Key result
High frailty in ACS is linked to ~234% higher in-hospital mortality versus low frailty.
Why the study?
Frailty predicts adverse outcomes, but data regarding its prevalence and treatment in patients with acute coronary syndrome remain limited.
Does high frailty increase in-hospital mortality and reduce the frequency of invasive treatment in patients hospitalized for acute coronary syndrome?
Observational (n=5,889,972)
Yes
Does high frailty increase in-hospital mortality and reduce the frequency of invasive treatment in patients hospitalized for acute coronary syndrome?
Effect estimate: adjusted OR 3.34 (95% CI 3.29-3.4)
Frailty, assessed by the Hospital Frailty Risk Score, is present in nearly one-sixth of ACS patients and is strongly associated with lower rates of invasive treatment and substantially higher in-hospital mortality.
May aid risk stratification in ACS; leaves open whether frailty modifies treatment effects or warrants dedicated trials.
Background: Frailty is a significant predictor for adverse outcomes. Yet, data on prevalence and treatment of frail patients with acute coronary syndrome (ACS) remains limited. We aimed to investigate frailty prevalence, interventional treatment frequency, and in-hospital outcome for all patients hospitalized for ACS in Germany from 2005 to 2022 and validate the Hospital Frailty Risk Score (HFRS) in this population. Methods: Data for 2005-2022 from the Statistical Federal Office included all cases with primary diagnosis of ACS treated in Germany. Patients were categorized into low, intermediate, and high frailty by HFRS. Diagnoses, procedures, and in-hospital outcomes were analyzed. Univariable and multivariable logistic regressions as well as sensitivity analyses were performed. Findings: Between 2005 and 2022, 5,889,972 ACS patients were hospitalized in Germany. Mean age was 69 years (standard deviation (SD) ± 12.85 years) and 2,060,224 (34.98%) were female. In-hospital mortality was 6.2%. Among all, 5,001,812 (84.9%) had a low, 784,106 (13.3%) an intermediate, and 104,054 (1.8%) a high HFRS. High-frailty patients were less likely to undergo coronary intervention than low-frailty patients (47.0% vs. 70.6%, p < 0.001), had longer hospital stays (21.6 days SD 19.4 ± vs. 5.6 days SD ± 5.2, p < 0.001), and higher in-hospital mortality (adjusted odds ratio (OR) 3.34 [confidence interval (95% CI) 3.29-3.4]). Interpretation: Nearly one-sixth of ACS-patients were frail according to HFRS. Frail patients had longer hospital stays, less often received interventional procedures, and showed substantially increased in-hospital mortality. In our aging population, frailty will play an increasing role in patient management. Frailty scores based on electronic patient records, like the HFRS, offer clinicians a tool for assessing in-hospital outcome in ACS patients, potentially enabling more individualized treatment approaches. Funding: None.
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Völschow et al. (2024) conducted an observational in Acute coronary syndrome (ACS) (n=5,889,972). High frailty (Hospital Frailty Risk Score) vs. Low frailty was evaluated on In-hospital mortality (adjusted OR 3.34, 95% CI 3.29-3.4). High frailty in patients hospitalized for acute coronary syndrome was associated with significantly higher in-hospital mortality compared to low frailty (adjusted OR 3.34; 95% CI 3.29-3.4).
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