Update on Frailty Original Article| Volume 19, ISSUE 4, P296-303, April 2018

An Easy Assessment of Frailty at Baseline Independently Predicts Prognosis in Very Elderly Patients With Acute Coronary Syndromes

Published:November 16, 2017DOI:



      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.


      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.


      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.


      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.


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      Linked Article

      • Going Beyond the Mortality: The Forgotten Quality of Life in the Very Elderly
        Journal of the American Medical Directors AssociationVol. 19Issue 6
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          We 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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