Prognosis Impact of Frailty Assessed by the Edmonton Frail Scale in the Setting of Acute Coronary Syndrome in the Elderly

Blanco, Stéphane; Ferrières, Jean; Bongard, Vanina; Toulza, Olivier; Sebai, Fatia; Billet, Sophie; Biendel, Caroline; Lairez, Olivier; Lhermusier, Thibault; Boudou, Nicolas; Campelo‐Parada, Francisco; Roncalli, Jérôme; Galinier, Michel; Carrié, Didier; Elbaz, Meyer; Bouisset, Frédéric

doi:10.1016/j.cjca.2017.03.026

Cited by 44 publications

(25 citation statements)

References 24 publications

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“…29 In another study in 236 patients with ACS aged ≥80 in France, the prevalence of frailty defined by the Edmonton Frailty Scale was 20.8%. 47 Our study found that the prevalence of frailty in women was higher than in men, which is consistent with the literature on sex difference in frailty. 48,49 Overall, only half of the participants received PCI and we found that frailty did not have an independent impact on whether the patients received PCI or not.…”

Section: Discussionsupporting

confidence: 92%

<p>Frailty in Older Patients with Acute Coronary Syndrome in Vietnam</p>

Nguyen¹,

Le²,

Tran³

et al. 2019

CIA

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Background: There has been limited evidence about frailty in older patients with acute coronary syndrome (ACS) in Vietnam. Aim: (1) To investigate the prevalence of frailty in older patients hospitalised with ACS and its associated factors; (2) To investigate the impact of frailty on percutaneous coronary intervention (PCI) and adverse outcomes in this population. Methods: Patients aged ≥60 with ACS admitted to two teaching hospitals in Vietnam were recruited from 9/2017 to 4/2018. Frailty was defined by the Reported Edmonton Frail Scale. Multivariate logistic regression was applied to investigate the associated factors of frailty and the impact of frailty on PCI and adverse outcomes. Results: There were 324 participants, mean age 73.5±8.3, 39.2% female. The prevalence of frailty was 48.1%. Advanced age, female gender, history of hypertension, heart failure, stroke and chronic kidney disease were significantly associated with a frailty status. Overall, 50.3% of the participants received PCI (58.3% in the non-frail vs 41.7% in the frail, p=0.003). However, frailty did not have an independent impact on PCI (adjusted OR 0.66, 95% CI 0.41-1.08). Frailty was significantly associated with increased risk of having arrhythmia during hospitalisation (adjusted OR 2.24, 95% CI 1.32-3.80), hospital-acquired pneumonia (adjusted OR 2.27, 95% CI 1.24-4.17), in-hospital mortality (adjusted OR 3.02, 95% CI 1.35-6.75), 30-day mortality (adjusted OR 3.28, 95% CI 1.59-6.76), and 30-day readmission (adjusted OR 2.53, 95% CI 1.38-4.63). Conclusion: In this study, frailty was present in nearly half of older patients with ACS and was associated with increased adverse outcomes. These findings suggest that frailty screening should be performed in older patients with ACS in Vietnam.

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Section: Discussionsupporting

confidence: 92%

<p>Frailty in Older Patients with Acute Coronary Syndrome in Vietnam</p>

Nguyen¹,

Le²,

Tran³

et al. 2019

CIA

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“…The assessment tool of frailty among these studies are as follows: 4 studies [11, 12, 16, 19] used Canadian Study of Health and Aging Clinical Frailty Scale (CSHA-CFS); 4 studies [8, 9, 13, 14] used Survey of Health, Ageing and Retirement in Europe Frailty Index (SHARE-FI) tool; 2 studies [17, 18] from the same cohort used Green Score; 2 studies [10, 15] used Edmonton Frail Scale (EFS); one [20] used Fried Frailty score; and one [21] used FRAIL scale. One last study [22] determined frailty with the help of computer program “optimization of care in geriatrics, depending on the degree of frailty” on the basis of the specialized geriatric examination.…”

Section: Resultsmentioning

confidence: 99%

“…All the 15 studies [8–22] reported the prevalence rate of frailty among participants, ranged from 4.7 to 53.2%. Eight studies [8–10, 13–15, 20, 21] reported the rate of pre-frailty ranged from 23.0 to 38.5%.…”

Section: Resultsmentioning

confidence: 99%

“…These 15 included studies [8–22] were of relatively high methodological quality with their scores ranging from 5 to 9 (mean score = 7.4) (Table 2). Eight studies [9, 10, 12–15, 17, 20] were graded as good quality and the rest 7 studies [8, 11, 16, 18, 19, 21, 22] were graded as fair. The representativeness of the exposed cohort, fully adjusted in the analysis and follow-up time were considered to be the most important indicators for methodological quality.…”

Section: Resultsmentioning

confidence: 99%

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Prognostic value of frailty in elderly patients with acute coronary syndrome: a systematic review and meta-analysis

