frailty and outcomes. Results Of the 116 ACS patients, 38 patients were frail (32.76%). Frail subjects were more often female (50%) and older (p < 0.01) and had higher rates of in-hospital adverse outcomes (OR = 2.37, p = 0.05) and NACE (OR = 7.12; p < 0.01). In univariate analysis, the increased frail score was significantly associated with increased odds of NACE (unadjusted OR = 1.98, 95% CI 1.17-3.35 for each score increase in Frail Score). In multivariable logistic regression, models controlling for age, gender, PCI, LVEF, and coronary angiography (adjusted OR 2.19, 95% CI 1.12-4.29 for each score increase in Frail Score). Conclusion This study revealed the reference data of frailty assessment in older patients with ACS in Vietnam. Our result indicated that over 30% of ACS older patients presented with frailty which was associated with an increased risk of in-hospital adverse outcomes and NACE. This study also provided promising information about the simple FRAIL scale's potential role in the risk stratification of older patients with ACS.
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Affiliation(s)
- Hung Manh Pham
- Vietnam National Heart Institute, Bach Mai Hospital, Hanoi, 100000, Vietnam
- Department of Cardiology, Hanoi Medical University, Hanoi, 100000, Vietnam
| | - Anh Phuong Nguyen
- Vietnam National Heart Institute, Bach Mai Hospital, Hanoi, 100000, Vietnam
- Department of Cardiology, Hanoi Medical University, Hanoi, 100000, Vietnam
| | - Huong Thi Thu Nguyen
- Department of Geriatrics, Hanoi Medical University, Hanoi, 100000, Vietnam
- Scientific Research Department, National Geriatric Hospital, Hanoi, 100000, Vietnam
| | - Tam Ngoc Nguyen
- Department of Geriatrics, Hanoi Medical University, Hanoi, 100000, Vietnam
- Scientific Research Department, National Geriatric Hospital, Hanoi, 100000, Vietnam
| | - Thanh Xuan Nguyen
- Department of Geriatrics, Hanoi Medical University, Hanoi, 100000, Vietnam
- Scientific Research Department, National Geriatric Hospital, Hanoi, 100000, Vietnam
| | - Thu Thi Hoai Nguyen
- Department of Geriatrics, Hanoi Medical University, Hanoi, 100000, Vietnam
- Scientific Research Department, National Geriatric Hospital, Hanoi, 100000, Vietnam
| | - Huong Thi Thanh Nguyen
- Physiology Department, Hanoi Medical University, Hanoi, 100000, Vietnam
- Dinh Tien Hoang Institute of Medicine, Hanoi, 100000, Vietnam
| | - Anh Trung Nguyen
- Department of Geriatrics, Hanoi Medical University, Hanoi, 100000, Vietnam
- Scientific Research Department, National Geriatric Hospital, Hanoi, 100000, Vietnam
| | - Quang Ngoc Nguyen
- Vietnam National Heart Institute, Bach Mai Hospital, Hanoi, 100000, Vietnam
- Department of Cardiology, Hanoi Medical University, Hanoi, 100000, Vietnam
| | - Giang Song Tran
- Vietnam National Heart Institute, Bach Mai Hospital, Hanoi, 100000, Vietnam
| | - Huyen Thi Thanh Vu
- Department of Geriatrics, Hanoi Medical University, Hanoi, 100000, Vietnam
- Scientific Research Department, National Geriatric Hospital, Hanoi, 100000, Vietnam
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16
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Ko D, Bostrom JA, Qazi S, Kramer DB, Kim DH, Orkaby AR. Frailty and Cardiovascular Mortality: A Narrative Review. Curr Cardiol Rep 2023; 25:249-259. [PMID: 36795307 PMCID: PMC10130976 DOI: 10.1007/s11886-023-01847-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/06/2023] [Indexed: 02/17/2023]
Abstract
PURPOSE OF REVIEW The goal of the narrative review is to provide an overview of the epidemiology of frailty in cardiovascular disease and cardiovascular mortality and discuss applications of frailty in cardiovascular care of older adults. RECENT FINDINGS Frailty is highly prevalent in older adults with cardiovascular disease and is a robust, independent predictor of cardiovascular death. There is a growing interest in using frailty to inform management of cardiovascular disease either through pre- or post-treatment prognostication or by delineating treatment heterogeneity in which frailty serves to distinguish patients with differential harms or benefits from a given therapy. Frailty can enable more individualized treatment in older adults with cardiovascular disease. Future studies are needed to standardize frailty assessment across cardiovascular trials and enable implementation of frailty assessment in cardiovascular clinical practice.
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Affiliation(s)
- Darae Ko
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA
- Section of Cardiovascular Medicine, Boston Medical Center, Boston University School of Medicine, Boston, USA
| | - John A Bostrom
- Section of Cardiovascular Medicine, Boston Medical Center, Boston University School of Medicine, Boston, USA
| | - Saadia Qazi
- Department of Medicine, VA Boston Healthcare System, Boston, MA, USA
- Division of Cardiology, Brigham and Women's Hospital, Boston, MA, USA
- Division of Aging, Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Daniel B Kramer
- Richart A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Dae Hyun Kim
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA
- Division of Gerontology, Beth Israel Deaconess Medical Center, Harvard University, Boston, MA, USA
| | - Ariela R Orkaby
- Department of Medicine, VA Boston Healthcare System, Boston, MA, USA.
- Division of Aging, Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA.
- New England GRECC (Geriatric Research, Education, and Clinical Center) VA Boston Healthcare System, 150 South Huntington, 02130, Boston, MA, USA.
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17
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Nowak W, Kowalik I, Nowicki M, Cichocki T, Stępińska J. The impact of frailty on in-hospital complications in elderly patients with acute coronary syndrome. J Geriatr Cardiol 2023; 20:174-184. [PMID: 37091258 PMCID: PMC10114198 DOI: 10.26599/1671-5411.2023.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2023] Open
Abstract
BACKGROUND Acute coronary syndrome (ACS) is linked to a range of in-hospital complications, and age is recognized as risk factor for adverse events. Discrepancies between physiological and chronological age are explained by frailty. However, the relationship between frailty and in-hospital complications is not clear. METHODS Assessment of frailty in patients was carried out using the FRAIL scale. In-hospital complications assessed included, bleeding, infection, arrhythmia, acute kidney injury (AKI), delirium, stroke/transient ischemic attack (TIA), liver injury, hypoglycemia, length of stay in the cardiac care unit (CCU). RESULTS Of the 174 patients, frailty was identified in 39.1% and pre-frailty in 29.9%. Frailty was associated with a higher incidence of all types of bleeding (frail vs. robust: 45.5% vs. 16.7%, P < 0.001) and infection (54.4% vs. 11.1%, P < 0.001), including pneumonia/lower respiratory tract infections (LRTI) and urinary tract infections (UTI). Incidence of antibiotic therapy (52.9% vs. 13.0%, P < 0.001), atrial fibrillation (AF) (47.1% vs. 9.3%, P < 0.001), AKI (57.3% vs. 20.4%, P < 0.001), delirium (52.9% vs. 3.7%, P < 0.001), liver injury, were higher in frail patients (17.6% vs. 0, P = 0.001), whilst their length of stay in the CCU was longer (4 days (2-6.5) vs. 2 days (2-3), P < 0.001). Infections, pneumonia/LRTI, antibiotic therapy during hospitalization, the incidence of AF and liver injury were more often in patients with pre-frailty compared to the robust group. After adjustment for potential confounders, frailty remained independently associated with an increased risk of infection (OR: 3.3 [1.6-7.0]), including pneumonia/LRTI (OR: 2.5 [1.1-5.8]) and UTI (OR: 4.8 [1.8-12.5]). Frail individuals had an increased requirement for antibiotic therapy (OR: 3.9 [1.9-8.1]), and greater risk of AF (OR: 3.5 [1.3-9.3]), AKI (OR: 2.6 [1.2-5.3]) delirium (OR: 11.7 [4.8-28.7]), as well as having to stay longer in the CCU (> 3 days) (OR: 3.7 [1.9-7.3]). CONCLUSIONS Frailty was associated with an increased risk of numerous in-hospital complications in elderly patients who had been hospitalized with ACS.
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Affiliation(s)
- Wojciech Nowak
- Department of Intensive Cardiac Therapy, National Institute of Cardiology, Warsaw, Poland
| | - Ilona Kowalik
- Clinical Research Support Center, National Institute of Cardiology, Warsaw, Poland
| | - Michał Nowicki
- Department of Intensive Cardiac Therapy, National Institute of Cardiology, Warsaw, Poland
| | - Tomasz Cichocki
- Department of Coronary Artery Disease and Cardiac Rehabilitation, National Institute of Cardiology, Warsaw, Poland
| | - Janina Stępińska
- Department of Intensive Cardiac Therapy, National Institute of Cardiology, Warsaw, Poland
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18
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Gonçalves ALP, Grisante DL, Silva RA, Santos VB, Lopes CT. Relationship Between Frailty, Sociodemographic and Clinical Characteristics, and Disease Severity of Older Adults With Acute Coronary Syndrome. Clin Nurs Res 2023; 32:677-687. [PMID: 35927950 DOI: 10.1177/10547738221115231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This study aimed to evaluate the relationship between frailty, sociodemographic and clinical characteristics, and disease severity of older adults with acute coronary syndrome (ACS). A total of 57 hospitalized patients ≥60 years with ACS were assessed for frailty through the Tilburg Frailty Indicator. Disease severity was assessed by the Global Registry of Acute Coronary Events, by the maximum troponin level, and by the number of severely obstructed coronary arteries. The relationship between variables was assessed by Mann Whitney's test, Pearson's chi-square test, likelihood-ratio test, Fisher's exact test, or Student's t test. Analyses were bootstrapped to 1,000 to reduce potential sample bias. About 54.4% were frail. Frailty was associated with ethnicity (p = .02), marital status (p = .05), ischemic equivalents (p = .01), self-perceived health (p = .002), arthritis/rheumatism/arthrosis (p = .002), and number of severely obstructed coronary arteries (p = .05). These relationships can support intensified surveillance planning for the elderly at greatest risk, structuring of transitional care, appropriate nurse-coordinated secondary prevention delivery in primary care, and cardiac rehabilitation following ACS.
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Affiliation(s)
- Alexia Louisie Pontes Gonçalves
- Escola Paulista de Enfermagem, Universidade Federal de São Paulo, São Paulo, Brazil.,Programa de Residência Multiprofissional em Saúde Cardiovascular, Instituto de Cardiologia Dante Pazzanese, São Paulo, Brazil
| | - Daiane Lopes Grisante
- Escola Paulista de Enfermagem, Universidade Federal de São Paulo, São Paulo, Brazil.,Hospital São Paulo, São Paulo, Brazil
| | - Renan Alves Silva
- Centro de Formação de Professores, Universidade Federal de Campina Grande, Cajazeiras, Paraíba, Brazil
| | | | - Camila Takao Lopes
- Escola Paulista de Enfermagem, Universidade Federal de São Paulo, São Paulo, Brazil
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19
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Hou XP, Zhang YY, Zhang HF, Wang S, Xing YL, Li HW, Sun Y. Combination of the Barthel Index at Discharge with GRACE Leads to Improved One-Year Mortality Prediction in Older Patients with Acute Myocardial Infarction. Clin Interv Aging 2023; 18:1-11. [PMID: 36628327 PMCID: PMC9826607 DOI: 10.2147/cia.s383609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 12/14/2022] [Indexed: 01/05/2023] Open
Abstract
Purpose Many older patients with acute myocardial infarction (AMI) have impaired ability for activities of daily living (ADL). Impaired ADL leads to poor prognosis in elderly patients. The Global Registry of Acute Coronary Events (GRACE) score is widely used for risk stratification in AMI patients but does not consider physical performance, which is an important prognosis predictor for older adults. This study assessed whether the Barthel Index (BI) score combine the GRACE score would achieve improved one-year mortality prediction in older AMI patients. Patients and Methods This single-center retrospective study included 688 AMI patients aged ≥65 years who were divided into an impaired ADL group (BI ≤60, n = 102) and a normal ADL group (BI >60, n = 586) based on BI scores at discharge. The participants were followed up for one year. Cox survival models were constructed for BI score, GRACE score, and BI score combined GRACE score for one-year mortality prediction. Results Patients had a mean age of 76.29 ± 7.42 years, and 399 were men (58%). A lower BI score was associated with more years of hypertension and diabetes, less revascularization, longer hospital stays, and higher one-year mortality after discharge. Multivariable Cox regression analysis identified BI as a significant risk factor for one-year mortality in older AMI patients (HR 0.977, 95% CI, 0.963-0.992, P = 0.002). BI (0.774, 95% CI: 0.731-0.818) and GRACE (0.758, 95% CI: 0.704-0.812) scores had similar predictive power, but their combination outperformed either score alone (0.810, 95% CI: 0.770-0.851). Conclusion BI at discharge is a significant risk factor for one-year mortality in older AMI patients, which can be better predicted by the combination of BI and GRACE scores.
