Abstract
Background
Information about the impact of frailty in patients with acute coronary syndromes
(ACS) is scarce. No study has assessed the prognostic impact of frailty as measured
by the FRAIL scale in very elderly patients with ACS.
Methods
The prospective multicenter LONGEVO-SCA registry included unselected patients with ACS aged 80 years or older. A comprehensive
geriatric assessment was performed during hospitalization, including frailty assessment
by the FRAIL scale. The primary endpoint was mortality at 6 months.
Results
A total of 532 patients were included. Mean age was 84.3 years, 61.7% male. Most patients
had positive troponin levels (84%) and high GRACE risk score values (mean 165). A
total of 205 patients were classified as prefrail (38.5%) and 145 as frail (27.3%).
Frail and prefrail patients had a higher prevalence of comorbidities, lower left ventricle
ejection fraction, and higher mean GRACE score value. A total of 63 patients (11.8%)
were dead at 6 months. Both prefrailty and frailty were associated with higher 6-month
mortality rates (P < .001). After adjusting for potential confounders, this association remained significant
(hazard ratio [HR] 2.71; 95% confidence interval [CI] 1.09–6.73 for prefrailty and
HR 2.99; 95% CI 1.20–7.44 for frailty, P = .024). The other independent predictors of mortality were age, Charlson Index,
and GRACE risk score.
Conclusions
The FRAIL scale is a simple tool that independently predicts mortality in unselected
very elderly patients with ACS. The presence of prefrailty criteria also should be
taken into account when performing risk stratification of these patients.
Keywords
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Article info
Publication history
Published online: November 16, 2017
Footnotes
The authors declare no conflicts of interest.
This paper has received funding from the Spanish Society of Cardiology (Proyectos de Investigación Clínica SEC 2015).
Members of the LONGEVO-SCA registry investigators are listed in Appendix 1.
Identification
Copyright
© 2017 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
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- Going Beyond the Mortality: The Forgotten Quality of Life in the Very ElderlyJournal of the American Medical Directors AssociationVol. 19Issue 6
- PreviewWe read with great interest the article by Alegre et al,1 who reported the prognostic impact of frailty measured by the Fatigue, Resistance, Ambulation, Illnesses, & Loss of Weight (FRAIL) scale in very elderly patients with acute coronary syndrome (ACS). The authors should be congratulated on this original article. Although the article is both exhaustive and clinically relevant, there is currently no information about the impact of frailty in the quality of life or in functional impairment in the very elderly patients with non-ST segment elevation acute coronary syndrome (NSTEACS) at 6 months.
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