Frailty Is Independently Associated With Short-Term Outcomes for Elderly Patients With Non–ST-Segment Elevation Myocardial Infarction

Abstract

Background-For the large and growing population of elderly patients with cardiovascular disease, it is important to identify clinically relevant measures of biological age and their contribution to risk. Frailty is an emerging concept in medicine denoting increased vulnerability and decreased physiological reserves. We analyzed the manner in which the variable frailty predicts short-term outcomes for elderly non-ST-segment elevation myocardial infarction patients. Methods and Results-Patients aged Ն75 years, with diagnosed non-ST-segment elevation myocardial infarction were included at 3 centers, and clinical data including judgment of frailty were collected prospectively. Frailty was defined according to the Canadian Study of Health and Aging Clinical Frailty Scale. The impact of the comorbid conditions on risk was quantified by the coronary artery disease-specific index. Of 307 patients, 149 (48.5%) were considered frail. By multiple logistic regression, frailty was found to be strongly and independently associated with risk for the primary composite outcome (death from any cause, myocardial reinfarction, revascularization due to ischemia, hospitalization for any cause, major bleeding, stroke/transient ischemic attack, and need for dialysis up to 1 month after inclusion) (odds ratio, 2.2; 95% confidence interval, 1.3-3.7), in-hospital mortality (odds ratio, 4.6; 95% confidence interval, 1.3-16.8), and 1-month mortality (odds ratio, 4.7; 95% confidence interval, 1.7-13.0). Conclusions-Frailty is strongly and independently associated with in-hospital mortality, 1-month mortality, prolonged hospital care, and the primary composite outcome. The combined use of frailty and comorbidity may constitute an ultimate risk prediction concept in regard to cardiovascular patients with complex needs. Clinical Trial Registration-http://www.clinicaltrials.gov.

Frailty and Outcomes After Myocardial Infarction: Insights From the CONCORDANCE Registry

“…In addition to greater cardiac and noncardiac comorbidities, frail patients had greater deficits in cognition, mobility, and continence. Our findings demonstrating that frailty is not only associated with increased in‐hospital but also midterm all‐cause mortality and hospitalizations following MI are consistent with prior analyses 3, 4, 5, 6. Despite this higher risk, frail patients were managed less aggressively compared with their nonfrail counterparts.…”

“…However, in patients with significant cardiovascular disease, the prevalence may be as high as 60% 2. Frailty has been associated with increased major adverse cardiac events after myocardial infarction (MI) 3, 4, 5, 6. Mechanisms proposed for worse outcomes are likely multifactorial.…”

Association of midlife obesity and cardiovascular risk with old age frailty: a 26-year follow-up of initially healthy men

“…It is thus paradoxical that those overweight and obese in midlife life may turn thin and frail in later years. Our findings further suggest that the reported coexistence of CVD and frailty 12,13 is at least partly explained by shared risk factors, and not only secondary effects of disease. These long-term results are in accordance with cross-sectional and old age studies on associations between obesity, smoking and frailty, 23,24 as well as with the Cardiovascular Health Study, 11 which showed that subclinical CVD was associated with frailty.…”

“…3,5 In cross-sectional settings, or prospectively in later life, frailty has been associated with both clinical and subclinical cardiovascular disease (CVD). [11][12][13] Accelerated cardiovascular ageing 14 could be one explanation for the proposed relationship between frailty and CVD and also shared biological alterations, such as lowgrade inflammation, 15 may have a role. We have speculated earlier that development of frailty and weight loss therefore could also explain the 'obesity paradox' 16 -better prognosis among older people with overweight or obesity.…”

Advanced Heart Failure Treatment Options Among the Elderly

“…48 When examined in the context of coronary artery disease, acute coronary syndromes and percutaneous coronary intervention, frailty has been extensively demonstrated to be a prognostic indicator of adverse cardiac events, rehospitalization and all-cause mortality. [48][49][50][51][52][53] Frailty itself in the elderly HF population is an independent predictor of emergency department visits, hospitalizations and mortality. 54,55 There is a close link between frailty and comorbidities, polypharmacy and malnutrition.…”