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Affiliation(s)
- Xiao-Pei Hou
- Department of Geriatrics, Beijing Friendship Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Yan-Yang Zhang
- Department of Geriatrics, Beijing Friendship Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Hong-Feng Zhang
- Department of Geriatrics, Beijing Friendship Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Shan Wang
- Department of Geriatrics, Beijing Friendship Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Yun-Li Xing
- Department of Geriatrics, Beijing Friendship Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Hong-Wei Li
- Department of Cardiology, Beijing Friendship Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Ying Sun
- Department of Geriatrics, Beijing Friendship Hospital, Capital Medical University, Beijing, People’s Republic of China,Correspondence: Ying Sun, Department of Geriatrics, Beijing Friendship Hospital, Capital Medical University, No. 95 of Yong’an Road, Xicheng District, Beijing, People’s Republic of China, Tel +86-010-63137740, Email
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20
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Kaul P, Rathwell S, Lam CSP, Westerhout CM, Spertus JA, Anstrom KJ, Blaustein RO, Ezekowitz JA, Pieske B, Roessig L, Butler J, Armstrong PW. Patient-Reported Frailty and Functional Status in Heart Failure With Preserved Ejection Fraction: Insights From VITALITY-HFpEF. JACC. HEART FAILURE 2023; 11:392-403. [PMID: 36881394 DOI: 10.1016/j.jchf.2022.11.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 10/28/2022] [Accepted: 11/23/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND The association between frailty and health status in patients with heart failure with preserved ejection fraction (HFpEF) is not well known. OBJECTIVES The authors examined the association between: 1) patient-reported frailty, measured by the Fried frailty phenotype, Kansas City Cardiomyopathy Questionnaire physical limitation score (KCCQ-PLS), 6-minute walking distance (6MWD), and other baseline characteristics; 2) baseline frailty compared with KCCQ-PLS and 24-week 6MWD; 3) frailty and changes in KCCQ-PLS and 6MWD; and 4) vericiguat and frailty at 24 weeks. METHODS In a post hoc analysis, patients in the VITALITY-HFpEF (Patient-reported Outcomes in Vericiguat-treated Patients With HFpEF) trial were categorized as not frail (0 symptoms), prefrail (1-2 symptoms), and frail (≥3 symptoms) according to patient-reported number of frailty symptoms. Correlations and linear regression models were used to examine the association between frailty and other measures, and between frailty and KCCQ-PLS at baseline with 24-week 6MWD. RESULTS Among 739 patients, 27.3% were not frail, 37.6% were prefrail, and 35.0% were frail at baseline. Frail patients were older, more likely to be women, and less likely to be from Asia. Baseline KCCQ-PLS and 6MWD (mean ± SD) among not frail, prefrail, and frail patients was 68.2 ± 23.2, 61.7 ± 22.6, and 48.4 ± 23.8 and 328.5 ± 117.1 m, 310.8 ± 98.9 m, and 250.7 ± 104.3 m (P < 0.01 for both). After accounting for baseline 6MWD, frailty status at baseline, but not KCCQ-PLS, was significantly associated with 6MWD at 24 weeks. By 24 weeks, 47.5% of patients had no change in frailty, 45.5% had become less frail, and 7.0% had become more frail. Treatment with vericiguat did not alter frailty status at 24 weeks. CONCLUSIONS Patient-reported frailty is modestly correlated with both the KCCQ-PLS and 6MWD but offers prognostic insight into 6MWD at 24 weeks. (Patient-reported Outcomes in Vericiguat-treated Patients With HFpEF [VITALITY-HFpEF]; NCT03547583).
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Affiliation(s)
- Padma Kaul
- Canadian VIGOUR Centre, University of Alberta, Edmonton, Alberta, Canada; Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
| | - Sarah Rathwell
- Canadian VIGOUR Centre, University of Alberta, Edmonton, Alberta, Canada
| | - Carolyn S P Lam
- National Heart Centre Singapore and Duke-National University of Singapore, Singapore
| | | | - John A Spertus
- Saint Luke's Mid America Heart Institute/University of Missouri-Kansas City, Kansas City, Missouri, USA
| | - Kevin J Anstrom
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA
| | | | - Justin A Ezekowitz
- Canadian VIGOUR Centre, University of Alberta, Edmonton, Alberta, Canada; Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Burkert Pieske
- Charité University Medicine, German Heart Center, Berlin, Germany
| | | | - Javed Butler
- Baylor University Medical Center, Dallas, Texas, USA
| | - Paul W Armstrong
- Canadian VIGOUR Centre, University of Alberta, Edmonton, Alberta, Canada; Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
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21
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Bencivenga L, Femminella GD, Ambrosino P, Bosco Q, De Lucia C, Perrotta G, Formisano R, Komici K, Vitale DF, Ferrara N, Maniscalco M, Cacciatore F, Papa A, Rengo G. Role of frailty on cardiac rehabilitation in hospitalized older patients. Aging Clin Exp Res 2022; 34:2675-2682. [PMID: 36065074 PMCID: PMC9675689 DOI: 10.1007/s40520-022-02220-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 08/03/2022] [Indexed: 01/04/2023]
Abstract
BACKGROUND Cardiovascular diseases are the leading cause of mortality, morbidity, and disability in the world, especially in the older adults. A relevant proportion of patients admitted to Cardiac Rehabilitation (CR) may suffer from frailty, a complex geriatric syndrome with multifactorial aetiology. AIMS The hypothesis underlying the study is that frailty complicates the management of older patients undergoing CR. The main objective is, therefore, to determine the relationship between frailty and CR outcomes in hospitalized older adults. METHODS The participants have been recruited among patients aged ≥ 65 years admitted at the hospital for CR. A Comprehensive Geriatric Assessment (CGA)-based Frailty Index (FI) was created following a standard procedure. The outcome was measured as the ratio between 6-min walk test (6MWT) distance at the end of CR and normal predicted values for a healthy adult of same age and gender, according to reference equations. RESULTS The study population consisted of 559 elderly patients, 387 males (69.2%), with age of 72 (69-76) years. The most frequent diagnosis at admission was ischaemic heart disease (231, 41.5%) and overall 6MWT ratio was 0.62 ± 0.21. At the multivariable regression analysis, gender, diagnosis and FI were significantly and independently associated with 6MWT ratio (p ≤ 0.0001, p ≤ 0.001 and p ≤ 0.0001, respectively), while no significant association emerged for age. CONCLUSION FI resulted independently correlated to 6MWT ratio in a population of older patients undergoing in-hospital CR programs. Frailty is a multifactorial geriatric syndrome whose assessment is essential for prognostic evaluation of older patients, also in CR clinical setting.
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Affiliation(s)
- Leonardo Bencivenga
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
- Gérontopôle de Toulouse, Institut du Vieillissement, CHU de Toulouse, Toulouse, France
| | | | - Pasquale Ambrosino
- Cardiac Rehabilitation Unit, Istituti Clinici Scientifici Maugeri IRCCS, Scientific Institute of Telese Terme, Bagni Vecchi, 1, 82037, Telese Terme, Italy
| | - Quirino Bosco
- Cardiac Rehabilitation Unit, Istituti Clinici Scientifici Maugeri IRCCS, Scientific Institute of Telese Terme, Bagni Vecchi, 1, 82037, Telese Terme, Italy
| | - Claudio De Lucia
- Cardiac Rehabilitation Unit, Istituti Clinici Scientifici Maugeri IRCCS, Scientific Institute of Telese Terme, Bagni Vecchi, 1, 82037, Telese Terme, Italy
| | - Giovanni Perrotta
- Department of Translational Medical Sciences, University of Naples "Federico II", Naples, Italy
- Cardiac Rehabilitation Unit, Istituti Clinici Scientifici Maugeri IRCCS, Scientific Institute of Telese Terme, Bagni Vecchi, 1, 82037, Telese Terme, Italy
| | - Roberto Formisano
- Cardiac Rehabilitation Unit, Istituti Clinici Scientifici Maugeri IRCCS, Scientific Institute of Telese Terme, Bagni Vecchi, 1, 82037, Telese Terme, Italy
| | - Klara Komici
- Department of Medicine and Health Sciences, University of Molise, 86100, Campobasso, Italy
| | | | - Nicola Ferrara
- Department of Translational Medical Sciences, University of Naples "Federico II", Naples, Italy
- Department of Medicine and Health Sciences, University of Molise, 86100, Campobasso, Italy
| | - Mauro Maniscalco
- Cardiac Rehabilitation Unit, Istituti Clinici Scientifici Maugeri IRCCS, Scientific Institute of Telese Terme, Bagni Vecchi, 1, 82037, Telese Terme, Italy
| | - Francesco Cacciatore
- Department of Translational Medical Sciences, University of Naples "Federico II", Naples, Italy
| | - Antimo Papa
- Cardiac Rehabilitation Unit, Istituti Clinici Scientifici Maugeri IRCCS, Scientific Institute of Telese Terme, Bagni Vecchi, 1, 82037, Telese Terme, Italy.
| | - Giuseppe Rengo
- Department of Translational Medical Sciences, University of Naples "Federico II", Naples, Italy.
- Cardiac Rehabilitation Unit, Istituti Clinici Scientifici Maugeri IRCCS, Scientific Institute of Telese Terme, Bagni Vecchi, 1, 82037, Telese Terme, Italy.
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22
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Udell JA, Lu D, Bagai A, Dodson JA, Desai NR, Fonarow GC, Goyal A, Garratt KN, Lucas J, Weintraub WS, Forman DE, Roe MT, Alexander KP. Preexisting frailty and outcomes in older patients with acute myocardial infarction. Am Heart J 2022; 249:34-44. [PMID: 35339451 DOI: 10.1016/j.ahj.2022.03.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 02/23/2022] [Accepted: 03/17/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Little is known about the prevalence and prognostic impact of preexisting frailty on acute care and in-hospital outcomes in older adults in the setting of acute myocardial infarction (AMI). METHODS Preexisting frailty was assessed at baseline in consecutive AMI patients ≥65 years of age treated at 778 hospitals participating in the NCDR ACTION Registry between January 1, 2015 to December 31, 2016. Three domains of preexisting frailty (cognition, ambulation, and functional independence) were abstracted from chart review and summed in 2 ways: an ACTION Frailty Scale based on responses to 6 groups adapted from the Canadian Study of Health and Aging Clinical Frailty Scale and an ACTION Frailty Score derived by summing a rank score of 0-2 assigned for each grade (total ranged between 0 to 6). Multivariable logistic regression examined the association between assigned frailty by score or scale and in-hospital mortality. RESULTS Among 143,722 older AMI patients, 108,059 (75.2%) were fit and/or well and 6,484 (4.5%) were vulnerable to frailty, while 7,527 (5.2%) had mild, 3,913 (2.7%) had moderate, 2,715 had (1.9%) severe, and 632 (0.4%) had very severe frailty according to the ACTION Frailty Scale, while 14,392 (10.0%) could not be categorized due to incomplete ascertainment. Frail patients were older, more frequently female, of non-white race and/or ethnicity, and less likely to be treated with guideline-recommended therapies. Increasing severity of frailty by this scale was associated with a step-wise higher risk for in-hospital mortality (P-trend < .001). Patient categories of the ACTION Frailty Score provided similar results. After adjustment, each 1-unit increase in Frailty Score was associated with a 12% higher mortality risk (OR 1.12, 95% CI 1.10-1.15). CONCLUSIONS Among older patients with acute myocardial infarction, frailty is common and independently associated with in-hospital mortality. These findings show the importance of pragmatic evaluation of frailty in hospital-level quality scores, guideline recommendations, and incorporation into other registry data collection efforts.
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Affiliation(s)
- Jacob A Udell
- Cardiovascular Division, Department of Medicine, Peter Munk Cardiac Centre, Toronto General Hospital and Women's College Hospital, University of Toronto, Canada; Duke Clinical Research Institute, Cardiovascular Division, Department of Medicine, Duke University, Durham, NC.
| | - Di Lu
- Duke Clinical Research Institute, Cardiovascular Division, Department of Medicine, Duke University, Durham, NC
| | - Akshay Bagai
- Terrence Donnelly Heart Center, St. Michael's Hospital, University of Toronto, Canada
| | - John A Dodson
- Leon H. Charney Division of Cardiology, Department of Medicine, NYU Langone Health, New York, NY
| | - Nihar R Desai
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine and Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT
| | - Gregg C Fonarow
- Division of Cardiology, University of California Los Angeles, Los Angeles, CA
| | - Abhinav Goyal
- Division of Cardiology, Emory Health Care, Emory School of Medicine, Atlanta, GA
| | - Kirk N Garratt
- Center for Heart and Vascular Health, ChristianaCare, Wilmington, DE
| | - Joseph Lucas
- Duke Clinical Research Institute, Cardiovascular Division, Department of Medicine, Duke University, Durham, NC
| | | | - Daniel E Forman
- Divisions of Geriatrics and Cardiology, Department of Medicine, University of Pittsburgh; Pittsburgh Geriatric, Research, Education, and Clinical Center (GRECC), VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
| | - Matthew T Roe
- Duke Clinical Research Institute, Cardiovascular Division, Department of Medicine, Duke University, Durham, NC
| | - Karen P Alexander
- Duke Clinical Research Institute, Cardiovascular Division, Department of Medicine, Duke University, Durham, NC
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23
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Comparison of the prognostic value of frailty assessment tools in patients aged ≥ 65 years hospitalized in a cardiac care unit with acute coronary syndrome. J Geriatr Cardiol 2022; 19:343-353. [PMID: 35722033 PMCID: PMC9170905 DOI: 10.11909/j.issn.1671-5411.2022.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Frailty is associated with adverse events in elderly patients with acute coronary syndrome (ACS). Our aim was to compare the prognostic value of four frailty scales in patients aged ≥ 65 years hospitalized with ACS in a cardiac care unit (CCU). METHODS Patients aged ≥ 65 years with ACS were included. Frailty was assessed using the Fried frailty scale (reference standard), the Edmonton Frail Scale (EFS), the FRAIL scale, and the Clinical frailty scale (CFS). The primary end point was all-cause mortality and the secondary end point was unscheduled rehospitalization. RESULTS One hundred and seventy four patients aged ≥ 65 years with ACS were recruited. The median follow-up was 637.5 days. Frailty was identified in 41.4%, 40.2%, 39.1% and 36.3% patients by the Fried frailty scale, EFS, FRAIL scale and CFS, respectively. The agreement coefficients were 0.88, 0.86, and 0.79 for the FRAIL scale, EFS and CFS, respectively. In the Cox regression model, frailty was associated with all-cause mortality regardless of the scale used (univariate: hazard ratio [HR] 95% CI = 10.5, 2.4-46.8 Fried frailty scale; 12.0, 2.7-53.4 FRAIL scale; 7.1, 2.0-25.2 EFS; 8.3, 2.4-29.6 CFS. Multivariate: HR = 5.1, 1.1-23.8 Fried frailty scale; 5.7, 1.2-26.8 FRAIL scale; 3.7, 1.0-14.0 EFS; 4.2, 1.1-15.9 CFS). The FRAIL scale had the highest HR. In the univariate analysis, frailty was associated with unscheduled rehospitalization (HR = 3.2, 1.7-6.0 Fried frailty scale; 3.4, 1.8-6.3 FRAIL scale; 3.5, 1.8-6.6 EFS; 3.1, 1.7-5.8 CFS). In the multivariate analysis, only the EFS independently predicted unscheduled rehospitalization (HR = 2.2, 1.1-4.63). CONCLUSIONS Frailty assessed by the Fried frailty scale, FRAIL scale, EFS and CFS is associated with all-cause mortality and unscheduled rehospitalization in elderly patients hospitalized in a CCU with ACS. The adjusted HR of the FRAIL scale for all-cause mortality was the highest among the scales compared, whereas the EFS was an independent predictor of unscheduled rehospitalization. These data should be taken into consideration when choosing a frailty assessment tool.
