Impact of Diabetes Mellitus and Frailty on Long-Term Outcomes in Elderly Patients with Acute Coronary Syndromes

Rodriguez-Queralto, Oriol; Formiga, Francesç; Carol, Antoni; Llibre, Cinta; Martínez‐Sellés, Manuel; Marı́n, Francisco; Díez‐Villanueva, Pablo; Sanchís, Juan; Bonanad, Clara; Corbi, Miguel; Aboal, Jaime; Rivera, Jaime A.; Alegre, Oriol; Bernal, Eva; Vicent, Lourdes; Arizá-Solé, Albert

doi:10.1007/s12603-020-1409-1

Cited by 3 publications

(5 citation statements)

References 23 publications

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“…Studies were conducted in China, [14–18] the United States, [19–21] Italy, [22] Spain, [23,24] the United Kingdom [25] and Japan. [26,27] Five frailty assessment tools were used in 14 studies, including the frailty index (FI), [14,15,19,24] frailty phenotype, [20,21,26,27] the FRAIL, [16–18,23] frailty staging system [22] and clinical frailty scale (CFS). [25] The characteristics and quality assessment results are shown in Table 1.…”

Section: Resultsmentioning

confidence: 99%

“…Studies were conducted in China, [14][15][16][17][18] the United States, [19][20][21] Italy, [22] Spain, [23,24] the United Kingdom [25] and Japan. [26,27] Five frailty assessment tools were used in 14 studies, including the frailty index (FI), [14,15,19,24] frailty phenotype, [20,21,26,27] the FRAIL, [16][17][18]23] frailty staging system [22] and clinical frailty scale (CFS). [25] The characteristics and quality assessment results are shown in Table 1.…”

Section: Characteristics and Quality Assessment Of Included Studiesmentioning

confidence: 99%

“…Shi 2023 [15] China ≥60 Cohort study Chao 2020 [16] China 74.0 ± 12.4 Rodríguez 2020 [23] Spain ≥80 Wang 2014 [21] Castro-Rodriguez 2016 [24] Spain 76…”

Section: Fi 10ymentioning

confidence: 99%

“…A total of 10 studies [14,15,[19][20][21][22][23][24][25][26] described the relationship between frailty and mortality. After the heterogeneity test, I 2 = 94.9%, P < .001, indicating significant heterogeneity between the studies.…”

Section: Primary Outcomes 331 Mortalitymentioning

confidence: 99%

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The impact of frailty on clinical outcomes among older adults with diabetes: A systematic review and meta-analysis

Cheng,

He,

Ning

et al. 2024

Medicine

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Background: Frailty has been identified as a risk factor for adverse outcomes in older adults with diabetes. This study aimed to investigate the impact of frailty on the prognosis of older adults with diabetes through a systematic review and meta-analysis, with the goal of offering insights for clinical decision-making. Methods: PubMed, Web of Science, Embase, Cochrane were systematically searched from inception to September 10th, 2023. Reviewers independently selected studies, extracted data and evaluated the quality of studies. Stata 15.1 Software was used to perform the meta-analysis. The primary outcomes of this study were mortality, hospitalization and disability, and the secondary outcomes were diabetes complications (including nephropathy, microvascular complications, macroangiopathy, cardiovascular events, hypoglycemia) and urolithiasis. Results: A total of 14 studies were included in this study, with low risk of bias and moderate to good quality. The results showed that frailty increased the risk of mortality (HR 1.91, 95% CI 1.55–2.35, P < .001), hospitalization (HR 2.19, 95% CI 1.53–3.13, P < .001), and disability in older adults with diabetes (HR 3.84, 95% CI 2.35–6.28, P < .001). In addition, frailty was associated with diabetes complications (including nephropathy, microvascular complications, macroangiopathy, cardiovascular events, hypoglycemia), urolithiasis. Conclusions: Frailty is an important predictor of adverse outcomes, such as mortality, hospitalization, and disability in older adults with diabetes. Accurate assessment of the frailty in older adults with diabetes can help improve the adverse outcomes of patients.

