Dataset Information

The impact of frailty on in-hospital complications in elderly patients with acute coronary syndrome.

ABSTRACT:

Background

Acute coronary syndrome (ACS) is linked to a range of in-hospital complications, and age is recognized as risk factor for adverse events. Discrepancies between physiological and chronological age are explained by frailty. However, the relationship between frailty and in-hospital complications is not clear.

Methods

Assessment of frailty in patients was carried out using the FRAIL scale. In-hospital complications assessed included, bleeding, infection, arrhythmia, acute kidney injury (AKI), delirium, stroke/transient ischemic attack (TIA), liver injury, hypoglycemia, length of stay in the cardiac care unit (CCU).

Results

Of the 174 patients, frailty was identified in 39.1% and pre-frailty in 29.9%. Frailty was associated with a higher incidence of all types of bleeding (frail vs. robust: 45.5% vs. 16.7%, P < 0.001) and infection (54.4% vs. 11.1%, P < 0.001), including pneumonia/lower respiratory tract infections (LRTI) and urinary tract infections (UTI). Incidence of antibiotic therapy (52.9% vs. 13.0%, P < 0.001), atrial fibrillation (AF) (47.1% vs. 9.3%, P < 0.001), AKI (57.3% vs. 20.4%, P < 0.001), delirium (52.9% vs. 3.7%, P < 0.001), liver injury, were higher in frail patients (17.6% vs. 0, P = 0.001), whilst their length of stay in the CCU was longer (4 days (2-6.5) vs. 2 days (2-3), P < 0.001). Infections, pneumonia/LRTI, antibiotic therapy during hospitalization, the incidence of AF and liver injury were more often in patients with pre-frailty compared to the robust group. After adjustment for potential confounders, frailty remained independently associated with an increased risk of infection (OR: 3.3 [1.6-7.0]), including pneumonia/LRTI (OR: 2.5 [1.1-5.8]) and UTI (OR: 4.8 [1.8-12.5]). Frail individuals had an increased requirement for antibiotic therapy (OR: 3.9 [1.9-8.1]), and greater risk of AF (OR: 3.5 [1.3-9.3]), AKI (OR: 2.6 [1.2-5.3]) delirium (OR: 11.7 [4.8-28.7]), as well as having to stay longer in the CCU (> 3 days) (OR: 3.7 [1.9-7.3]).

Conclusions

Frailty was associated with an increased risk of numerous in-hospital complications in elderly patients who had been hospitalized with ACS.

SUBMITTER: Nowak W

PROVIDER: S-EPMC10114198 | biostudies-literature | 2023 Mar

REPOSITORIES: biostudies-literature

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Publications

The impact of frailty on in-hospital complications in elderly patients with acute coronary syndrome.

Nowak Wojciech W Kowalik Ilona I Nowicki Michał M Cichocki Tomasz T Stępińska Janina J

Journal of geriatric cardiology : JGC 20230301 3

<h4>Background</h4>Acute coronary syndrome (ACS) is linked to a range of in-hospital complications, and age is recognized as risk factor for adverse events. Discrepancies between physiological and chronological age are explained by frailty. However, the relationship between frailty and in-hospital complications is not clear.<h4>Methods</h4>Assessment of frailty in patients was carried out using the FRAIL scale. In-hospital complications assessed included, bleeding, infection, arrhythmia, acute k ...[more]