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Ratcovich H, Beska B, Mills G, Holmvang L, Adams-Hall J, Stevenson H, Veerasamy M, Wilkinson C, Kunadian V. Five-year clinical outcomes in patients with frailty aged ≥75 years with non-ST elevation acute coronary syndrome undergoing invasive management. EUROPEAN HEART JOURNAL OPEN 2022; 2:oeac035. [PMID: 35919345 PMCID: PMC9242041 DOI: 10.1093/ehjopen/oeac035] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 04/27/2022] [Accepted: 05/12/2022] [Indexed: 01/05/2023]
Abstract
Aim Frailty is associated with adverse outcomes in older patients with acute coronary syndrome (ACS). The impact of frailty on long-term clinical outcomes following invasive management of non-ST elevation ACS (NSTEACS) is unknown. Methods and results The multi-centre Improve Clinical Outcomes in high-risk patieNts with ACS 1 (ICON-1) prospective cohort study consisted of patients aged >75 years undergoing coronary angiography following NSTEACS. Patients were categorized by frailty assessed by Canadian Study of Health and Ageing Clinical Frailty Scale (CFS) and Fried criteria. The primary composite endpoint was all-cause mortality, unplanned revascularization, myocardial infarction, stroke, and bleeding. Of 263 patients, 33 (12.5%) were frail, 152 (57.8%) were pre-frail, and 78 (29.7%) were robust according to CFS. By Fried criteria, 70 patients (26.6%, mean age 82.1 years) were frail, 147 (55.9%, mean age 81.3 years) were pre-frail, and 46 (17.5%, mean age 79.9 years) were robust. The composite endpoint was more common at 5 years among patients with frailty according to CFS (frail: 22, 66.7%; pre-frail: 81, 53.3%; robust: 27, 34.6%, P = 0.003), with a similar trend when using Fried criteria (frail: 39, 55.7%; pre-frail: 72, 49.0%; robust: 16, 34.8%, P = 0.085). Frailty measured with both CFS and Fried criteria was associated with the primary endpoint [age and sex-adjusted hazard ratio (HR) compared with robust groups. CFS: 2.22, 95% confidence interval (CI) 1.23-4.02, P = 0.008; Fried: HR 1.81, 95% CI 1.00-3.27, P = 0.048]. Conclusion In older patients who underwent angiography following NSTEACS, frailty is associated with an increased risk of the primary composite endpoint at 5 years. Registration Clinicaltrials.gov NCT01933581.
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Affiliation(s)
- Hanna Ratcovich
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, 4th Floor William Leech Building Newcastle upon Tyne, UK
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Benjamin Beska
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, 4th Floor William Leech Building Newcastle upon Tyne, UK
- Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Greg Mills
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, 4th Floor William Leech Building Newcastle upon Tyne, UK
| | - Lene Holmvang
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Jennifer Adams-Hall
- Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Hannah Stevenson
- Cardiovascular and Transplant Research, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Murugapathy Veerasamy
- Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust and Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Chris Wilkinson
- Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Vijay Kunadian
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, 4th Floor William Leech Building Newcastle upon Tyne, UK
- Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
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25
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Ekerstad N, Javadzadeh D, Alexander KP, Bergström O, Eurenius L, Fredrikson M, Gudnadottir G, Held C, Ängerud KH, Jahjah R, Jernberg T, Mattsson E, Melander K, Mellbin L, Ohlsson M, Ravn-Fischer A, Svennberg L, Yndigegn T, Alfredsson J. Clinical Frailty Scale classes are independently associated with 6-month mortality for patients after acute myocardial infarction. EUROPEAN HEART JOURNAL. ACUTE CARDIOVASCULAR CARE 2022; 11:89-98. [PMID: 34905049 PMCID: PMC8826894 DOI: 10.1093/ehjacc/zuab114] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 11/09/2021] [Accepted: 11/19/2021] [Indexed: 12/22/2022]
Abstract
Aims Data on the prognostic value of frailty to guide clinical decision-making for patients with myocardial infarction (MI) are scarce. To analyse the association between frailty classification, treatment patterns, in-hospital outcomes, and 6-month mortality in a large population of patients with MI. Methods and results An observational, multicentre study with a retrospective analysis of prospectively collected data using the SWEDEHEART registry. In total, 3381 MI patients with a level of frailty assessed using the Clinical Frailty Scale (CFS-9) were included. Of these patients, 2509 (74.2%) were classified as non-vulnerable non-frail (CFS 1–3), 446 (13.2%) were vulnerable non-frail (CFS 4), and 426 (12.6%) were frail (CFS 5–9). Frailty and non-frail vulnerability were associated with worse in-hospital outcomes compared with non-frailty, i.e. higher rates of mortality (13.4% vs. 4.0% vs. 1.8%), cardiogenic shock (4.7% vs. 2.5% vs. 1.9%), and major bleeding (4.5% vs. 2.7% vs. 1.1%) (all P < 0.001), and less frequent use of evidence-based therapies. In Cox regression analyses, frailty was strongly and independently associated with 6-month mortality compared with non-frailty, after adjustment for age, sex, the GRACE risk score components, and other potential risk factors [hazard ratio (HR) 3.32, 95% confidence interval (CI) 2.30–4.79]. A similar pattern was seen for vulnerable non-frail patients (fully adjusted HR 2.07, 95% CI 1.41–3.02). Conclusion Frailty assessed with the CFS was independently and strongly associated with all-cause 6-month mortality, also after comprehensive adjustment for baseline differences in other risk factors. Similarly, non-frail vulnerability was independently associated with higher mortality compared with those with preserved functional ability.
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Affiliation(s)
- Niklas Ekerstad
- Department of Health, Medicine and Caring Sciences, Unit of Health Care Analysis and National Centre for Priorities in Health, Linköping University, Sandbäcksgatan 7, 58183 Linköping, Sweden.,The Research and Development Unit, NU Hospital Group, Trollhättan, Sweden
| | | | | | - Olle Bergström
- Department of Medicine, Växjö County Hospital, Växjö, Sweden
| | - Lars Eurenius
- Department of Clinical Physiology, Karolinska University Hospital, Stockholm, Sweden
| | - Mats Fredrikson
- Department of Biomedical and Clinical Sciences, Faculty of Medicine and Health, Linköping University, Linköping, Sweden
| | - Gudny Gudnadottir
- Section of Geriatrics, Department of Acute Medicine and Geriatrics, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Claes Held
- Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden
| | | | - Radwan Jahjah
- Department of Cardiology, Unit of Cardiovascular Sciences, Linköping University, Linköping, Sweden.,Department of Health, Medicine and Caring Sciences, Unit of Cardiovascular Sciences, Linköping University, Linköping, Sweden
| | - Tomas Jernberg
- Department of Clinical Sciences, Danderyd University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Ewa Mattsson
- Department of Cardiology, Skåne University Hospital, Lund, Sweden
| | | | - Linda Mellbin
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Monica Ohlsson
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
| | - Annica Ravn-Fischer
- Department of Cardiology, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Lars Svennberg
- Department of Cardiology, County Hospital of Gävle, Region Gävleborg, Sweden
| | | | - Joakim Alfredsson
- Department of Cardiology, Unit of Cardiovascular Sciences, Linköping University, Linköping, Sweden.,Department of Health, Medicine and Caring Sciences, Unit of Cardiovascular Sciences, Linköping University, Linköping, Sweden
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26
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Wang XF, Zhao M, Liu F, Sun GR. Value of GRACE and SYNTAX scores for predicting the prognosis of patients with non-ST elevation acute coronary syndrome. World J Clin Cases 2021; 9:10143-10150. [PMID: 34904084 PMCID: PMC8638065 DOI: 10.12998/wjcc.v9.i33.10143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 08/09/2021] [Accepted: 08/17/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND GRACE and SYNTAX scores are important tools to assess prognosis in non-ST-elevation acute coronary syndrome (NSTE-ACS). However, there have been few studies on their value in patients receiving different types of therapies.
AIM To explore the value of GRACE and SYNTAX scores in predicting the prognosis of patients with NSTE-ACS receiving different types of therapies.
METHODS The data of 386 patients with NSTE-ACS were retrospectively analyzed and categorized into different groups. A total of 195 patients who received agents alone comprised the medication group, 156 who received medical therapy combined with stents comprised the stent group, and 35 patients who were given agents and underwent coronary artery bypass grafting (CABG) comprised the CABG group. General information was compared among the three groups. GRACE and SYNTAX scores were calculated. The association between the relationship between GRACE and SYNTAX scores and the occurrence of major adverse cardiovascular events (MACEs) was analyzed. Pearson’s correlation analysis was used to determine the factors influencing prognosis in patients with NSTE-ACS. Univariate and multivariate analyses were conducted to analyze the predictive value of GRACE and SYNTAX scores for predicting prognosis in patients with NSTE-ACS using the Cox proportional-hazards model.
RESULTS The incidence of MACE increased with the elevation of GRACE and SYNTAX scores (all P < 0.05). The incidence of MACE was 18.5%, 36.5%, and 42.9% in the medication group, stent group, and CABG group, respectively. By comparison, the incidence of MACE was significantly lower in the medication group than in the stent and CABG groups (all P < 0.05). The incidence of MACE was 6.2%, 28.0% and 40.0% in patients with a low GRACE score in the medication group, stent group, and CABG group, respectively (P < 0.05). The incidence of MACE was 31.0%, 30.3% and 42.9% in patients with a medium GRACE score in the medication group, stent group, and CABG group, respectively (P > 0.05). The incidence of MACE was 16.9%, 46.2%, and 43.8% in patients with a high GRACE score in the medication group, stent group, and CABG group, respectively (P < 0.05). The incidence of MACE was 16.2%, 35.4% and 60.0% in patients with a low SYNTAX score in the medication group, stent group, and CABG group, respectively (P < 0.05). The incidence of MACE was 37.5%, 40.9%, and 41.7% in patients with a medium SYNTAX score in the medication group, stent group, and CABG group, respectively (P > 0.05). MACE incidence was 50.0%, 75.0%, and 25.0% in patients with a high SYNTAX score in the medication group, stent group, and CABG group, respectively (P < 0.05). Univariate Cox regression analyses showed that both GRACE score (hazard ratio [HR] = 1.212, 95% confidence interval [CI]: 1.083 to 1.176; P < 0.05) and SYNTAX score (HR = 1.160, 95%CI: 1.104 to 1.192; P < 0.05) were factors influencing MACE (all P < 0.05). Multivariate Cox regression analyses showed that GRACE (HR = 1.091, 95%CI: 1.015 to 1.037; P < 0.05) and SYNTAX scores (HR = 1.031, 95%CI: 1.076 to 1.143; P < 0.05) were independent predictors of MACE (all P < 0.05).
CONCLUSION GRACE and SYNTAX scores are of great value for evaluating the prognosis of NSTE-ACS patients, and prevention and early intervention strategies should be used in clinical practice targeting different risk scores.
