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

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.

Informations de copyright

Copyright © 2024. Published by Elsevier B.V.

Déclaration de conflit d'intérêts

Declaration of competing interest JtB report grants from the Netherlands Organization for Health Research and Development, a Dutch government institution called ZonMw, and AstraZeneca; and personal fees from AstraZeneca, Boehinger Ingelheim, Bayer, Ferrer, Pfizer, and Merck, outside the submitted work. RFS reports research grants and personal fees from AstraZeneca, Cytosorbents and GlyCardial Diagnostics; and personal fees from Alfasigma, Alnylam, Bayer, Bristol Myers Squibb/Pfizer, Chiesi, CSL Behring, Daiichi Sankyo, HengRui, Idorsia, Intas Pharmaceuticals, Medscape, Novartis, Novo Nordisk, PhaseBio, Portola and Sanofi Aventis. DA reports research grants from TA Sciences, and personal fees from Philips/Volcano, Pfizer, Astra Zeneca and Novartis. AvH reports unrestricted grants to institution from Medtronic, AZ, Boehringer Ingelheim, Abbott. CvB reports no personal fees; institutional research grants to the research department of Thoraxcentrum Twente from Abbott Vascular, Biotronik, Boston Scientific, and Medtronic, outside the submitted work.. VD report grants from the Netherlands Organization for Health Research and Development, a Dutch government institution called ZonMw. All other authors do not report any relationships that could be construed as a conflict of interest.