PMID: 37091258

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Project description:IntroductionWith the implementation of early reperfusion therapy, the number of complications in patients with acute coronary syndrome (ACS) has diminished significantly. However, ACS patients are still routinely admitted to units with high-level monitoring such as the coronary or intensive care unit (CCU/ICU). The cost of these admissions is high and there is often a shortage of beds. The aim of this study was to analyze the complications in contemporary emergency department (ED) patients with ACS and to map patient management.MethodsThis observational study was a secondary analysis of data collected in the ESC-TROP trial (NCT03421873) that included 26,545 consecutive chest pain patients ≥18 years at five Swedish EDs. Complications were defined as the following within 30 days: death, cardiac arrest, cardiogenic shock, pulmonary edema, severe ventricular arrhythmia, high-degree atrioventricular (AV) block that required a pacemaker, and mechanical complications such as papillary muscle rupture, cardiac tamponade, or ventricular septum defects (VSDs). Complications were identified via diagnosis and/or intervention codes in the database, and manual chart review was performed in cases with complications.ResultsOf all 26,545 patients, 2,463 (9.3%) were diagnosed with ACS, and 151 of these (6.1%) suffered any complication within 30 days. Mean age was higher in patients with (79.2 years) than without (69.4 years) complications, and more were female (39.7% vs. 33.0%). Eighty-four (3.4% of all ACS patients) patients died, 33 (1.3%) had cardiac arrest, 22 (0.9%) respiratory failure, 13 (0.5%) high-degree AV block, 10 (0.4%) cardiogenic shock, 12 (0.5%) severe ventricular arrhythmia, and 2 each (<0.1%) had VSD or cardiac tamponade. Almost 30% of the complications were present already at the ED, and 40% of patients with complications were not admitted to the CCU/ICU. Only 80 (53%) of the patients with complications underwent coronary angiography and 62 (41%) were revascularized with percutaneous coronary intervention or coronary artery bypass grafting.ConclusionWith current care, serious complications occurred in only 6 out of 100 ACS patients, and 2 of these complications were present already at the ED. Four out of 10 ACS patients with complications were not admitted to the CCU/ICU and about half did not undergo coronary angiography. Further research is needed to improve risk assessment in ED ACS patients, which may allow more effective use of cardiac monitoring and hospital resources.

Project description:BackgroundWe aimed to compare the agreement between two common frailty assessment tools, Clinical Frailty Scale (CFS) and Hospital Frailty Risk Score (HFRS), and their ability to predict mid-term adverse outcomes in older patients admitted with acute coronary syndrome (ACS).MethodsWe conducted a prospective analysis of patients aged ≥ 60 admitted with ACS at multiple centers in Vietnam between July 2022 and June 2023. A cross-tabulation method was used to describe the correlation between CFS and HFRS. To test the predictive accuracy of HFRS for identifying patients with frailty according to CFS, we evaluated the area under the curves of receiver operating characteristic (ROC) analysis. Youden J index was used to identify a new optimal probability threshold for HFRS. We employed Cox regression models to investigate the association between frailty assessed by CFS, HFRS (using both old and new cut-offs), and 9-month mortality.ResultsWe included 504 older patients admitted with ACS (median age 72.7 years; male: 59.9%). The correlation between CFS and HFRS was fair (AUC = 0.787, p < 0.010). HFRS had a sensitivity of 39.7% and a specificity of 79.2% to detect frailty based on CFS classification. The new optimal probability threshold of HFRS (≥ 1.15 points) improved the instrument's performance with a significantly higher sensitivity of 90.2%. While frailty categorized by HFRS with the original cut-off did not impact mid-term all-cause and cardiovascular mortality, frailty according to CFS and HFRS with the new threshold was shown to be a predictor of mid-term all-cause and cardiovascular mortality (HR = 4.48, p < 0.001 vs. HR = 2.29, p = 0.001; HR = 5.19, p < 0.001 vs. HR = 1.99, p = 0.020).ConclusionsAlthough a fair correlation existed between the CFS and the HFRS in older patients with ACS, HFRS demonstrated limited predictive validity for mid-term mortality. We advocate for a revised cutoff (HFRS ≥ 1.15 points) to enhance its sensitivity and predictive accuracy. Future research should prioritize the integration of additional clinical biomarkers and conducting longitudinal studies to assess the efficacy of targeted interventions informed by frailty scores, ultimately striving to improve outcomes in this vulnerable population.

Dataset Information

The impact of frailty on in-hospital complications in elderly patients with acute coronary syndrome.

Background

Methods

Results

Conclusions

Publications

The impact of frailty on in-hospital complications in elderly patients with acute coronary syndrome.

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