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Affiliation(s)
- Xiao-Feng Wang
- Department of Cardiology, Cangzhou Central Hospital, Cangzhou 061000, Hebei Province, China
| | - Ming Zhao
- Department of Cardiology, Cangzhou Central Hospital, Cangzhou 061000, Hebei Province, China
| | - Fei Liu
- Department of Cardiology, Cangzhou Central Hospital, Cangzhou 061000, Hebei Province, China
| | - Guo-Rong Sun
- Department of Cardiology, Cangzhou Central Hospital, Cangzhou 061000, Hebei Province, China
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García-Blas S, Bonanad C, Fernández-Cisnal A, Sastre-Arbona C, Ruescas-Nicolau MA, González D’Gregorio J, Valero E, Miñana G, Palau P, Tarazona-Santabalbina FJ, Ruiz Ros V, Núñez J, Sanchis J. Frailty Scales for Prognosis Assessment of Older Adult Patients after Acute Myocardial Infarction. J Clin Med 2021; 10:jcm10184278. [PMID: 34575389 PMCID: PMC8465296 DOI: 10.3390/jcm10184278] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 09/10/2021] [Accepted: 09/16/2021] [Indexed: 12/30/2022] Open
Abstract
We aimed to compare the prognostic value of two different measures, the Fried's Frailty Scale (FFS) and the Clinical Frailty Scale (CFS), following myocardial infarction (MI). We included 150 patients ≥ 70 years admitted from AMI. Frailty was evaluated on the day before discharge. The primary endpoint was number of days alive and out of hospital (DAOH) during the first 800 days. Secondary endpoints were mortality and a composite of mortality and reinfarction. Frailty was diagnosed in 58% and 34% of patients using the FFS and CFS scales, respectively. During the first 800 days 34 deaths and 137 admissions occurred. The number of DAOH decreased significantly with increasing scores of both FFS (p < 0.001) and CFS (p = 0.049). In multivariate analysis, only the highest scores (FFS = 5, CFS ≥ 6) were independently associated with fewer DAOH. At a median follow-up of 946 days, frailty assessed both by FFS and CFS was independently associated with death and MI (HR = 2.70 95%CI = 1.32-5.51 p = 0.001; HR = 2.01 95%CI = 1.1-3.66 p = 0.023, respectively), whereas all-cause mortality was only associated with FFS (HR = 1.51 95%CI = 1.08-2.10 p = 0.015). Frailty by FFS or CFS is independently associated with shorter number DAOH post-MI. Likewise, frailty assessed by either scale is associated with a higher rate of death and reinfarction, whereas FFS outperforms CFS for mortality prediction.
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Affiliation(s)
- Sergio García-Blas
- Cardiology Department, University Clinic Hospital of Valencia, 46010 Valencia, Spain; (S.G.-B.); (C.B.); (A.F.-C.); (C.S.-A.); (J.G.D.); (E.V.); (G.M.); (P.P.); (V.R.R.); (J.N.)
- Instituto de Investigación Sanitaria INCLIVA, 46010 Valencia, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), 28029 Madrid, Spain
| | - Clara Bonanad
- Cardiology Department, University Clinic Hospital of Valencia, 46010 Valencia, Spain; (S.G.-B.); (C.B.); (A.F.-C.); (C.S.-A.); (J.G.D.); (E.V.); (G.M.); (P.P.); (V.R.R.); (J.N.)
- Instituto de Investigación Sanitaria INCLIVA, 46010 Valencia, Spain
- Department of Medicine, Faculty of Medicine, University of Valencia, 46010 Valencia, Spain
| | - Agustín Fernández-Cisnal
- Cardiology Department, University Clinic Hospital of Valencia, 46010 Valencia, Spain; (S.G.-B.); (C.B.); (A.F.-C.); (C.S.-A.); (J.G.D.); (E.V.); (G.M.); (P.P.); (V.R.R.); (J.N.)
- Instituto de Investigación Sanitaria INCLIVA, 46010 Valencia, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), 28029 Madrid, Spain
| | - Clara Sastre-Arbona
- Cardiology Department, University Clinic Hospital of Valencia, 46010 Valencia, Spain; (S.G.-B.); (C.B.); (A.F.-C.); (C.S.-A.); (J.G.D.); (E.V.); (G.M.); (P.P.); (V.R.R.); (J.N.)
- Instituto de Investigación Sanitaria INCLIVA, 46010 Valencia, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), 28029 Madrid, Spain
| | | | - Jessika González D’Gregorio
- Cardiology Department, University Clinic Hospital of Valencia, 46010 Valencia, Spain; (S.G.-B.); (C.B.); (A.F.-C.); (C.S.-A.); (J.G.D.); (E.V.); (G.M.); (P.P.); (V.R.R.); (J.N.)
- Instituto de Investigación Sanitaria INCLIVA, 46010 Valencia, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), 28029 Madrid, Spain
| | - Ernesto Valero
- Cardiology Department, University Clinic Hospital of Valencia, 46010 Valencia, Spain; (S.G.-B.); (C.B.); (A.F.-C.); (C.S.-A.); (J.G.D.); (E.V.); (G.M.); (P.P.); (V.R.R.); (J.N.)
- Instituto de Investigación Sanitaria INCLIVA, 46010 Valencia, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), 28029 Madrid, Spain
| | - Gema Miñana
- Cardiology Department, University Clinic Hospital of Valencia, 46010 Valencia, Spain; (S.G.-B.); (C.B.); (A.F.-C.); (C.S.-A.); (J.G.D.); (E.V.); (G.M.); (P.P.); (V.R.R.); (J.N.)
- Instituto de Investigación Sanitaria INCLIVA, 46010 Valencia, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), 28029 Madrid, Spain
- Department of Medicine, Faculty of Medicine, University of Valencia, 46010 Valencia, Spain
| | - Patricia Palau
- Cardiology Department, University Clinic Hospital of Valencia, 46010 Valencia, Spain; (S.G.-B.); (C.B.); (A.F.-C.); (C.S.-A.); (J.G.D.); (E.V.); (G.M.); (P.P.); (V.R.R.); (J.N.)
- Instituto de Investigación Sanitaria INCLIVA, 46010 Valencia, Spain
- Department of Medicine, Faculty of Medicine, University of Valencia, 46010 Valencia, Spain
| | | | - Vicente Ruiz Ros
- Cardiology Department, University Clinic Hospital of Valencia, 46010 Valencia, Spain; (S.G.-B.); (C.B.); (A.F.-C.); (C.S.-A.); (J.G.D.); (E.V.); (G.M.); (P.P.); (V.R.R.); (J.N.)
- Instituto de Investigación Sanitaria INCLIVA, 46010 Valencia, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), 28029 Madrid, Spain
- Department of Medicine, Faculty of Medicine, University of Valencia, 46010 Valencia, Spain
| | - Julio Núñez
- Cardiology Department, University Clinic Hospital of Valencia, 46010 Valencia, Spain; (S.G.-B.); (C.B.); (A.F.-C.); (C.S.-A.); (J.G.D.); (E.V.); (G.M.); (P.P.); (V.R.R.); (J.N.)
- Instituto de Investigación Sanitaria INCLIVA, 46010 Valencia, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), 28029 Madrid, Spain
- Department of Medicine, Faculty of Medicine, University of Valencia, 46010 Valencia, Spain
| | - Juan Sanchis
- Cardiology Department, University Clinic Hospital of Valencia, 46010 Valencia, Spain; (S.G.-B.); (C.B.); (A.F.-C.); (C.S.-A.); (J.G.D.); (E.V.); (G.M.); (P.P.); (V.R.R.); (J.N.)
- Instituto de Investigación Sanitaria INCLIVA, 46010 Valencia, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), 28029 Madrid, Spain
- Department of Medicine, Faculty of Medicine, University of Valencia, 46010 Valencia, Spain
- Correspondence:
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García-Blas S, Cordero A, Diez-Villanueva P, Martinez-Avial M, Ayesta A, Ariza-Solé A, Mateus-Porta G, Martínez-Sellés M, Escribano D, Gabaldon-Perez A, Bodi V, Bonanad C. Acute Coronary Syndrome in the Older Patient. J Clin Med 2021; 10:4132. [PMID: 34575243 PMCID: PMC8467899 DOI: 10.3390/jcm10184132] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 09/06/2021] [Accepted: 09/07/2021] [Indexed: 01/21/2023] Open
Abstract
Coronary artery disease is one of the leading causes of morbidity and mortality, and its prevalence increases with age. The growing number of older patients and their differential characteristics make its management a challenge in clinical practice. The aim of this review is to summarize the state-of-the-art in diagnosis and treatment of acute coronary syndromes in this subgroup of patients. This comprises peculiarities of ST-segment elevation myocardial infarction (STEMI) management, updated evidence of non-STEMI therapeutic strategies, individualization of antiplatelet treatment (weighting ischemic and hemorrhagic risks), as well as assessment of geriatric conditions and ethical issues in decision making.
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Affiliation(s)
- Sergio García-Blas
- Cardiology Department, Hospital Clínico Universitario de Valencia, INCLIVA Biomedical Research Institute, University of Valencia, 46010 Valencia, Spain; (S.G.-B.); (A.G.-P.); (V.B.)
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), 28029 Madrid, Spain; (A.C.); (M.M.-S.); (D.E.)
| | - Alberto Cordero
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), 28029 Madrid, Spain; (A.C.); (M.M.-S.); (D.E.)
- Cardiology Department, Hospital Universitario de San Juan, 03550 Alicante, Spain
| | - Pablo Diez-Villanueva
- Cardiology Department, Hospital Universitario de La Princesa, 28006 Madrid, Spain; (P.D.-V.); (M.M.-A.)
| | - Maria Martinez-Avial
- Cardiology Department, Hospital Universitario de La Princesa, 28006 Madrid, Spain; (P.D.-V.); (M.M.-A.)
| | - Ana Ayesta
- Cardiology Department, Hospital Central de Asturias, 33011 Oviedo, Spain;
| | - Albert Ariza-Solé
- Cardiology Department, Hospital Universitari de Bellvitge, L’Hospitalet de Llobregat, 08907 Barcelona, Spain; (A.A.-S.); (G.M.-P.)
| | - Gemma Mateus-Porta
- Cardiology Department, Hospital Universitari de Bellvitge, L’Hospitalet de Llobregat, 08907 Barcelona, Spain; (A.A.-S.); (G.M.-P.)
| | - Manuel Martínez-Sellés
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), 28029 Madrid, Spain; (A.C.); (M.M.-S.); (D.E.)
- Cardiology Department, Hospital Universitario Gregorio Marañón, Universidad Europea, Universidad Complutense, 28007 Madrid, Spain
| | - David Escribano
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), 28029 Madrid, Spain; (A.C.); (M.M.-S.); (D.E.)
- Cardiology Department, Hospital Universitario de San Juan, 03550 Alicante, Spain
| | - Ana Gabaldon-Perez
- Cardiology Department, Hospital Clínico Universitario de Valencia, INCLIVA Biomedical Research Institute, University of Valencia, 46010 Valencia, Spain; (S.G.-B.); (A.G.-P.); (V.B.)
| | - Vicente Bodi
- Cardiology Department, Hospital Clínico Universitario de Valencia, INCLIVA Biomedical Research Institute, University of Valencia, 46010 Valencia, Spain; (S.G.-B.); (A.G.-P.); (V.B.)
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), 28029 Madrid, Spain; (A.C.); (M.M.-S.); (D.E.)
| | - Clara Bonanad
- Cardiology Department, Hospital Clínico Universitario de Valencia, INCLIVA Biomedical Research Institute, University of Valencia, 46010 Valencia, Spain; (S.G.-B.); (A.G.-P.); (V.B.)
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Morici N, De Servi S, De Luca L, Crimi G, Montalto C, De Rosa R, De Luca G, Rubboli A, Valgimigli M, Savonitto S. Management of acute coronary syndromes in older adults. Eur Heart J 2021; 43:1542-1553. [PMID: 34347065 DOI: 10.1093/eurheartj/ehab391] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 04/03/2021] [Accepted: 06/03/2021] [Indexed: 12/22/2022] Open
Abstract
Older patients are underrepresented in prospective studies and randomized clinical trials of acute coronary syndromes (ACS). Over the last decade, a few specific trials have been conducted in this population, allowing more evidence-based management. Older adults are a heterogeneous, complex, and high-risk group whose management requires a multidimensional clinical approach beyond coronary anatomic variables. This review focuses on available data informing evidence-based interventional and pharmacological approaches for older adults with ACS, including guideline-directed management. Overall, an invasive approach appears to demonstrate a better benefit-risk ratio compared to a conservative one across the ACS spectrum, even considering patients' clinical complexity and multiple comorbidities. Conversely, more powerful strategies of antithrombotic therapy for secondary prevention have been associated with increased bleeding events and no benefit in terms of mortality reduction. An interdisciplinary evaluation with geriatric assessment should always be considered to achieve a holistic approach and optimize any treatment on the basis of the underlying biological vulnerability.
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Affiliation(s)
- Nuccia Morici
- Unità di Cure Intensive Cardiologiche, and De Gasperis Cardio-Center, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy.,Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milano, Italy
| | | | - Leonardo De Luca
- Department of Cardiosciences, Azienda Ospedaliera San Camillo-Forlanini, Roma, Italy
| | - Gabriele Crimi
- Cardio Thoraco Vascular Department (DICATOV), Interventional Cardiology Unit, IRCCS Policlinico San Martino, Genova, Italy
| | | | - Roberta De Rosa
- Department of Cardiology, Goethe University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Giuseppe De Luca
- Division of Cardiology, AOU Maggiore della Carità, Università del Piemonte Orientale, Novara, Italy
| | - Andrea Rubboli
- Division of Cardiology, Department of Cardiovascular Disease-AUSL Romagna, Ospedale S. Maria delle Croci, Ravenna, Italy
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Collet JP, Thiele H, Barbato E, Barthélémy O, Bauersachs J, Bhatt DL, Dendale P, Dorobantu M, Edvardsen T, Folliguet T, Gale CP, Gilard M, Jobs A, Jüni P, Lambrinou E, Lewis BS, Mehilli J, Meliga E, Merkely B, Mueller C, Roffi M, Rutten FH, Sibbing D, Siontis GC. Guía ESC 2020 sobre el diagnóstico y tratamiento del síndrome coronario agudo sin elevación del segmento ST. Rev Esp Cardiol (Engl Ed) 2021. [DOI: 10.1016/j.recesp.2020.12.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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31
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Tkacheva ON, Kotovskaya YV, Runihina NK, Frolova EV, Milto AS, Aleksanyan LA, Tyukhmenev EA, Shedrina AY, Rozanov AV, Ostapenko VS, Sharashkina NV, Eruslanova KA, Esenbekova EE, Fedin MA. Comprehensive geriatric assessment in elderly and senile patients with cardiovascular diseases. Expert opinion of the Russian Association of Gerontologists and Geriatricians. ACTA ACUST UNITED AC 2021; 61:71-78. [PMID: 34112078 DOI: 10.18087/cardio.2021.5.n1349] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 09/01/2020] [Indexed: 11/18/2022]
Abstract
Senile asthenia syndrome (SAS) is a geriatric syndrome characterized by age-associated decline of the physiological reserve and function in multiple systems, which results in higher vulnerability to effects of endo- and exogenous factors and a high risk of unfavorable outcomes, loss of self-sufficiency, and death. Generally, SAS is observed in elderly patients with comorbidities. In cardiovascular diseases, SAS is associated with a poor prognosis, including a higher incidence of exacerbation and death both during acute events and in chronic disease. However, SAS is often not taken into account in developing diagnostic and therapeutic programs for managing elderly patients with cardiovascular diseases (CVD). This article analyzes available scientific information about SAS, algorithms for SAS diagnosis, and the scales that may be useful in developing individual plans for management of elderly patients with CVD.
