TY - JOUR
T1 - The impact of patient-reported frailty on cardiovascular outcomes in elderly patients after non-ST-acute coronary syndrome
AU - van den Broek, W W A
AU - Gimbel, M E
AU - Hermanides, R S
AU - Runnett, C
AU - Storey, R F
AU - Knaapen, P
AU - Emans, M E
AU - Oemrawsingh, R M
AU - Cooke, J
AU - Galasko, G
AU - Walhout, R
AU - Stoel, M G
AU - von Birgelen, C
AU - van Bergen, Paul F M M
AU - Brinckman, S L
AU - Aksoy, I
AU - Liem, A
AU - Van't Hof, A W J
AU - Jukema, J W
AU - Heestermans, A A C M
AU - Nicastia, D
AU - Alber, H
AU - Austin, D
AU - Nasser, A
AU - Deneer, V
AU - Ten Berg, J M
PY - 2024/6/15
Y1 - 2024/6/15
N2 - BACKGROUND: As life expectancy increases, the population of older individuals with coronary artery disease and frailty is growing. We aimed to assess the impact of patient-reported frailty on the treatment and prognosis of elderly early survivors of non-ST-elevation acute coronary syndrome (NSTE-ACS). METHODS: Frailty data were obtained from two prospective trials, POPular Age and the POPular Age Registry, which both assessed elderly NSTE-ACS patients. Frailty was assessed one month after admission with the Groningen Frailty Indicator (GFI) and was defined as a GFI-score of 4 or higher. In these early survivors of NSTE-ACS, we assessed differences in treatment and 1-year outcomes between frail and non-frail patients, considering major adverse cardiovascular events (MACE, including cardiovascular mortality, myocardial infarction, and stroke) and major bleeding. RESULTS: The total study population consisted of 2192 NSTE-ACS patients, aged =70?years. The GFI-score was available in 1320 patients (79?±?5?years, 37% women), of whom 712 (54%) were considered frail. Frail patients were at higher risk for MACE than non-frail patients (9.7% vs. 5.1%, adjusted hazard ratio [HR] 1.57, 95% confidence interval [CI] 1.01-2.43, p?=?0.04), but not for major bleeding (3.7% vs. 2.8%, adjusted HR 1.23, 95% CI 0.65-2.32, p?=?0.53). Cubic spline analysis showed a gradual increase of the risk for clinical outcomes with higher GFI-scores. CONCLUSIONS: In elderly NSTE-ACS patients who survived 1-month follow-up, patient-reported frailty was independently associated with a higher risk for 1-year MACE, but not with major bleeding. These findings emphasize the importance of frailty screening for risk stratification in elderly NSTE-ACS patients.
AB - BACKGROUND: As life expectancy increases, the population of older individuals with coronary artery disease and frailty is growing. We aimed to assess the impact of patient-reported frailty on the treatment and prognosis of elderly early survivors of non-ST-elevation acute coronary syndrome (NSTE-ACS). METHODS: Frailty data were obtained from two prospective trials, POPular Age and the POPular Age Registry, which both assessed elderly NSTE-ACS patients. Frailty was assessed one month after admission with the Groningen Frailty Indicator (GFI) and was defined as a GFI-score of 4 or higher. In these early survivors of NSTE-ACS, we assessed differences in treatment and 1-year outcomes between frail and non-frail patients, considering major adverse cardiovascular events (MACE, including cardiovascular mortality, myocardial infarction, and stroke) and major bleeding. RESULTS: The total study population consisted of 2192 NSTE-ACS patients, aged =70?years. The GFI-score was available in 1320 patients (79?±?5?years, 37% women), of whom 712 (54%) were considered frail. Frail patients were at higher risk for MACE than non-frail patients (9.7% vs. 5.1%, adjusted hazard ratio [HR] 1.57, 95% confidence interval [CI] 1.01-2.43, p?=?0.04), but not for major bleeding (3.7% vs. 2.8%, adjusted HR 1.23, 95% CI 0.65-2.32, p?=?0.53). Cubic spline analysis showed a gradual increase of the risk for clinical outcomes with higher GFI-scores. CONCLUSIONS: In elderly NSTE-ACS patients who survived 1-month follow-up, patient-reported frailty was independently associated with a higher risk for 1-year MACE, but not with major bleeding. These findings emphasize the importance of frailty screening for risk stratification in elderly NSTE-ACS patients.
KW - Antiplatelet therapy
KW - Cardiovascular outcomes
KW - Coronary artery disease
KW - Elderly
KW - Frailty
KW - Non-ST-elevation acute coronary syndrome
U2 - 10.1016/j.ijcard.2024.131940
DO - 10.1016/j.ijcard.2024.131940
M3 - Article
SN - 0167-5273
VL - 405
JO - International Journal of Cardiology
JF - International Journal of Cardiology
M1 - 131940
ER -