Dou

Wang

et al. 2019

BMC Geriatr

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Background: Frailty is common and associated with poorer outcomes in the elderly, but its prognostic value in acute coronary syndromes (ACS) requires clarification. We thus undertook a systematic review and meta-analysis to evaluate the relationship between frailty and poor prognosis in patients with ACS. Methods: We systematically searched PubMed, Embase to find literatures which studied the prognostic value of frailty in elderly patients with ACS. Our main endpoints were the all-cause mortality, cardiovascular disease (CVD), major bleeding and readmissions. We pooled studies using random-effect generic inverse variance method, and conducted three pre-specified subgroup analyses. Results: Of 1216 identified studies, 15 studies were included in our analysis. Compared with the normal group, frailty (HR = 2.65; 95%CI: 1.81-3.89, I 2 = 60.2%) and pre-frailty (HR = 1.41; 95%CI: 1.19-1.66, I 2 = 0%) were characterized by a higher risk of mortality after adjustment. Frailty also was associated with increased risk of any-type CVD, major bleeding and hospital readmissions in elderly patients with ACS. The pooled effect sizes in frail patients were 1.54 (95%CI: 1.32-1.79), 1.51 (95%CI: 1.14-1.99) and 1.51 (95%CI: 1.09-2.10). Conclusions: Frailty provides quantifiable and significant prognostic value for mortality and adverse events in elderly ACS patients, helping doctors to appraise the comprehensive prognosis risk and to applicate appropriate management strategies.

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“…As mentioned before, all these features were more common in patients with higher CHA 2 DS 2 ‐VASc Score, as well as others with clinical and prognostic implications, such as worse baseline creatinine clearance or previous heart failure. Besides, Blanco et al also demonstrated frailty was associated with poorer outcomes in this scenario 20 . Indeed, patients with higher CHA 2 DS 2 ‐VASc Score were more often frail (patients in group 2 were twice as frail as those in group 1, with no differences regarding prefrailty) according to FRAIL scale, and they also showed worse functional, cognitive, and nutritional status on admission.…”

Section: Discussionmentioning

confidence: 90%

Baseline CHA ₂ DS ₂ ‐VASc score and prognosis in octogenarians with non‐ST segment elevation acute coronary syndrome

et al. 2021

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Background CHA2DS2‐VASc Score is widely used to predict thromboembolic risk in patients with Atrial Fibrillation (AF). We sought to study if this score predicts outcomes in elderly patients with Non‐ST segment Elevation Acute Coronary Syndromes (NSTEACS). Methods The multicenter LONGEVO‐SCA prospective registry included 532 unselected patients with NSTEACS aged ≥80 years. Data to calculate CHA2DS2‐VASc Score were available in 523 patients (98.3%). They were classified according to CHA2DS2‐VASc Score: group 1 (score ≤ 4), and 2 (5‐9). We studied outcomes in terms of mortality or readmission at 6 months follow‐up. Results A total of 266 patients (51%) had a high CHA2DS2‐VASc Score (group 2). They were more often women, with more cardiovascular risk factors, such as hypertension or diabetes mellitus, and history of previous stroke and cardiovascular disease and heart failure (all, P = .001). Geriatric syndromes (Barthel Index, Lawton Brody, cognitive impairment, and frailty) and Charlson Index were worse in this group (all, P = .001). They had poorer clinical status on admission, with worse Killip class and lower left ventricle ejection fraction (all, P = .001), and developed new‐onset AF more often during admission (12.4% vs. 6.6%, P = .024). At six months follow‐up, patients in group 2 had higher reinfarction, all‐cause mortality, and mortality or readmission rates. A CHA2DS2‐VASc Score > 4 was associated with mortality or readmission at 6 months (HR 2.07, P < .001). However, after adjusting for potential confounders, this last association was not significant (P = .175). Conclusions A CHA2DS2‐VASc Score > 4 is present in half of octogenarians with NSTEACS and is associated with poorer outcomes. However, it is not an independent predictor of events and should not replace recommended tools for risk prediction in this setting.

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Prognosis Impact of Frailty Assessed by the Edmonton Frail Scale in the Setting of Acute Coronary Syndrome in the Elderly

Cited by 44 publications

References 24 publications

<p>Frailty in Older Patients with Acute Coronary Syndrome in Vietnam</p>

<p>Frailty in Older Patients with Acute Coronary Syndrome in Vietnam</p>

Prognostic value of frailty in elderly patients with acute coronary syndrome: a systematic review and meta-analysis

Baseline CHA ₂ DS ₂ ‐VASc score and prognosis in octogenarians with non‐ST segment elevation acute coronary syndrome

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Prognosis Impact of Frailty Assessed by the Edmonton Frail Scale in the Setting of Acute Coronary Syndrome in the Elderly

Cited by 44 publications

References 24 publications

<p>Frailty in Older Patients with Acute Coronary Syndrome in Vietnam</p>

<p>Frailty in Older Patients with Acute Coronary Syndrome in Vietnam</p>

Prognostic value of frailty in elderly patients with acute coronary syndrome: a systematic review and meta-analysis

Baseline CHA 2 DS 2 ‐VASc score and prognosis in octogenarians with non‐ST segment elevation acute coronary syndrome

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Product

Resources

About

Baseline CHA ₂ DS ₂ ‐VASc score and prognosis in octogenarians with non‐ST segment elevation acute coronary syndrome