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Affiliation(s)
- O N Tkacheva
- Pirogov Russian National Research Medical University, Russian Gerintology Research and Clinical Centre, Moscow, Russia
| | - Yu V Kotovskaya
- Pirogov Russian National Research Medical University, Russian Gerintology Research and Clinical Centre, Moscow, Russia
| | - N K Runihina
- Pirogov Russian National Research Medical University, Russian Gerintology Research and Clinical Centre, Moscow, Russia
| | - E V Frolova
- North-Western State Medical University named after I.I. Mechnikov
| | - A S Milto
- Moscow Regional Research and Clinical Institute (MONIKI) named after M.F. Vladimirskogo
| | - L A Aleksanyan
- Pirogov Russian National Research Medical University, Russian Gerintology Research and Clinical Centre, Moscow, Russia
| | - E A Tyukhmenev
- Moscow Regional Research and Clinical Institute (MONIKI) named after M.F. Vladimirskogo
| | - A Yu Shedrina
- Pirogov Russian National Research Medical University, Russian Gerintology Research and Clinical Centre, Moscow, Russia
| | - A V Rozanov
- Pirogov Russian National Research Medical University, Russian Gerintology Research and Clinical Centre, Moscow, Russia
| | - V S Ostapenko
- Pirogov Russian National Research Medical University, Russian Gerintology Research and Clinical Centre, Moscow, Russia
| | - N V Sharashkina
- Pirogov Russian National Research Medical University, Russian Gerintology Research and Clinical Centre, Moscow, Russia
| | - K A Eruslanova
- Pirogov Russian National Research Medical University, Russian Gerintology Research and Clinical Centre, Moscow, Russia
| | - E E Esenbekova
- Pirogov Russian National Research Medical University, Russian Gerintology Research and Clinical Centre, Moscow, Russia
| | - M A Fedin
- Pirogov Russian National Research Medical University, Russian Gerintology Research and Clinical Centre, Moscow, Russia
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Giallauria F, Di Lorenzo A, Venturini E, Pacileo M, D’Andrea A, Garofalo U, De Lucia F, Testa C, Cuomo G, Iannuzzo G, Gentile M, Nugara C, Sarullo FM, Marinus N, Hansen D, Vigorito C. Frailty in Acute and Chronic Coronary Syndrome Patients Entering Cardiac Rehabilitation. J Clin Med 2021; 10:1696. [PMID: 33920796 PMCID: PMC8071180 DOI: 10.3390/jcm10081696] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 04/09/2021] [Accepted: 04/12/2021] [Indexed: 12/18/2022] Open
Abstract
Worldwide population ageing is partly due to advanced standard of care, leading to increased incidence and prevalence of geriatric syndromes such as frailty and disability. Hence, the age at the onset of acute coronary syndromes (ACS) keeps growing as well. Moreover, ageing is a risk factor for both frailty and cardiovascular disease (CVD). Frailty and CVD in the elderly share pathophysiological mechanisms and associated conditions, such as malnutrition, sarcopenia, anemia, polypharmacy and both increased bleeding/thrombotic risk, leading to a negative impact on outcomes. In geriatric populations ACS is associated with an increased frailty degree that has a negative effect on re-hospitalization and mortality outcomes. Frail elderly patients are increasingly referred to cardiac rehabilitation (CR) programs after ACS; however, plans of care must be tailored on individual's clinical complexity in terms of functional capacity, nutritional status and comorbidities, cognitive status, socio-economic support. Completing rehabilitative intervention with a reduced frailty degree, disability prevention, improvement in functional state and quality of life and reduction of re-hospitalization are the goals of CR program. Tools for detecting frailty and guidelines for management of frail elderly patients post-ACS are still debated. This review focused on the need of an early identification of frail patients in elderly with ACS and at elaborating personalized plans of care and secondary prevention in CR setting.
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Affiliation(s)
- Francesco Giallauria
- Department of Translational Medical Sciences, “Federico II” University of Naples, 80131 Naples, Italy; (A.D.L.); (U.G.); (F.D.L.); (C.T.); (G.C.); (C.V.)
| | - Anna Di Lorenzo
- Department of Translational Medical Sciences, “Federico II” University of Naples, 80131 Naples, Italy; (A.D.L.); (U.G.); (F.D.L.); (C.T.); (G.C.); (C.V.)
| | - Elio Venturini
- Cardiac Rehabilitation Unit, Azienda USL Toscana Nord-Ovest, Cecina Civil Hospital, 57023 Cecina (LI), Italy;
| | - Mario Pacileo
- Division of Cardiology/UTIC, “Umberto I” Hospital, Nocera Inferiore (ASL Salerno), 84014 Nocera Inferiore (SA), Italy; (M.P.); (A.D.)
| | - Antonello D’Andrea
- Division of Cardiology/UTIC, “Umberto I” Hospital, Nocera Inferiore (ASL Salerno), 84014 Nocera Inferiore (SA), Italy; (M.P.); (A.D.)
- Division of Cardiology, “Luigi Vanvitelli” University of Naples, 80131 Naples, Italy
| | - Umberto Garofalo
- Department of Translational Medical Sciences, “Federico II” University of Naples, 80131 Naples, Italy; (A.D.L.); (U.G.); (F.D.L.); (C.T.); (G.C.); (C.V.)
| | - Felice De Lucia
- Department of Translational Medical Sciences, “Federico II” University of Naples, 80131 Naples, Italy; (A.D.L.); (U.G.); (F.D.L.); (C.T.); (G.C.); (C.V.)
| | - Crescenzo Testa
- Department of Translational Medical Sciences, “Federico II” University of Naples, 80131 Naples, Italy; (A.D.L.); (U.G.); (F.D.L.); (C.T.); (G.C.); (C.V.)
| | - Gianluigi Cuomo
- Department of Translational Medical Sciences, “Federico II” University of Naples, 80131 Naples, Italy; (A.D.L.); (U.G.); (F.D.L.); (C.T.); (G.C.); (C.V.)
| | - Gabriella Iannuzzo
- Department of Clinical Medicine and Surgery, “Federico II” University of Naples, 80131 Naples, Italy; (G.I.); (M.G.)
| | - Marco Gentile
- Department of Clinical Medicine and Surgery, “Federico II” University of Naples, 80131 Naples, Italy; (G.I.); (M.G.)
| | - Cinzia Nugara
- Cardiovascular Rehabilitation Unit, Buccheri La Ferla Fatebenefratelli Hospital, 90123 Palermo, Italy; (C.N.); (F.M.S.)
| | - Filippo M Sarullo
- Cardiovascular Rehabilitation Unit, Buccheri La Ferla Fatebenefratelli Hospital, 90123 Palermo, Italy; (C.N.); (F.M.S.)
| | - Nastasia Marinus
- REVAL-Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, BE3590 Diepenbeek, Belgium; (N.M.); (D.H.)
- BIOMED-Biomedical Research Center, Hasselt University, BE3590 Diepenbeek, Belgium
| | - Dominique Hansen
- REVAL-Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, BE3590 Diepenbeek, Belgium; (N.M.); (D.H.)
- BIOMED-Biomedical Research Center, Hasselt University, BE3590 Diepenbeek, Belgium
- Heart Centre Hasselt, Jessa Hospital, BE3500 Hasselt, Belgium
| | - Carlo Vigorito
- Department of Translational Medical Sciences, “Federico II” University of Naples, 80131 Naples, Italy; (A.D.L.); (U.G.); (F.D.L.); (C.T.); (G.C.); (C.V.)
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Collet JP, Thiele H, Barbato E, Barthélémy O, Bauersachs J, Bhatt DL, Dendale P, Dorobantu M, Edvardsen T, Folliguet T, Gale CP, Gilard M, Jobs A, Jüni P, Lambrinou E, Lewis BS, Mehilli J, Meliga E, Merkely B, Mueller C, Roffi M, Rutten FH, Sibbing D, Siontis GCM. 2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. Eur Heart J 2021; 42:1289-1367. [PMID: 32860058 DOI: 10.1093/eurheartj/ehaa575] [Citation(s) in RCA: 2739] [Impact Index Per Article: 913.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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Chung KJNC, Wilkinson C, Veerasamy M, Kunadian V. Frailty Scores and Their Utility in Older Patients with Cardiovascular Disease. ACTA ACUST UNITED AC 2021; 16:e05. [PMID: 33897831 PMCID: PMC8054346 DOI: 10.15420/icr.2020.18] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 12/09/2020] [Indexed: 12/13/2022]
Abstract
The world’s population is ageing, resulting in more people with frailty receiving treatment for cardiovascular disease (CVD). The emergence of novel interventions, such as transcatheter aortic valve implantation, has also increased the proportion of older patients being treated in later stages of life. This increasing population burden makes the assessment of frailty of utmost importance, especially in patients with CVD. Despite a growing body of evidence on the association between frailty and CVD, there is no consensus on the optimal frailty assessment tool for use in clinical settings. Previous studies have shown limited concordance between validated frailty instruments. This review evaluates the evidence on the utility of frailty assessment tools in patients with CVD, and the effect of frailty on different outcomes measured.
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Affiliation(s)
- Kenneth Jordan Ng Cheong Chung
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University Newcastle upon Tyne, UK.,Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundations Trust Newcastle upon Tyne, UK
| | - Chris Wilkinson
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University Newcastle upon Tyne, UK
| | - Murugapathy Veerasamy
- Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust Leeds, UK.,Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds UK
| | - Vijay Kunadian
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University Newcastle upon Tyne, UK.,Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundations Trust Newcastle upon Tyne, UK
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Sanchis J, Ruiz V, Sastre C, Bonanad C, Ruescas A, Fernández-Cisnal A, Mollar A, Valero E, Blas SG, González J, Pernias V, Miñana G, Núñez J, Ariza-Solé A. Frailty Tools for Assessment of Long-term Prognosis After Acute Coronary Syndrome. Mayo Clin Proc Innov Qual Outcomes 2020; 4:642-648. [PMID: 33367209 PMCID: PMC7749270 DOI: 10.1016/j.mayocpiqo.2020.06.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Objective To evaluate the 5 components of the Fried frailty phenotype (self-reported unintentional weight loss, physical activity questionnaire, gait speed, grip strength, and self-reported exhaustion) for long-term outcomes in elderly survivors of acute coronary syndrome. Methods A total of 342 consecutive patients (from October 1, 2010, to February 1, 2012) were included. The 5 components of the Fried score and albumin concentration, as malnutrition index, were assessed before hospital discharge. Patients were followed up until April 2020 (median follow-up, 8.7 years). The end point was postdischarge all-cause mortality. Results Mean ± SD age was 77±7 years and mean ± SD Fried score was 2.0±1.1 points. A total of 216 (63%) patients died. After adjusting for clinical covariates, the Fried phenotype was associated with mortality (per points, hazard ratio [HR], 1.35; 95% CI, 1.17 to 1.57; P<.001). Among Fried components, physical activity (HR, 2.21; 95% CI, 1.34 to 3.65; P=.002) and gait speed (HR, 1.77; 95% CI, 1.29 to 2.43; P<.001) were the deficits independendtly associated with mortality. Albumin level provided further prognostic information (per increase in g/dL; HR, 0.63, 95% CI, 0.45 to 0.88; P=.007). The model adding the components of the Fried score and albumin level to the clinical model showed the highest risk reclassification (integrated discrimination improvement, 0.040; 95% CI, 0.018 to 0.075; P=.001; continuous net reclassification improvement, 0.291; 95% CI, 0.132 to 0.397; P=.001) in comparison with the model using clinical covariates alone. Conclusion Frailty assessment using the Fried phenotype has prognostic value for long-term mortality in elderly survivors of acute coronary syndrome. Physical activity and gait speed are the predictive components of the Fried score. Albumin level provides incremental prognostic information.
