Abstract
Objectives
No previous studies have assessed the role of the FRAIL scale in predicting long-term
outcomes in older patients with acute coronary syndromes (ACS).
Design, Setting and Participants
The multicenter observational LONGEVO-SCA registry included unselected patients ≥80 years of age with ACS from 44 centers.
A comprehensive geriatric assessment was performed during hospitalization.
Measures
Frailty was measured by the FRAIL scale. For the purpose of this study, main outcome
measured was mortality or readmission at 24 months.
Results
A total of 498 patients were included. Mean age was 84.3 years. A total of 198 patients
(33.1%) were prefrail and 135 (27.1%) frail. Patients who were prefrail and frail
had a higher degree of comorbidities, and higher prevalence of disability, cognitive
impairment, and nutritional risk. A total of 165 out of 498 patients (33.1%) died,
and 331 patients (66.7%) died or were readmitted at 24 months. Both prefrailty and
frailty were associated with a higher mortality compared with robust patients (P < .001). The incidence of mortality or readmission was also higher in patients who
were prefrail or frail (P < .001). After adjusting for potential confounders, the association between frailty
and mortality or readmission remained significant (hazard ratio 1.28 for prefrailty
and hazard ratio 1.96 for frailty, P < .001). The FRAIL scale showed an optimal ability for predicting mortality or readmission
(area under the receiver operating characteristics curve 0.86, 95% confidence interval
0.83‒0.89). The area under the receiver operating characteristics curve from the Global
Registry of Acute Coronary Events risk score was 0.89. No significant differences
were observed between both AUC values (P = .163).
Conclusions and Implications
The FRAIL scale independently predicted long-term outcomes in older patients with
ACS. The predictive ability of this scale was comparable to the strongly recommended
Global Registry of Acute Coronary Events risk score. Frailty assessment is mandatory
for improving risk prediction in these complex patients.
Keywords
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Article info
Publication history
Published online: November 26, 2019
Footnotes
The LONGEVO-SCA Project has received a grant from the Spanish Society of Cardiology.
The authors declare no conflicts of interest.
Identification
Copyright
© 2019 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
