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

Dou, Qingyu; Wang, Wen; Wang, Hui; Ma, Yao; Hai, Shan; Lin, Xiufang; Liu, Ying; Zhang, Xinjun; Wu, Jiarui; Dong, Birong

doi:10.1186/s12877-019-1242-8

Cited by 55 publications

(44 citation statements)

References 40 publications

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“…As expected, in our sample of older adults with pre-existing CHD our findings showed increased mortality as the rates and risk of frailty increase. These results are similar to those in CVD [12,16,25], acute coronary syndrome [31][32][33], and myocardial infarction [34], as well as after CVD interventions [35][36][37]. This lends credence to using the HFRS for observational research, or for applications with electronic medical records (EMR) to identify frailty using ICD-10-CM codes to determine who may be at greater risk for readmission or death.…”

Section: Resultssupporting

confidence: 59%

Hospital readmission and mortality: associations to a hospital frailty risk score in a national sample of US older adults with pre-existing coronary heart disease, an observational study.

Davis–Ajami¹,

Chang²,

Wu³

2020

Preprint

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Background Coronary heart disease (CHD) is the most common form of heart disease and a leading cause of death in cardiovascular disease (CVD). Although frailty has been studied in CVD, a condition encompassing heart disease and stroke, frailty in hospitalized elders with CHD is under researched. The study aimed to examine how a Hospital Frailty Risk Score (HFRS) influenced readmission and in-hospital mortality rates in older patients with CHD.Methods Adults > 65 years with pre-existing CHD identified by ICD-10-CM codes from the 2016 Nationwide Readmissions Database (NRD) were included in the study. Frailty risk was determined using a validated Hospital Frailty Risk Score (HFRS) based on ICD-10-CM codes. Readmission was defined as a) any subsequent inpatient readmission and b) 30-day readmission after an index event. In-hospital mortality was measured as death during index event, any readmission death, and death during a 30-day readmission.Results Frailty risk was identified in 92.4% of the 1.09 million eligible adults with CHD. Readmission and in-hospital mortality rates were higher in frail patients. Compared to the non-frail, patients with low, intermediate, and high frailty risk showed 27% vs 28%, 47% vs 49%, and 42% vs 49% greater risk for readmission and 30-day readmission, respectively. Patients with intermediate and high frailty risk were 2.31 and 3.44 times more likely to die during the index events, 2.15 and 2.44 times more likely to die during readmission, and 2.26 and 2.68 times more likely to die during 30-day readmission.Conclusion Readmission and mortality rates increased proportionally to the level of frailty risk in older adults with CHD. CHD, frailty, and older age together profoundly impact patients’ health outcomes in negative ways and places patients at a higher risk of mortality and readmission rate than non-frail patients. Further research should investigate interventions to improve frailty risk in CHD.

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Section: Resultssupporting

confidence: 59%

Hospital readmission and mortality: associations to a hospital frailty risk score in a national sample of US older adults with pre-existing coronary heart disease, an observational study.

Davis–Ajami¹,

Chang²,

Wu³

2020

Preprint

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“…Previous studies showed that frailty was associated with longer length of stay, in-hospital complications and short-term mortality. 20,50 Notably, acquired pneumonia was the second most common adverse event during hospitalisation in the studied participants (24.4% overall, 13.7% in the non-frail and 35.9% in the frail). Frailty is a complex process that involves multiple system impairments, including the immune system.…”

Section: Discussionmentioning

confidence: 94%

<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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“…Frailty is defined as a clinically recognizable state of increased vulnerability, resulting from aging-associated decline in reserve and function across multiple physiologic systems [20][21][22][23]. In the absence of a gold standard, frailty has been operationally defined by Fried et al [22] as a condition meeting 3 of the 5 phenotypic criteria indicating compromised energetics, namely, low grip strength, low energy, slowed waking speed, low physical activity, and unintentional weight loss [21].…”

Section: Discussionmentioning

confidence: 99%

Psoas Muscle Area Measured with Computed Tomography at Admission to Intensive Care Unit: Prediction of In-Hospital Mortality in Patients with Pulmonary Embolism

Akkoç

Toptaş

Yalcin

et al. 2020

BioMed Research International

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Aim. Sarcopenia, a core component of physical frailty, is an independent risk factor for suboptimal health outcomes in hospitalized patients, especially in the intensive care patients. Psoas muscle areas can be assessed to identify sarcopenia. The aim of this study was to determine the prognostic value of psoas muscle area measured with CT for the prediction of in-hospital mortality in patients with pulmonary embolism at admission to the intensive care unit. Methods. Patients with an admission abdominal computed tomography scan and requiring intensive care unit (ICU) stay were reviewed. Selected clinical data of patients admitted to intensive care unit for the management of pulmonary embolism were collected. Using CT scan images at the level of L3 vertebra, the psoas muscle area value was obtained by dividing the sum of the right and left psoas muscle areas into the body surface area. Results. In-hospital mortality rate was 22.5% in 89 patients. The pulmonary embolism patients with in-hospital mortality had higher PESI and lower value of psoas muscle area, in addition to the lower systolic blood pressure and arterial oxygen saturation at admission. The increase in the value of psoas muscle area is associated with a decrease in the rate of in-hospital mortality. In patients with in-hospital mortality related to pulmonary embolism, the higher PESI and the lower value of psoas muscle area were considered in accordance with the outcome of patients. Conclusions. For the prediction of in-hospital mortality risk in patients with pulmonary embolism managed in intensive care unit, the psoas muscle area value has a merit to be used among the routine diagnostic procedures after further studies conducted with different severity of pulmonary embolism.

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

Cited by 55 publications

References 40 publications

Hospital readmission and mortality: associations to a hospital frailty risk score in a national sample of US older adults with pre-existing coronary heart disease, an observational study.

Hospital readmission and mortality: associations to a hospital frailty risk score in a national sample of US older adults with pre-existing coronary heart disease, an observational study.

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

Psoas Muscle Area Measured with Computed Tomography at Admission to Intensive Care Unit: Prediction of In-Hospital Mortality in Patients with Pulmonary Embolism

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