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Affiliation(s)
- Juan Sanchis
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, Universidad de Valencia, Valencia, Spain
| | - Vicent Ruiz
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, Universidad de Valencia, Valencia, Spain
| | - Clara Sastre
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, Universidad de Valencia, Valencia, Spain
| | - Clara Bonanad
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, Universidad de Valencia, Valencia, Spain
| | - Arancha Ruescas
- Departamento de Fisioterapia, Universidad de Valencia, Valencia, Spain
| | - Agustín Fernández-Cisnal
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, Universidad de Valencia, Valencia, Spain
| | - Anna Mollar
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, Universidad de Valencia, Valencia, Spain
| | - Ernesto Valero
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, Universidad de Valencia, Valencia, Spain
| | - Sergio García Blas
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, Universidad de Valencia, Valencia, Spain
| | - Jessika González
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, Universidad de Valencia, Valencia, Spain
| | - Vicente Pernias
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, Universidad de Valencia, Valencia, Spain
| | - Gema Miñana
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, Universidad de Valencia, Valencia, Spain
| | - Julio Núñez
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, Universidad de Valencia, Valencia, Spain
| | - Albert Ariza-Solé
- Servicio de Cardiología, Hospital Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
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Hanlon P, Butterly E, Lewsey J, Siebert S, Mair FS, McAllister DA. Identifying frailty in trials: an analysis of individual participant data from trials of novel pharmacological interventions. BMC Med 2020; 18:309. [PMID: 33087107 PMCID: PMC7579922 DOI: 10.1186/s12916-020-01752-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 08/18/2020] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Frailty is common in clinical practice, but trials rarely report on participant frailty. Consequently, clinicians and guideline-developers assume frailty is largely absent from trials and have questioned the relevance of trial findings to frail people. Therefore, we examined frailty in phase 3/4 industry-sponsored clinical trials of pharmacological interventions for three exemplar conditions: type 2 diabetes mellitus (T2DM), rheumatoid arthritis (RA), and chronic obstructive pulmonary disease (COPD). METHODS We constructed a 40-item frailty index (FI) in 19 clinical trials (7 T2DM, 8 RA, 4 COPD, mean age 42-65 years) using individual-level participant data. Participants with a FI > 0.24 were considered 'frail'. Baseline disease severity was assessed using HbA1c for T2DM, Disease Activity Score-28 (DAS28) for RA, and % predicted FEV1 for COPD. Using generalised gamma regression, we modelled FI on age, sex, and disease severity. In negative binomial regression, we modelled serious adverse event rates on FI and combined results for each index condition in a random-effects meta-analysis. RESULTS All trials included frail participants: prevalence 7-21% in T2DM trials, 33-73% in RA trials, and 15-22% in COPD trials. The 99th centile of the FI ranged between 0.35 and 0.45. Female sex was associated with higher FI in all trials. Increased disease severity was associated with higher FI in RA and COPD, but not T2DM. Frailty was associated with age in T2DM and RA trials, but not in COPD. Across all trials, and after adjusting for age, sex, and disease severity, higher FI predicted increased risk of serious adverse events; the pooled incidence rate ratios (per 0.1-point increase in FI scale) were 1.46 (95% CI 1.21-1.75), 1.45 (1.13-1.87), and 1.99 (1.43-2.76) for T2DM, RA, and COPD, respectively. CONCLUSION The upper limit of frailty in trials is lower than has been described in the general population. However, mild to moderate frailty was common, suggesting trial data may be harnessed to inform disease management in people living with frailty. Participants with higher FI experienced more serious adverse events, suggesting screening for frailty in trial participants would enable identification of those that merit closer monitoring. Frailty is identifiable and prevalent among middle-aged and older participants in phase 3/4 drug trials and has clinically important safety implications.
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Affiliation(s)
- Peter Hanlon
- Institute of Health and Wellbeing, University of Glasgow, 1 Lilybank Gardens, Glasgow, G12 8RZ, UK
| | - Elaine Butterly
- Institute of Health and Wellbeing, University of Glasgow, 1 Lilybank Gardens, Glasgow, G12 8RZ, UK
| | - Jim Lewsey
- Institute of Health and Wellbeing, University of Glasgow, 1 Lilybank Gardens, Glasgow, G12 8RZ, UK
| | - Stefan Siebert
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK
| | - Frances S Mair
- Institute of Health and Wellbeing, University of Glasgow, 1 Lilybank Gardens, Glasgow, G12 8RZ, UK
| | - David A McAllister
- Institute of Health and Wellbeing, University of Glasgow, 1 Lilybank Gardens, Glasgow, G12 8RZ, UK.
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Li F, Li D, Yu J, Jia Y, Jiang Y, Chen T, Gao Y, Wan Z, Cao Y, Zeng Z, Zeng R. Barthel Index as a Predictor of Mortality in Patients with Acute Coronary Syndrome: Better Activities of Daily Living, Better Prognosis. Clin Interv Aging 2020; 15:1951-1961. [PMID: 33116449 PMCID: PMC7568594 DOI: 10.2147/cia.s270101] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 08/27/2020] [Indexed: 02/05/2023] Open
Abstract
Background The Barthel index (BI) is a widely used assessment tool for evaluating physical performance in activities of daily living (ADL). The association between BI scores and mortality in hospital and during follow-up of acute coronary syndrome (ACS) patients remains unclear. The present study investigated whether the BI score could be used as a predictor for mortality of ACS. Methods We investigated ACS patients from the multi-center Retrospective Evaluation of Acute Chest Pain (REACP) study. The association between BI scores and all-cause mortality of patients with ACS was analyzed by Cox proportional hazards models. The primary endpoint was all-cause death and the secondary endpoint was cardiac death during follow-up. Results Among 2908 patients with ACS enrolled, 277 (9.5%) patients died within a median follow-up time of 10.6 months. Patients with lower BI had higher risks of mortality, compared with those with higher BI in ACS patients. Kaplan–Meier analysis revealed that patients with lower BI had worse survival rates than patients with higher BI (P < 0.001). After adjustment for potential influencing factors, multivariate Cox regression analysis showed that the BI was independently associated with all-cause mortality and cardiac mortality, respectively. Conclusion The BI at admission has the powerful potential to provide useful prognostic information of early risk stratification, and routine recording of the BI at the ED visit may help in decision-making and health care planning for patients with ACS.
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Affiliation(s)
- Fanghui Li
- Department of Emergency Medicine and Laboratory of Emergency Medicine, Deep Underground Space Medical Center, West China Hospital, and Disaster Medical Center, Sichuan University, Chengdu, People's Republic of China
| | - Dongze Li
- Department of Emergency Medicine and Laboratory of Emergency Medicine, Deep Underground Space Medical Center, West China Hospital, and Disaster Medical Center, Sichuan University, Chengdu, People's Republic of China
| | - Jing Yu
- West China School of Nursing, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Yu Jia
- Department of Emergency Medicine and Laboratory of Emergency Medicine, Deep Underground Space Medical Center, West China Hospital, and Disaster Medical Center, Sichuan University, Chengdu, People's Republic of China
| | - Ying Jiang
- Department of Emergency Medicine and Laboratory of Emergency Medicine, Deep Underground Space Medical Center, West China Hospital, and Disaster Medical Center, Sichuan University, Chengdu, People's Republic of China
| | - Tengda Chen
- Department of Emergency Medicine and Laboratory of Emergency Medicine, Deep Underground Space Medical Center, West China Hospital, and Disaster Medical Center, Sichuan University, Chengdu, People's Republic of China
| | - Yongli Gao
- Department of Emergency Medicine and Laboratory of Emergency Medicine, Deep Underground Space Medical Center, West China Hospital, and Disaster Medical Center, Sichuan University, Chengdu, People's Republic of China
| | - Zhi Wan
- Department of Emergency Medicine and Laboratory of Emergency Medicine, Deep Underground Space Medical Center, West China Hospital, and Disaster Medical Center, Sichuan University, Chengdu, People's Republic of China
| | - Yu Cao
- Department of Emergency Medicine and Laboratory of Emergency Medicine, Deep Underground Space Medical Center, West China Hospital, and Disaster Medical Center, Sichuan University, Chengdu, People's Republic of China
| | - Zhi Zeng
- Department of Emergency Medicine and Laboratory of Emergency Medicine, Deep Underground Space Medical Center, West China Hospital, and Disaster Medical Center, Sichuan University, Chengdu, People's Republic of China
| | - Rui Zeng
- Department of Emergency Medicine and Laboratory of Emergency Medicine, Deep Underground Space Medical Center, West China Hospital, and Disaster Medical Center, Sichuan University, Chengdu, People's Republic of China.,Department of Cardiology, West China Hospital, Sichuan University, Chengdu, People's Republic of China
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Zhang S, Meng H, Chen Q, Wang X, Zou J, Hao Q, Yang M, Wu J. Is frailty a prognostic factor for adverse outcomes in older patients with acute coronary syndrome? Aging Clin Exp Res 2020; 32:1435-1442. [PMID: 31489598 DOI: 10.1007/s40520-019-01311-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 08/06/2019] [Indexed: 02/05/2023]
Abstract
BACKGROUND There is very limited guidance in regard to how biological age should be estimated and how different comorbidity conditions influence the benefit-risk ration of interventions. Frailty is an important health-related problem in patients, especially in older adults. It is a reflection of biologic rather than chronologic age; frailty may explain why there remains substantial heterogeneity in clinical outcomes within the older patients' population. AIMS We aimed to review the prognostic value of frailty for adverse outcomes in older patients with acute coronary syndrome (ACS). METHODS Studies published until December 31, 2018, identified by systematic Medline, Embase, and Cochrane Controlled Register of Trials (CENTRAL) searches were reviewed for the association between frailty and mortality in older patients with ACS. We used the Newcastle-Ottawa Quality Assessment Scale to assess the quality of the included studies. We extracted the information of hazard ratios (HR) and odds ratios (OR) with accompanying 95% confidence intervals (CI), and P values of multivariable analysis. Heterogeneity across studies was determined using the Cochran Q value by Review Manager 5.3. RESULTS A total of 11 articles involving 7212 patients were included in this meta-analysis. Two studies (Sujino, Y 2015 and Alonso, S.GL 2016; n = 264) reported that frailty was significantly associated with in-hospital mortality in patients with ACS (range of reported OR between 6.38 and 12.0). We performed a subgroup analysis of the other nine studies based on differences in the follow-up time. Pooled meta-analysis demonstrates that frailty was associated with short-term, medium-term, and long-term mortality (HR = 3.67, 4.09, 1.66). There was no association between frailty and bleeding in older patients with ACS. CONCLUSIONS Frailty measured by Canadian Study of Health and Aging Clinical Frailty Scale (CSHA-CFS), the Edmonton Frail Scale (EFS), Fried score, Green scores, frailty instrument from the Survey of Health, Ageing and Retirement in Europe (SHARE-FI) index, and FRAIL (Fatigue, Resistance, Ambulation, Illnesses, Loss of weight) scale, leads to significantly higher mortality rates in older patients with ACS.
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Affiliation(s)
- Shaomin Zhang
- The Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, 610041, China
| | | | - Qian Chen
- The Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Xiaoling Wang
- The Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Jiatong Zou
- The Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Qiukui Hao
- The Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Ming Yang
- The Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, 610041, China.
| | - Jinhui Wu
- The Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, 610041, China.
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Enhancing Functional Risk Stratification in Contemporary Cardiac Rehabilitation: RESPONDING TO PATIENTS WHO ARE INCREASINGLY OLDER AND MORE PHYSICALLY IMPAIRED. J Cardiopulm Rehabil Prev 2020; 40:394-398. [PMID: 32604217 DOI: 10.1097/hcr.0000000000000498] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
PURPOSE Current American Association of Cardiovascular and Pulmonary Rehabilitation guidelines rely primarily on cardiovascular disease (CVD)-centered metrics to stratify risk and guide care. Yet, contemporary CVD patients are often older and are more likely to have risks attributable to rudimentary functional impairments that can have disproportionate bearing on management and prognosis. In this study, we stratified risk using novel indices of physical function as well as traditional indices of CVD in patients enrolling in phase II cardiac rehabilitation (CR). We hypothesized that risk stratification (RS) using functional criteria would be nonconcordant with CVD RS in a significant number of patients, thus inferring the conceptual value of CR management priorities that are better tailored for distinctive functional risks in many patients. METHODS This was a retrospective analysis of a comprehensive quality improvement database with 489 patients. Risk stratification using novel functional indices (ie, gait speed, Timed Up and Go, hand grip, sit to stand, tandem stand, and a 6-min walk test) was compared with RS using traditional CVD criteria. RESULTS Using functional RS, 97 patients were determined to be high risk versus 235 at low risk. Using CVD RS in the same cohort, 227 patients had high risk versus 161 who had low risk. Functional RS was consistent with CVD RS only 42.9% of the time. CONCLUSION Functional RS and CVD RS varied in the same patients. Enhanced assessment of functional risks adds important prognostic refinement and greater potential to tailor exercise therapy, nutrition, and other CR caregiving priorities.
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Association of frailty with all-cause mortality and bleeding among elderly patients with acute myocardial infarction: a systematic review and meta-analysis. JOURNAL OF GERIATRIC CARDIOLOGY : JGC 2020; 17:270-278. [PMID: 32547610 PMCID: PMC7276305 DOI: 10.11909/j.issn.1671-5411.2020.05.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Background Frailty is a multidimensional syndrome that reflects the physiological reserve of elderly. It is related to unfavorable outcomes in various cardiovascular conditions. We conducted a systematic review and meta-analysis of the association of frailty with all-cause mortality and bleeding after acute myocardial infarction (AMI) in the elderly. Methods We comprehensively searched the databases of MEDLINE and EMBASE from inception to March 2019. The studies that reported mortality and bleeding in AMI patients who were evaluated and classified by frailty status were included. Data from each study were combined using the random-effects, generic inverse variance method of DerSimonian and Laird to calculate hazard ratio (HR), and 95% confidence interval (CI). Results Twenty-one studies from 2011 to 2019 were included in this meta-analysis involving 143,301 subjects (mean age 75.33-year-old, 60.0% male). Frailty status was evaluated using different methods such as Fried Frailty Index. Frailty was statistically associated with increased early mortality in nine studies (pooled HR = 2.07, 95% CI: 1.67–2.56, P < 0.001, I2 = 41.2%) and late mortality in 11 studies (pooled HR = 2.30, 95% CI: 1.70–3.11, P < 0.001, I2 = 65.8%). Moreover, frailty was also statistically associated with higher bleeding in 7 studies (pooled HR = 1.34, 95% CI: 1.12–1.59, P < 0.001, I2 = 4.7%). Conclusion Frailty is strongly and independently associated with bleeding, early and late mortality in elderly with AMI. Frailty assessment should be considered as an additional risk factor and used to guide toward personalized treatment strategies.
