What is the clinical evidence from this study?

Study design: Meta-Analysis. Population: Acute coronary syndrome (ACS) (n=8554). Intervention: Frailty vs. Normal/robust group. Primary outcome: Adjusted all-cause mortality (HR 2.65, 95% CI 1.81-3.89).

August 15, 2019Open Access

Prognostic value of frailty in elderly patients with acute coronary syndrome: a systematic review and meta-analysis

Key Result

Frailty was associated with a significantly higher adjusted risk of all-cause mortality (HR 2.65) compared to robust patients among elderly individuals with acute coronary syndrome.

Study Design

Type

Meta-Analysis (n=8,554)

Multicenter

Yes

Structured PICO

Does frailty predict mortality and adverse events in elderly patients with acute coronary syndrome?

Population

8,554 elderly patients (age ≥65 years) with acute coronary syndrome (ACS) pooled from 15 studies (13 individual cohorts).

Intervention

Frailty (assessed by various tools including CSHA-CFS, SHARE-FI, Green Score, EFS, Fried Frailty score, FRAIL scale)

Comparator

Robust/non-frail patients

Outcome

All-cause mortality, cardiovascular disease (CVD) (re-infarction and stroke/TIA), major bleeding, and readmissionshard clinical

Frailty provides significant prognostic value for mortality, cardiovascular events, major bleeding, and readmissions in elderly patients with acute coronary syndrome.

Main Result

Effect estimate: HR 2.65 (95% CI 1.81-3.89)

Limitations

Insufficient data to detect statistical differences between subgroups according to type of ACS and follow-up time.
Heterogeneity in age inclusion criteria, with some studies recruiting only participants older than 80 or 85 years.
None of the included studies reported results concerning quality of life or activities of daily living (ADL).

Abstract

BACKGROUND: Frailty is common and associated with poorer outcomes in the elderly, but its prognostic value in acute coronary syndromes (ACS) requires clarification. We thus undertook a systematic review and meta-analysis to evaluate the relationship between frailty and poor prognosis in patients with ACS. METHODS: We systematically searched PubMed, Embase to find literatures which studied the prognostic value of frailty in elderly patients with ACS. Our main endpoints were the all-cause mortality, cardiovascular disease (CVD), major bleeding and readmissions. We pooled studies using random-effect generic inverse variance method, and conducted three pre-specified subgroup analyses. RESULTS: = 0%) were characterized by a higher risk of mortality after adjustment. Frailty also was associated with increased risk of any-type CVD, major bleeding and hospital readmissions in elderly patients with ACS. The pooled effect sizes in frail patients were 1.54 (95%CI: 1.32-1.79), 1.51 (95%CI: 1.14-1.99) and 1.51 (95%CI: 1.09-2.10). CONCLUSIONS: Frailty provides quantifiable and significant prognostic value for mortality and adverse events in elderly ACS patients, helping doctors to appraise the comprehensive prognosis risk and to applicate appropriate management strategies.

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