Comorbidity assessment for mortality risk stratification in elderly patients with acute coronary syndrome

Sanchís, Juan; Soler, Meritxell; Núñez, Julio; Ruíz, Vicente; Bonanad, Clara; Formiga, Francesç; Valero, Ernesto; Martínez‐Sellés, Manuel; Marı́n, Francisco; Ruescas, Arancha; García‐Blas, Sergio; Miñana, Gema; Abu‐Assi, Emad; Bueno, Héctor; Arizá-Solé, Albert

doi:10.1016/j.ejim.2019.01.018

Cited by 31 publications

(34 citation statements)

References 32 publications

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“…related with an increased risk of death. 10,11 However, there is scarce information on the prognostic role of frailty and atrial AF in elderly patients with an ACS. The aim of this study was to analyse the management of elderly patients with frailty and AF who suffered an ACS as well as the influence of comorbidity status in adverse events at short-term follow-up in a 'real-world' multicenter prospective cohort of patients included in the LONGEVO registry.…”

Section: Esteve-pastor Et Almentioning

confidence: 99%

Impact of frailty and atrial fibrillation in elderly patients with acute coronary syndromes

Esteve‐Pastor

Martín

Alegre

et al. 2021

Eur J Clin Investigation

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Background: There is scarce information on the prognostic role of frailty and atrial fibrillation (AF) in elderly patients with acute coronary syndrome (ACS). Methods: The aim was to analyse the management of elderly patients with frailty and AF who suffered an ACS using data of the prospective multicentre LONGEVO-SCA registry. We evaluated the predictive performance of FRAIL, Charlson scores and AF status for adverse events at 6-month follow-up. Results: A total of 531 unselected patients with ACS and above 80 years old [mean age 84.4 (SD = 3.6) years; 322 (60.6%) male] were enrolled, of whom 128 (24.1%) with AF and 145 (27.3%) with frailty. Mutually exclusive number of patients were as follows: non-frail and sinus rhythm (SR) 304 (57.2%); frail and SR 99 (18.6%); nonfrail and AF 82 (15.4%); and frail and AF 46 (8.7%). Frail and AF patients compared with non-frail and SR patients had higher risk of all-cause mortality [HR 2.61, (95%

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Section: Esteve-pastor Et Almentioning

confidence: 99%

Impact of frailty and atrial fibrillation in elderly patients with acute coronary syndromes

Esteve‐Pastor

Martín

Alegre

et al. 2021

Eur J Clin Investigation

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“…Of these, low physical activity (using the Minnesota Leisure Time Activity questionnaire) and slowness (time to walk 4.57 m) retained the greatest value for risk assessment on top of clinical data and the most relevant comorbid conditions. 10 Physical activity questionnaires are tools used for classifying level of physical activity. The Minnesota Leisure Time Activity questionnaire was developed to quantify the level of exercise that would produce a protective effect against coronary heart disease.…”

Section: Fried Scale and Its Componentsmentioning

confidence: 99%

Frailty Tools for Assessment of Long-term Prognosis After Acute Coronary Syndrome

Forés

Ruiz

Sastre

et al. 2020

Mayo Clinic Proceedings: Innovations, Quality & Outcomes

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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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“…Geriatric conditions beyond aging influence clinical outcomes in older adults with acute coronary syndrome [1]. Frailty and comorbidities are the most extensively researched geriatric conditions [2,3]. Few studies have evaluated cognitive impairment in patients with acute coronary syndrome [4][5][6][7][8].…”

Section: Introductionmentioning

confidence: 99%

Long-Term Prognostic Value of Cognitive Impairment on Top of Frailty in Older Adults after Acute Coronary Syndrome

Forés

Bonanad

García‐Blas

et al. 2021

JCM

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Frailty is a marker of poor prognosis in older adults after acute coronary syndrome. We investigated whether cognitive impairment provides additional prognostic information. The study population consisted of a prospective cohort of 342 older (>65 years) adult survivors after acute coronary syndrome. Frailty (Fried score) and cognitive function (Pfeiffer’s Short Portable Mental Status Questionnaire—SPMSQ) were assessed at discharge. The endpoints were mortality or acute myocardial infarction at 8.7-year median follow-up. Patient distribution according to SPMSQ results was: no cognitive impairment (SPMSQ = 0 errors; n = 248, 73%), mild impairment (SPMSQ = 1–2 errors; n = 52, 15%), and moderate to severe impairment (SPMSQ ≥3 errors; n = 42, 12%). A total of 245 (72%) patients died or had an acute myocardial infarction, and 216 (63%) patients died. After adjustment for clinical data, comorbidities, and Fried score, the SPMSQ added prognostic value for death or myocardial infarction (per number of errors; HR = 1.11, 95%, CI 1.04–1.19, p = 0.002) and death (HR = 1.11, 95% 1.03–1.20, p = 0.007). An SPMSQ with ≥3 errors identified the highest risk subgroup. Geriatric conditions (SPSMQ and Fried score) explained 19% and 43% of the overall chi-square of the models for predicting death or myocardial infarction and death, respectively. Geriatric assessment after acute coronary syndrome should include both frailty and cognitive function. This is particularly important given that cognitive impairment without dementia can be subclinical and thus remain undetected.

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Comorbidity assessment for mortality risk stratification in elderly patients with acute coronary syndrome

Cited by 31 publications

References 32 publications

Impact of frailty and atrial fibrillation in elderly patients with acute coronary syndromes

Impact of frailty and atrial fibrillation in elderly patients with acute coronary syndromes

Frailty Tools for Assessment of Long-term Prognosis After Acute Coronary Syndrome

Long-Term Prognostic Value of Cognitive Impairment on Top of Frailty in Older Adults after Acute Coronary Syndrome

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