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FRAIL Scale also Predicts Long-Term Outcomes in Older Patients With Acute Coronary Syndromes. J Am Med Dir Assoc 2020; 21:683-687.e1. [DOI: 10.1016/j.jamda.2019.10.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 10/02/2019] [Accepted: 10/06/2019] [Indexed: 11/23/2022]
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Liu Y, Liu S, Wang K, Liu H. Association of Frailty With Antiplatelet Response Among Elderly Chinese Patients With Coronary Artery Disease Undergoing Percutaneous Coronary Intervention. Clin Appl Thromb Hemost 2020; 26:1076029620915994. [PMID: 32348163 PMCID: PMC7288840 DOI: 10.1177/1076029620915994] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Frailty has been implicated as a prognostic factor for ischemic cardiovascular diseases. However, the effects of frailty on platelet responses to aspirin and clopidogrel remain under investigation. In this study, we enrolled consecutive elderly patients with coronary artery disease (CAD) who were treated by percutaneous coronary intervention (PCI) to evaluate this association. A total of 264 patients (aged 70-95 years) were included. Patients were divided into 2 groups: a nonfrail (nFR) group and a frail (FR) group according to the Clinical Frailty Scale. Platelet reactivity was assessed with a light transmittance aggregometry method, and arachidonic acid and adenosine diphosphate induced maximum platelet aggregation (AA-MPA/ADP-MPA) were calculated to evaluate the platelet response to aspirin and clopidogrel. The results showed that the AA-MPA and ADP-MPA of the FR group were significantly higher than those in the nFR group (17.49 ± 6.65 vs 15.19 ± 6.33, P < .01; 56.13 ± 10.14 vs 45.45 ± 11.59, P < .01). High on-aspirin platelet response (HAPR) and high on-clopidogrel platelet response (HCPR) were significantly more common in the FR group than in the nFR group (24.67% vs 13.16%, P = .028, 37.33% vs 15.79%, P < .01). According to multivariable regression analyses, frailty was found to be independently associated with AA-MPA (βcoefficient = 1.883, P = .042) and ADP-MPA (βcoefficient = 9.287, P < .001), and it was an independent predictor of HAPR (odds ratio [OR]: 2.696, P < .01) and HCPR (OR: 2.543, P < .01). It was concluded that among elderly patients with CAD undergoing PCI, frailty is an independent predictor of HAPR and HCPR, and the state of frailty is independently associated with the platelet responses to clopidogrel and aspirin.
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Affiliation(s)
- Yang Liu
- Medical School of Chinese People's Liberation Army, Beijing, China.,Department of Cardiology, The 2nd Medical Center of Chinese People's Liberation Army General Hospital, Beijing, China
| | - Shaoyan Liu
- Department of Cardiology, Laiyang Central Hospital, Yantai, China
| | - Keyu Wang
- Clinical Laboratory, The 2nd Medical Center of Chinese People's Liberation Army General Hospital, Beijing, China
| | - Hongbin Liu
- Medical School of Chinese People's Liberation Army, Beijing, China.,Department of Cardiology, The 2nd Medical Center of Chinese People's Liberation Army General Hospital, Beijing, China
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Xu W, Cai Y, Liu H, Fan L, Wu C. Frailty as a predictor of all-cause mortality and readmission in older patients with acute coronary syndrome : A systematic review and meta-analysis. Wien Klin Wochenschr 2020; 132:301-309. [PMID: 32342196 DOI: 10.1007/s00508-020-01650-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 03/28/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND Evidence from longitudinal studies linking frailty and outcome after acute coronary syndrome (ACS) is mixed. This systematic review and meta-analysis aimed to examine whether frailty is a predictor of all-cause mortality and hospital readmission in older patients with ACS. METHODS A systematic search was carried out in PubMed, EMBASE and Web of Science databases for studies evaluating the association between frailty and outcomes in older patients with ACS. A meta-analysis was performed to determine the pooled effect estimate for the association between frailty and mortality and hospital readmission, respectively. RESULTS A total of 1459 articles were retrieved based on our search strategy. Fifteen studies involving 10,245 patients were included in the meta-analysis. The pooled prevalence of frailty was 32% (95% confidence interval [CI]: 25-39%), and the pooled prevalence of pre-frailty was 33% (95% CI: 26-40%) in elderly patients with ACS. Pooled analyses showed that frailty was associated with significantly higher risk of all-cause mortality and readmission (hazard ratios [HRs] = 2.43 and 2.32, respectively). Pre-frailty was also associated with significantly higher risk of all-cause mortality and readmission, respectively (HRs = 1.55 and 1.34, respectively). CONCLUSIONS Both frailty and pre-frailty are risk factors for all-cause mortality and readmission in older patients with ACS. Therefore, frailty assessment should be given sufficient attention in the management of older patients with ACS to help improve survival and reduce readmission rate.
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Affiliation(s)
- Weihao Xu
- Geriatric Cardiology Department of The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, 100853, Beijing, China
| | - Yulun Cai
- Geriatric Cardiology Department of The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, 100853, Beijing, China
| | - Hongbin Liu
- Geriatric Cardiology Department of The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, 100853, Beijing, China.
| | - Li Fan
- Geriatric Cardiology Department of The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, 100853, Beijing, China.
| | - Chenkai Wu
- Global Health Research Center, Duke Kunshan University, 215316, Kunshan, Jiangsu, China. .,Duke Global Health Institute, Duke University, Durham, NC, USA.
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Nishihira K, Yoshioka G, Kuriyama N, Ogata K, Kimura T, Matsuura H, Furugen M, Koiwaya H, Watanabe N, Shibata Y. Impact of frailty on outcomes in elderly patients with acute myocardial infarction who undergo percutaneous coronary intervention. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2020; 7:189-197. [DOI: 10.1093/ehjqcco/qcaa018] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 02/16/2020] [Accepted: 02/29/2020] [Indexed: 12/18/2022]
Abstract
Abstract
Aims
Frailty is characterized by reduced biological reserves and weakened resistance to stressors, and is common in older adults. This study evaluated the prognostic implications of frailty at hospitalization in elderly patients with acute myocardial infarction (AMI) who undergo percutaneous coronary intervention (PCI).
Methods and results
We prospectively analysed 546 AMI patients aged ≥80 years undergoing PCI from 2009 to 2017. Frailty was classified based on impairment in walking (unassisted, assisted, and wheelchair/non-ambulatory), cognition (normal, mildly impaired, moderately to severely impaired), and basic activities of daily living. Impairment in each domain was scored as 0, 1, or 2, and patients were categorized into the following three groups based on total score: no frailty (0), mild frailty (1–2), moderate-to-severe frailty (≥3). The median follow-up period was 589 days. Of the 546 patients, 27.8% were frail (mild or moderate-to-severe), and this proportion significantly increased to 35.5% at discharge (P < 0.001). Compared to non-frail patients, frail patients were older, less likely to be male, and had a higher rate of advanced Killip class. Major bleeding (no frailty, 9.6%; mild frailty, 16.9%; moderate-to-severe frailty, 31.8%; P < 0.001) and in-hospital mortality (no frailty, 8.4%; mild frailty, 15.4%; moderate-to-severe frailty, 27.3%; P < 0.001) increased as frailty worsened. After adjusting for confounders, frailty was independently associated with higher mid-term all-cause mortality (hazard ratio, 1.81; 95% confidence interval, 1.23–2.65; P = 0.002).
Conclusion
Frailty in AMI patients aged ≥80 years undergoing PCI was associated with major bleeding, in-hospital death, and mid-term mortality.
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Affiliation(s)
- Kensaku Nishihira
- Department of Cardiology, Miyazaki Medical Association Hospital, 738-1 Funado, Shinbeppu-cho, Miyazaki 880-0834, Japan
- Department of Cardiovascular Medicine, Faculty of Medicine, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki 889-1692, Japan
| | - Goro Yoshioka
- Department of Cardiology, Miyazaki Medical Association Hospital, 738-1 Funado, Shinbeppu-cho, Miyazaki 880-0834, Japan
| | - Nehiro Kuriyama
- Department of Cardiology, Miyazaki Medical Association Hospital, 738-1 Funado, Shinbeppu-cho, Miyazaki 880-0834, Japan
| | - Kenji Ogata
- Department of Cardiology, Miyazaki Medical Association Hospital, 738-1 Funado, Shinbeppu-cho, Miyazaki 880-0834, Japan
| | - Toshiyuki Kimura
- Department of Cardiology, Miyazaki Medical Association Hospital, 738-1 Funado, Shinbeppu-cho, Miyazaki 880-0834, Japan
| | - Hirohide Matsuura
- Department of Cardiology, Miyazaki Medical Association Hospital, 738-1 Funado, Shinbeppu-cho, Miyazaki 880-0834, Japan
| | - Makoto Furugen
- Department of Cardiology, Miyazaki Medical Association Hospital, 738-1 Funado, Shinbeppu-cho, Miyazaki 880-0834, Japan
| | - Hiroshi Koiwaya
- Department of Cardiology, Miyazaki Medical Association Hospital, 738-1 Funado, Shinbeppu-cho, Miyazaki 880-0834, Japan
| | - Nozomi Watanabe
- Department of Cardiology, Miyazaki Medical Association Hospital, 738-1 Funado, Shinbeppu-cho, Miyazaki 880-0834, Japan
| | - Yoshisato Shibata
- Department of Cardiology, Miyazaki Medical Association Hospital, 738-1 Funado, Shinbeppu-cho, Miyazaki 880-0834, Japan
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Relation of Low Lymphocyte Count to Frailty and its Usefulness as a Prognostic Biomarker in Patients >65 Years of Age With Acute Coronary Syndrome. Am J Cardiol 2020; 125:1033-1038. [PMID: 31959430 DOI: 10.1016/j.amjcard.2020.01.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 01/02/2020] [Accepted: 01/03/2020] [Indexed: 12/26/2022]
Abstract
Low lymphocyte count, as a marker of inflammation and immunosuppression, may be useful for identifying frail patients. In this work, we aimed to evaluate the association between low-relative lymphocyte count (Lymph%) and frailty status in patients >65 years old with acute coronary syndromes (ACS), and whether Lymph% is associated with morbimortality beyond standard prognosticators and frailty. In this prospective observational study, we included 488 hospital survivors of an episode of an ACS >65 years old. Total and differential white blood cells and frailty status were assessed at discharge. Frailty was evaluated using the Fried score at discharge and defined as Fried≥3. The independent association between Lymph% and Fried≥3 was evaluated by multivariate logistic regression analysis. The associations between Lymph% with long-term all-cause mortality and recurrent admission were evaluated with Cox regression and shared frailty regression, respectively. The mean age of the sample was 78 ± 7 years and 41% were females. The median (interquartile range) of the Lymph% was 21% (15 to 27) and 41% showed Fried≥3. In multivariate analysis, Lymph% was inversely related to the odds of frailty with an exponential increase risk from values below 15% (p = 0.001). Likewise, Lymph% was inverse and independently associated with a higher risk of long-term mortality (p = 0.011), recurrent all-cause (p = 0.020), and cardiovascular readmissions (p = 0.024). In conclusion, in patients >65 years with a recent ACS, low Lymph% evaluated at discharge is associated with a higher risk of frailty. Low Lymph% was also associated with a higher risk of long-term mortality and recurrent admissions beyond standard prognosticators and Fried score.
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Anand A, Cudmore S, Robertson S, Stephen J, Haga K, Weir CJ, Murray SA, Boyd K, Gunn J, Iqbal J, MacLullich A, Shenkin SD, Fox KAA, Mills N, Denvir MA. Frailty assessment and risk prediction by GRACE score in older patients with acute myocardial infarction. BMC Geriatr 2020; 20:102. [PMID: 32164580 PMCID: PMC7069195 DOI: 10.1186/s12877-020-1500-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 02/28/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Risk prediction after myocardial infarction is often complex in older patients. The Global Registry of Acute Coronary Events (GRACE) model includes clinical parameters and age, but not frailty. We hypothesised that frailty would enhance the prognostic properties of GRACE. METHODS We performed a prospective observational cohort study in two independent cardiology units: the Royal Infirmary of Edinburgh, UK (primary cohort) and the South Yorkshire Cardiothoracic Centre, Sheffield, UK (external validation). The study sample included 198 patients ≥65 years old hospitalised with type 1 myocardial infarction (primary cohort) and 96 patients ≥65 years old undergoing cardiac catheterisation for myocardial infarction (external validation). Frailty was assessed using the Clinical Frailty Scale (CFS). The GRACE 2.0 estimated risk of 12-month mortality, Charlson comorbidity index and Karnofsky disability scale were also determined for each patient. RESULTS Forty (20%) patients were frail (CFS ≥5). These individuals had greater comorbidity, functional impairment and a higher risk of death at 12 months (49% vs. 9% in non-frail patients, p < 0.001). The hazard of 12-month all-cause mortality nearly doubled per point increase in CFS after adjustment for age, sex and comorbidity (Hazard Ratio [HR] 1.90, 95% CI 1.47-2.44, p < 0.001). The CFS had good discrimination for mortality by Receiver Operating Characteristic (ROC) curve analysis (Area Under the Curve [AUC] 0.81, 95% CI 0.72-0.89) and enhanced the GRACE estimate (AUC 0.86 vs. 0.80 without CFS, p = 0.04). At existing GRACE thresholds, the CFS resulted in a Net Reclassification Improvement (NRI) of 0.44 (95% CI 0.28-0.60, p < 0.001), largely through reductions in risk estimates amongst non-frail patients. Similar findings were observed in the external validation cohort (NRI 0.46, 95% CI 0.23-0.69, p < 0.001). CONCLUSIONS The GRACE score overestimated mortality risk after myocardial infarction in these cohorts of older patients. The CFS is a simple guided frailty tool that may enhance prediction in this setting. These findings merit evaluation in larger cohorts of unselected patients. TRIAL REGISTRATION Clinicaltrials.gov; NCT02302014 (November 26th 2014, retrospectively registered).