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Section: Resultsmentioning

confidence: 99%

Section: Characteristics and Quality Assessment Of Included Studiesmentioning

confidence: 99%

“…Shi 2023 [15] China ≥60 Cohort study Chao 2020 [16] China 74.0 ± 12.4 Rodríguez 2020 [23] Spain ≥80 Wang 2014 [21] Castro-Rodriguez 2016 [24] Spain 76…”

Section: Fi 10ymentioning

confidence: 99%

Section: Primary Outcomes 331 Mortalitymentioning

confidence: 99%

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The impact of frailty on clinical outcomes among older adults with diabetes: A systematic review and meta-analysis

Cheng,

He,

Ning

et al. 2024

Medicine

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“…In the Elderly-ACS 2 trial, diabetes was associated with an increase in cardiovascular mortality but only due to its association with higher rates of comorbidities and cardiovascular risk profile [ 27 ]. In the elderly, diabetes seems to be associated with a higher incidence of events mainly among frail patients, with a similar incidence of mortality or readmission in non-frail patients [ 28 , 29 ]. The impact of diabetes on prognosis seems to be particularly strong in elderly women [ 30 ].…”

Section: Comorbiditiesmentioning

confidence: 99%

Invasive Strategy in Octogenarians with Non-ST-Segment Elevation Acute Myocardial Infarction

Álvarez-Zaballos,

Juárez-Fernández,

Martínez-Sellés

2024

Rev. Cardiovasc. Med.

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With population aging and the subsequent accumulation of cardiovascular risk factors, a growing proportion of patients presenting with acute coronary syndrome (ACS) are octogenarian (aged between 80 and 89). The marked heterogeneity of this population is due to several factors like age, comorbidities, frailty, and other geriatric conditions. All these variables have a strong impact on outcomes. In addition, a high prevalence of multivessel disease, complex coronary anatomies, and peripheral arterial disease, increases the risk of invasive procedures in these patients. In advanced age, the type and duration of antithrombotic therapy need to be individualized according to bleeding risk. Although an invasive strategy for non-ST-segment elevation acute myocardial infarction (NSTEMI) is recommended for the general population, its need is not so clear in octogenarians. For instance, although frail patients could benefit from revascularization, their higher risk of complications might change the risk/benefit ratio. Age alone should not be the main factor to consider when deciding the type of strategy. The risk of futility needs to be taken into account and identification of risk factors for adverse outcomes, such as renal impairment, could help in the decision-making process. Finally, an initially selected conservative strategy should be open to a change to invasive management depending on the clinical course (recurrent angina, ventricular arrhythmias, heart failure). Further evidence, ideally from prospective randomized clinical trials is urgent, as the population keeps growing.

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Management strategy of non-ST segment elevation acute coronary syndromes in octogenarians: a call for a personalized approach

Martínez-Solano¹,

Alonso-García²,

Álvarez-Zaballos³

et al. 2021

Rev. Cardiovasc. Med.

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The rate of octogenarians among patients with non-ST segment elevation acute coronary syndrome (NSTEACS) will continue to increase in the coming years due to population aging. Routine invasive management of NSTEACS has shown long-term benefit in general population but evidence-based recommendations in this subset of patients remain scarce. The decision-making process in elderly patients should take into account several geriatric factors including frailty, comorbidities, dependency, cognitive impairment, malnutrition, and polymedication. Chronological age is a poor marker of the biological situation in octogenarians and heterogeneity is common. Recent studies support an invasive strategy in most octogenarians. However, observational data suggest that significant comorbidities seem to be related to futility of an invasive approach whereas the risk-benefit balance in frail patients might favor revascularization. Further studies are needed to define a tailored approach in each octogenarian with NSTEACS through a better assessment and quantification of frailty, comorbidities and ischemic risk.

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Impact of Diabetes Mellitus and Frailty on Long-Term Outcomes in Elderly Patients with Acute Coronary Syndromes

Cited by 3 publications

References 23 publications

The impact of frailty on clinical outcomes among older adults with diabetes: A systematic review and meta-analysis

The impact of frailty on clinical outcomes among older adults with diabetes: A systematic review and meta-analysis

Invasive Strategy in Octogenarians with Non-ST-Segment Elevation Acute Myocardial Infarction

Management strategy of non-ST segment elevation acute coronary syndromes in octogenarians: a call for a personalized approach

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