Is frailty a prognostic factor for adverse outcomes in older patients with acute coronary syndrome?
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REVIEW
Is frailty a prognostic factor for adverse outcomes in older patients with acute coronary syndrome? Shaomin Zhang1 · Hongdao Meng2 · Qian Chen1 · Xiaoling Wang1 · Jiatong Zou1 · Qiukui Hao1 · Ming Yang1 · Jinhui Wu1 Received: 25 July 2019 / Accepted: 6 August 2019 © Springer Nature Switzerland AG 2019
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
Ming Yang and Jinhui Wu have contributed equally to this work. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s40520-019-01311-6) contains supplementary material, which is available to authorized users. * Ming Yang [email protected] * Jinhui Wu [email protected] 1
The Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu 610041, China
University of South Florida, T
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