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Affiliation(s)
- Atul Anand
- BHF Centre for Cardiovascular Science, University of Edinburgh, Room SU.305 Chancellor's Building, Edinburgh, EH16 4SB, UK.
- Geriatric Medicine Research Group, University of Edinburgh, Edinburgh, UK.
| | - Sarah Cudmore
- Department of Cardiology, Edinburgh Heart Centre, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Shirley Robertson
- Department of Cardiology, Edinburgh Heart Centre, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Jacqueline Stephen
- Edinburgh Clinical Trials Unit, Usher Institute for Population Health Sciences and Informatics University of Edinburgh, Edinburgh, UK
| | - Kristin Haga
- Department of Cardiology, Edinburgh Heart Centre, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Christopher J Weir
- Edinburgh Clinical Trials Unit, Usher Institute for Population Health Sciences and Informatics University of Edinburgh, Edinburgh, UK
| | - Scott A Murray
- Primary Palliative Care Research Group, Usher Institute for Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Kirsty Boyd
- Primary Palliative Care Research Group, Usher Institute for Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Julian Gunn
- South Yorkshire Cardiothoracic Centre, Northern General Hospital, Sheffield, UK
| | - Javaid Iqbal
- South Yorkshire Cardiothoracic Centre, Northern General Hospital, Sheffield, UK
| | | | - Susan D Shenkin
- Geriatric Medicine Research Group, University of Edinburgh, Edinburgh, UK
| | - Keith A A Fox
- BHF Centre for Cardiovascular Science, University of Edinburgh, Room SU.305 Chancellor's Building, Edinburgh, EH16 4SB, UK
| | - Nicholas Mills
- BHF Centre for Cardiovascular Science, University of Edinburgh, Room SU.305 Chancellor's Building, Edinburgh, EH16 4SB, UK
| | - Martin A Denvir
- BHF Centre for Cardiovascular Science, University of Edinburgh, Room SU.305 Chancellor's Building, Edinburgh, EH16 4SB, UK
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Lunney M, Ruospo M, Natale P, Quinn RR, Ronksley PE, Konstantinidis I, Palmer SC, Tonelli M, Strippoli GF, Ravani P. Pharmacological interventions for heart failure in people with chronic kidney disease. Cochrane Database Syst Rev 2020; 2:CD012466. [PMID: 32103487 PMCID: PMC7044419 DOI: 10.1002/14651858.cd012466.pub2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Approximately half of people with heart failure have chronic kidney disease (CKD). Pharmacological interventions for heart failure in people with CKD have the potential to reduce death (any cause) or hospitalisations for decompensated heart failure. However, these interventions are of uncertain benefit and may increase the risk of harm, such as hypotension and electrolyte abnormalities, in those with CKD. OBJECTIVES This review aims to look at the benefits and harms of pharmacological interventions for HF (i.e., antihypertensive agents, inotropes, and agents that may improve the heart performance indirectly) in people with HF and CKD. SEARCH METHODS We searched the Cochrane Kidney and Transplant Register of Studies through 12 September 2019 in consultation with an Information Specialist and using search terms relevant to this review. Studies in the Register are identified through searches of CENTRAL, MEDLINE, and EMBASE, conference proceedings, the International Clinical Trials Register (ICTRP) Search Portal and ClinicalTrials.gov. SELECTION CRITERIA We included randomised controlled trials of any pharmacological intervention for acute or chronic heart failure, among people of any age with chronic kidney disease of at least three months duration. DATA COLLECTION AND ANALYSIS Two authors independently screened the records to identify eligible studies and extracted data on the following dichotomous outcomes: death, hospitalisations, worsening heart failure, worsening kidney function, hyperkalaemia, and hypotension. We used random effects meta-analysis to estimate treatment effects, which we expressed as a risk ratio (RR) with 95% confidence intervals (CI). We assessed the risk of bias using the Cochrane tool. We applied the GRADE methodology to rate the certainty of evidence. MAIN RESULTS One hundred and twelve studies met our selection criteria: 15 were studies of adults with CKD; 16 studies were conducted in the general population but provided subgroup data for people with CKD; and 81 studies included individuals with CKD, however, data for this subgroup were not provided. The risk of bias in all 112 studies was frequently high or unclear. Of the 31 studies (23,762 participants) with data on CKD patients, follow-up ranged from three months to five years, and study size ranged from 16 to 2916 participants. In total, 26 studies (19,612 participants) reported disaggregated and extractable data on at least one outcome of interest for our review and were included in our meta-analyses. In acute heart failure, the effects of adenosine A1-receptor antagonists, dopamine, nesiritide, or serelaxin on death, hospitalisations, worsening heart failure or kidney function, hyperkalaemia, hypotension or quality of life were uncertain due to sparse data or were not reported. In chronic heart failure, the effects of angiotensin-converting enzyme inhibitors (ACEi) or angiotensin receptor blockers (ARB) (4 studies, 5003 participants: RR 0.85, 95% CI 0.70 to 1.02; I2 = 78%; low certainty evidence), aldosterone antagonists (2 studies, 34 participants: RR 0.61 95% CI 0.06 to 6.59; very low certainty evidence), and vasopressin receptor antagonists (RR 1.26, 95% CI 0.55 to 2.89; 2 studies, 1840 participants; low certainty evidence) on death (any cause) were uncertain. Treatment with beta-blockers may reduce the risk of death (any cause) (4 studies, 3136 participants: RR 0.69, 95% CI 0.60 to 0.79; I2 = 0%; moderate certainty evidence). Treatment with ACEi or ARB (2 studies, 1368 participants: RR 0.90, 95% CI 0.43 to 1.90; I2 = 97%; very low certainty evidence) had uncertain effects on hospitalisation for heart failure, as treatment estimates were consistent with either benefit or harm. Treatment with beta-blockers may decrease hospitalisation for heart failure (3 studies, 2287 participants: RR 0.67, 95% CI 0.43 to 1.05; I2 = 87%; low certainty evidence). Aldosterone antagonists may increase the risk of hyperkalaemia compared to placebo or no treatment (3 studies, 826 participants: RR 2.91, 95% CI 2.03 to 4.17; I2 = 0%; low certainty evidence). Renin inhibitors had uncertain risks of hyperkalaemia (2 studies, 142 participants: RR 0.86, 95% CI 0.49 to 1.49; I2 = 0%; very low certainty). We were unable to estimate whether treatment with sinus node inhibitors affects the risk of hyperkalaemia, as there were few studies and meta-analysis was not possible. Hyperkalaemia was not reported for the CKD subgroup in studies investigating other therapies. The effects of ACEi or ARB, or aldosterone antagonists on worsening heart failure or kidney function, hypotension, or quality of life were uncertain due to sparse data or were not reported. Effects of anti-arrhythmic agents, digoxin, phosphodiesterase inhibitors, renin inhibitors, sinus node inhibitors, vasodilators, and vasopressin receptor antagonists were very uncertain due to the paucity of studies. AUTHORS' CONCLUSIONS The effects of pharmacological interventions for heart failure in people with CKD are uncertain and there is insufficient evidence to inform clinical practice. Study data for treatment outcomes in patients with heart failure and CKD are sparse despite the potential impact of kidney impairment on the benefits and harms of treatment. Future research aimed at analysing existing data in general population HF studies to explore the effect in subgroups of patients with CKD, considering stage of disease, may yield valuable insights for the management of people with HF and CKD.
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Affiliation(s)
- Meaghan Lunney
- University of Calgary, Department of Community Health Sciences, 3330 Hospital Drive NW, Calgary, Alberta, Canada, T2N 4N1
| | - Marinella Ruospo
- The University of Sydney, Sydney School of Public Health, Sydney, Australia
- University of Bari, Department of Emergency and Organ Transplantation, Bari, Italy
| | - Patrizia Natale
- The University of Sydney, Sydney School of Public Health, Sydney, Australia
- University of Bari, Department of Emergency and Organ Transplantation, Bari, Italy
| | - Robert R Quinn
- University of Calgary, Department of Community Health Sciences, 3330 Hospital Drive NW, Calgary, Alberta, Canada, T2N 4N1
- Cumming School of Medicine, University of Calgary, Department of Medicine, Calgary, Canada
| | - Paul E Ronksley
- University of Calgary, Department of Community Health Sciences, 3330 Hospital Drive NW, Calgary, Alberta, Canada, T2N 4N1
| | - Ioannis Konstantinidis
- University of Pittsburgh Medical Center, Department of Medicine, 3459 Fifth Avenue, Pittsburgh, PA, USA, 15213
| | - Suetonia C Palmer
- Christchurch Hospital, University of Otago, Department of Medicine, Nephrologist, Christchurch, New Zealand
| | - Marcello Tonelli
- Cumming School of Medicine, University of Calgary, Department of Medicine, Calgary, Canada
| | - Giovanni Fm Strippoli
- The University of Sydney, Sydney School of Public Health, Sydney, Australia
- University of Bari, Department of Emergency and Organ Transplantation, Bari, Italy
- The Children's Hospital at Westmead, Cochrane Kidney and Transplant, Centre for Kidney Research, Westmead, NSW, Australia, 2145
| | - Pietro Ravani
- University of Calgary, Department of Community Health Sciences, 3330 Hospital Drive NW, Calgary, Alberta, Canada, T2N 4N1
- Cumming School of Medicine, University of Calgary, Department of Medicine, Calgary, Canada
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Comprehensive Geriatric Assessment in Cardiovascular Disease. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2020; 1216:87-97. [PMID: 31894550 DOI: 10.1007/978-3-030-33330-0_10] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Frailty and cardiovascular disease (CVD) are both highly prevalent in older adults. Cardiovascular disease has been identified as the most frequent cause of death, while frailty has been identified as one of geriatric giants characterized by decreased physiological reserves and increased vulnerability. However, the exact pathobiological links between the two conditions have not been fully elucidated. Consequently, we observe a relevant difficulty not only in accurately defining cardiovascular risk in vulnerable elderly patients (and the other way around), but also a lack of consensus regarding CVD management in the very old. Nowadays, considering the enormous technical innovation, many elderly patients, if appropriately selected, could be eligible even for the most complex treatments, including invasive cardiological procedures. Identification of frail patients at risk of negative outcomes can allow the customization of therapeutic interventions in elderly patients with CVD, allowing the elderly who can benefit from them to undergo even invasive procedures and avoiding futile or dangerous treatments for the most vulnerable patients. A large number of tools and definitions for assessing frailty have been proposed; different scales and assessment tools can be useful for different purposes, but at present there is no clear indication for their use in CVD. In this chapter, we will describe the main geriatric approach to ascertain frailty, the assessment tools used in patients with cardiovascular diseases, and propose an operational strategy to evaluate frailty and identify patients eligible for pharmacologic or surgical interventions.
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Rodríguez-Queraltó O, Formiga F, Carol A, Llibre C, Martínez-Sellés M, Marín F, Díez-Villanueva P, Sanchis J, Bonanad C, Corbí M, Aboal J, Angel Perez-Rivera J, Alegre O, Bernal E, Vicent L, Ariza-Solé A. Impact of Diabetes Mellitus and Frailty on Long-Term Outcomes in Elderly Patients with Acute Coronary Syndromes. J Nutr Health Aging 2020; 24:723-729. [PMID: 32744568 DOI: 10.1007/s12603-020-1409-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Diabetes mellitus (DM) and frailty are common in older patients with acute coronary syndromes (ACS). No data exists about its prognostic impact on long-term outcomes and their possible interaction in this setting. DESIGN Observational prospective study. SETTING Multicenter registry conducted in 44 hospitals in Spain. PARTICIPANTS Consecutive patients with ACS aged 80≥years. MEASUREMENTS A comprehensive geriatric evaluation was performed during hospitalization, including frailty assessment by the FRAIL score. The impact of DM and frailty on the incidence of mortality/readmission at 24 months was analysed by a Cox regression model. RESULTS A total of 498 patients were included (mean age 84.3 years). Prevalence of previous DM was 199/498 (40.0%). The rate of frail patients was 135/498 (27.1%). The incidence of mortality/readmission was higher frail patients (HR 2.49) (both p<0.001). In contrast, DM was not significantly associated to a higher rate of outcomes (HR 1.23, p=0.060) in the whole cohort. Among non-frail patients, patients with DM had a similar incidence of mortality or readmission (p=0.959). In contrast, among frail patients, DM was significantly associated with a higher incidence of events (HR 1.51, p=0.034). CONCLUSIONS Unlike frailty status, DM was not associated to poorer long-term outcome in elderly patients with ACS. Among frail patients the presence of DM seems to provide additional prognostic information.
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Affiliation(s)
- O Rodríguez-Queraltó
- Albert Ariza Solé. Cardiology Department. Bellvitge University Hospital, Feixa Llarga s/n. 08907. L'Hospitalet de Llobregat. Barcelona. Spain, Email address: , Fax Number +34932607618; Telephone number +34932607924
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Vrints CJ. Thanksgiving. EUROPEAN HEART JOURNAL. ACUTE CARDIOVASCULAR CARE 2019; 8:685-686. [PMID: 31805789 DOI: 10.1177/2048872619895220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
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