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Is frailty a prognostic factor for adverse outcomes in older patients with acute coronary syndrome?

  • Shaomin Zhang
  • Hongdao Meng
  • Qian Chen
  • Xiaoling Wang
  • Jiatong Zou
  • Qiukui Hao
  • Ming YangEmail author
  • Jinhui WuEmail author
Review
  • 42 Downloads

Abstract

Background

There is very limited guidance in regard to how biological age should be estimated and how different comorbidity conditions influence the benefit–risk ration of interventions. Frailty is an important health-related problem in patients, especially in older adults. It is a reflection of biologic rather than chronologic age; frailty may explain why there remains substantial heterogeneity in clinical outcomes within the older patients’ population.

Aims

We aimed to review the prognostic value of frailty for adverse outcomes in older patients with acute coronary syndrome (ACS).

Methods

Studies published until December 31, 2018, identified by systematic Medline, Embase, and Cochrane Controlled Register of Trials (CENTRAL) searches were reviewed for the association between frailty and mortality in older patients with ACS. We used the Newcastle–Ottawa Quality Assessment Scale to assess the quality of the included studies. We extracted the information of hazard ratios (HR) and odds ratios (OR) with accompanying 95% confidence intervals (CI), and P values of multivariable analysis. Heterogeneity across studies was determined using the Cochran Q value by Review Manager 5.3.

Results

A total of 11 articles involving 7212 patients were included in this meta-analysis. Two studies (Sujino, Y 2015 and Alonso, S.GL 2016; n = 264) reported that frailty was significantly associated with in-hospital mortality in patients with ACS (range of reported OR between 6.38 and 12.0). We performed a subgroup analysis of the other nine studies based on differences in the follow-up time. Pooled meta-analysis demonstrates that frailty was associated with short-term, medium-term, and long-term mortality (HR = 3.67, 4.09, 1.66). There was no association between frailty and bleeding in older patients with ACS.

Conclusions

Frailty measured by Canadian Study of Health and Aging Clinical Frailty Scale (CSHA-CFS), the Edmonton Frail Scale (EFS), Fried score, Green scores, frailty instrument from the Survey of Health, Ageing and Retirement in Europe (SHARE-FI) index, and FRAIL (Fatigue, Resistance, Ambulation, Illnesses, Loss of weight) scale, leads to significantly higher mortality rates in older patients with ACS.

Keywords

Frailty Mortality Acute coronary syndrome 

Notes

Funding

The authors gratefully acknowledge the financial support provided by National Key R&D Program of China (No. 2018YFC2002100 and no. 2018YFC2002103).

Compliance with ethical standards

Conflict of interest

No conflict of interest exists in the submission of this manuscript and the manuscript is approved by all the authors for publication.

Statement of human and animal rights

Not applicable.

Informed consent

All authors gave their informed consent prior to their inclusion in the present study.

Supplementary material

40520_2019_1311_MOESM1_ESM.doc (20 kb)
Supplementary material 1 (DOC 19 kb)

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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.The Center of Gerontology and Geriatrics, West China HospitalSichuan UniversityChengduChina
  2. 2.University of South FloridaTampaUSA

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