Impact of frailty on outcomes in acute ST‐elevated myocardial infarctions undergoing percutaneous coronary intervention

Abstract

Aims We analyzed the impact of frailty on readmission rates for ST‐elevated myocardial infarctions (STEMIs) and the utilization of percutaneous coronary intervention (PCI) in STEMI admissions. Methods and Results The 2016−2019 Nationwide Readmission Database was analyzed for patients admitted with an acute STEMI. Patients were categorized by frailty risk and analyzed for 30‐day readmission risk after acute STEMIs, PCI utilization and outcomes, and healthcare resource utilization. Qualifying index admissions were found in 584,918 visits. Low risk frailty was noted in 78.20%, intermediate risk in 20.67%, and high risk in 1.14% of admissions. Thirty‐day readmissions occurred in 7.74% of index admissions, increasing with frailty (p < 0.001). Readmission risk increased with frailty, 1.37 times with intermediate and 1.21 times with high‐risk frailty. PCI was performed in 86.40% of low‐risk, 66.03% of intermediate‐risk, and 58.90% of high‐risk patients (p < 0.001). Intermediate patients were 55.02% less likely and high‐risk patients were 61.26% less likely to undergo PCI (p < 0.001). Length of stay means for index admissions were 2.96, 7.83, and 16.32 days for low, intermediate, and high‐risk groups. Intermediate and high‐risk frailty had longer length of stay, higher total cost, and were more likely to be discharged to a skilled facility (p < 0.001). Conclusion Among adult, all‐payer inpatient visits, frailty discerned by the hospital frailty risk score was associated with increased readmissions, increased healthcare resource utilization, and lower PCI administration.

Prevalence of frailty according to the Hospital Frailty Risk Score and related factors in older patients with acute coronary syndromes in Vietnam

“…These reasons might contribute to a lower prevalence of frailty assessed by HFRS in this study compared to studies on a similar subject. However, when compared to studies using a similar frailty definition on ACS and myocardial infarction subjects, the prevalence of frailty in our study was higher 13,18 . In studies conducted in the United States, the prevalence of frailty assessed by HFRS was approximately 18% in the ACS patient group and 22% in the myocardial infarction with ST elevation patient group 13,18 .…”

“…However, when compared to studies using a similar frailty definition on ACS and myocardial infarction subjects, the prevalence of frailty in our study was higher. 13,18 In studies conducted in the United States, the prevalence of frailty assessed by HFRS was approximately 18% in the ACS patient group and 22% in the myocardial infarction with ST elevation patient group. 13,18 These differences can be attributed to the study subjects, while the population of both studies was all hospitalised patients, our study was conducted in older patients who had more comorbidities and a higher prevalence of frailty.…”

“…11 The Hospital Frailty Risk Score has been used to assess frailty in patients hospitalised for ACS, myocardial infarction, heart failure, pneumonia or undergoing surgeries. [12][13][14][15][16][17][18][19] There have been several studies examining frailty using this new scale; however, most of these studies were conducted in developed countries. Therefore, we conducted this study in Vietnam to determine the prevalence of frailty assessed by HFRS in older patients with ACS and the association between frailty assessed by HFRS and prescriptions of cardiovascular medications, percutaneous coronary intervention (PCI) and in-hospital adverse events.…”

“…Using HFRS with different thresholds to classify the level of frailty showed a correlation with frailty scales such as Fried and Rockwood 11 . The Hospital Frailty Risk Score has been used to assess frailty in patients hospitalised for ACS, myocardial infarction, heart failure, pneumonia or undergoing surgeries 12‐19 . There have been several studies examining frailty using this new scale; however, most of these studies were conducted in developed countries.…”

Does frailty should stop us now?

“…Due to the evidence gap in this setting, there is a need for further prospective trials to ascertain the role of this frailty score in these patients. In the meantime, studies like those by Joseph et al 4 inform us that PCI reduce in-hospital mortality in all frailty groups, thus…”