Niklas Ekerstad1,2, Staffan Pettersson3, Karen Alexander4, David Andersson5, Sofia Eriksson3, Magnus Janzon3, Marcus Lindenberger3, Eva Swahn3, Joakim Alfredsson3. 1. 1 Department of Medical and Health Sciences, Linköping University, Sweden. 2. 2 Department of Cardiology, NU (NÄL-Uddevalla) Hospital Group, Sweden. 3. 3 Department of Cardiology and Department of Medical and Health Sciences, Linköping University, Sweden. 4. 4 Department of Medicine, Duke Clinical Research Institute, USA. 5. 5 Department of Management and Engineering, Linköping University, Sweden.
Abstract
BACKGROUND: There is a growing body of evidence on the relevance of using frailty measures also in a cardiovascular context. The estimated time to death is crucial in clinical decision-making in cardiology. However, data on the importance of frailty in long-term mortality are very scarce. The aim of the study was to assess the prognostic value of frailty on mortality at long-term follow-up of more than 5 years in patients 75 years or older hospitalised for non-ST-segment elevation myocardial infarction. We hypothesised that frailty is independently associated with long-term mortality. DESIGN: This was a prospective, observational study conducted at three centres. METHODS AND RESULTS: Frailty was assessed according to the Canadian Study of Health and Aging clinical frailty scale (CFS). Of 307 patients, 149 (48.5%) were considered frail according to the study instrument (degree 5-7 on the scale). The long-term all-cause mortality of more than 5 years (median 6.7 years) was significantly higher among frail patients (128, 85.9%) than non-frail patients (85, 53.8%), ( P < 0.001). In Cox regression analysis, frailty was independently associated with mortality from the index hospital admission to the end of follow-up (hazard ratio 2.06, 95% confidence interval 1.51-2.81; P < 0.001) together with age ( P < 0.001), ejection fraction ( P = 0.012) and Charlson comorbidity index ( P = 0.018). CONCLUSIONS: In elderly non-ST-segment elevation myocardial infarction patients, frailty was independently associated with all-cause mortality at long-term follow-up of more than 6 years. The combined use of frailty and comorbidity may be the ultimate risk prediction concept in the context of cardiovascular patients with complex needs.
BACKGROUND: There is a growing body of evidence on the relevance of using frailty measures also in a cardiovascular context. The estimated time to death is crucial in clinical decision-making in cardiology. However, data on the importance of frailty in long-term mortality are very scarce. The aim of the study was to assess the prognostic value of frailty on mortality at long-term follow-up of more than 5 years in patients 75 years or older hospitalised for non-ST-segment elevation myocardial infarction. We hypothesised that frailty is independently associated with long-term mortality. DESIGN: This was a prospective, observational study conducted at three centres. METHODS AND RESULTS: Frailty was assessed according to the Canadian Study of Health and Aging clinical frailty scale (CFS). Of 307 patients, 149 (48.5%) were considered frail according to the study instrument (degree 5-7 on the scale). The long-term all-cause mortality of more than 5 years (median 6.7 years) was significantly higher among frail patients (128, 85.9%) than non-frail patients (85, 53.8%), ( P < 0.001). In Cox regression analysis, frailty was independently associated with mortality from the index hospital admission to the end of follow-up (hazard ratio 2.06, 95% confidence interval 1.51-2.81; P < 0.001) together with age ( P < 0.001), ejection fraction ( P = 0.012) and Charlson comorbidity index ( P = 0.018). CONCLUSIONS: In elderly non-ST-segment elevation myocardial infarctionpatients, frailty was independently associated with all-cause mortality at long-term follow-up of more than 6 years. The combined use of frailty and comorbidity may be the ultimate risk prediction concept in the context of cardiovascularpatients with complex needs.
Authors: Michał Węgiel; Paweł Kleczyński; Artur Dziewierz; Łukasz Rzeszutko; Andrzej Surdacki; Stanisław Bartuś; Tomasz Rakowski Journal: J Cardiovasc Dev Dis Date: 2022-05-05
Authors: Benjamin Beska; Greg B Mills; Hanna Ratcovich; Chris Wilkinson; Abdulla A Damluji; Vijay Kunadian Journal: BMJ Open Date: 2022-07-26 Impact factor: 3.006