The impact of patient-reported frailty on cardiovascular outcomes in elderly patients after non-ST-acute coronary syndrome.

Autor: van den Broek WWA; St. Antonius Hospital, Department of Cardiology, Nieuwegein, the Netherlands., Gimbel ME; St. Antonius Hospital, Department of Cardiology, Nieuwegein, the Netherlands., Hermanides RS; Isala Hospital, Department of Cardiology, Zwolle, the Netherlands., Runnett C; Northumbria Healthcare NHS Foundation Trust, Department of Cardiology, Newcastle, United Kingdom., Storey RF; University of Sheffield, Division of Clinical Medicine, Sheffield, United Kingdom., Knaapen P; Amsterdam University Medical Centre, Department of Cardiology, Amsterdam, the Netherlands., Emans ME; Ikazia Hospital, Department of Cardiology, Rotterdam, the Netherlands., Oemrawsingh RM; Albert Schweitzer Hospital, Department of Cardiology, Dordrecht, the Netherlands., Cooke J; Chesterfield Royal Hospital NHS Foundation Trust, Department of Cardiology, Chesterfield, United Kingdom., Galasko G; Blackpool Teaching Hospital NHS Foundation Trust, Department of Cardiology, Blackpool, United Kingdom., Walhout R; Gelderse Vallei Hospital, Department of Cardiology, Ede, the Netherlands., Stoel MG; Medisch Spectrum Twente, Department of Cardiology, Enschede, the Netherlands., von Birgelen C; Medisch Spectrum Twente, Department of Cardiology, Enschede, the Netherlands; University of Twente, Department of Health Technology and Services Research, Technical Medical Centre, Enschede, the Netherlands., van Bergen PFMM; Dijklander Hospital, Department of Cardiology, Maelsonstraat 3, 1624 NP Hoorn, the Netherlands., Brinckman SL; Department of Cardiology, Tergooi MC, Blaricum, the Netherlands., Aksoy I; Admiraal de Ruyter Hospital, Department of Cardiology, Goes, the Netherlands., Liem A; Franciscus Gasthuis, Department of Cardiology, Rotterdam, the Netherlands., Van't Hof AWJ; Cardiovascular Research Institute Maastricht (CARIM), Maastricht, the Netherlands; Zuyderland Medical Centre, Department of Cardiology, Heerlen, the Netherlands., Jukema JW; Leids University Medical Centre, Department of Cardiology, Leiden, the Netherlands., Heestermans AACM; Department of Cardiology, Noordwest Hospital Group, Alkmaar, the Netherlands., Nicastia D; Department of Cardiology, Gelre Hospital, Apeldoorn, the Netherlands., Alber H; KABEG Klinikum, Department for Internal Medicine and Cardiology, Klagenfurt am Wörthersee, Austria., Austin D; The James Cook University Hospital, Academic Cardiovascular Unit, Middlesbrough, United Kingdom., Nasser A; South Tyneside and Sunderland NHS Foundation Trust, Department of Cardiology, South Shields, United Kingdom., Deneer V; Department of Clinical Pharmacy, Division of Laboratories, Pharmacy, and Biomedical Genetics, University Medical Center Utrecht, Utrecht, the Netherlands; Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, the Netherlands., Ten Berg JM; St. Antonius Hospital, Department of Cardiology, Nieuwegein, the Netherlands; Cardiovascular Research Institute Maastricht (CARIM), Maastricht, the Netherlands. Electronic address: jurtenberg@gmail.com.
Jazyk: angličtina
Zdroj: International journal of cardiology [Int J Cardiol] 2024 Jun 15; Vol. 405, pp. 131940. Date of Electronic Publication: 2024 Mar 07.
DOI: 10.1016/j.ijcard.2024.131940
Abstrakt: 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.
Competing Interests: Declaration of competing interest JtB report grants from the Netherlands Organization for Health Research and Development, a Dutch government institution called ZonMw, and AstraZeneca; and personal fees from AstraZeneca, Boehinger Ingelheim, Bayer, Ferrer, Pfizer, and Merck, outside the submitted work. RFS reports research grants and personal fees from AstraZeneca, Cytosorbents and GlyCardial Diagnostics; and personal fees from Alfasigma, Alnylam, Bayer, Bristol Myers Squibb/Pfizer, Chiesi, CSL Behring, Daiichi Sankyo, HengRui, Idorsia, Intas Pharmaceuticals, Medscape, Novartis, Novo Nordisk, PhaseBio, Portola and Sanofi Aventis. DA reports research grants from TA Sciences, and personal fees from Philips/Volcano, Pfizer, Astra Zeneca and Novartis. AvH reports unrestricted grants to institution from Medtronic, AZ, Boehringer Ingelheim, Abbott. CvB reports no personal fees; institutional research grants to the research department of Thoraxcentrum Twente from Abbott Vascular, Biotronik, Boston Scientific, and Medtronic, outside the submitted work. VD report grants from the Netherlands Organization for Health Research and Development, a Dutch government institution called ZonMw. All other authors do not report any relationships that could be construed as a conflict of interest.
(Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)
Databáze: MEDLINE
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