Abstract
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.
Original language | English |
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Article number | 131940 |
Journal | International Journal of Cardiology |
Volume | 405 |
Early online date | 7 Mar 2024 |
DOIs | |
Publication status | Published - 15 Jun 2024 |
Bibliographical note
Publisher Copyright:© 2024 The Authors
Funding
The POPular Age trial (NCT02317198) was supported by ZonMw (grant number 836011016) and the POPular Age Registry by AstraZeneca (grant number ESR-16-11872) and the St. Antonius Research fund (no grant number) .
Funders | Funder number |
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St. Antonius Research fund | |
ZonMw | 836011016 |
ZonMw | |
AstraZeneca | ESR-16-11872 |
AstraZeneca |
Keywords
- Antiplatelet therapy
- Cardiovascular outcomes
- Coronary artery disease
- Elderly
- Frailty
- Non-ST-elevation acute coronary syndrome