Key result
High frailty assessed by the Edmonton Frail Scale was associated with a 5-fold increased risk of all-cause mortality compared to low frailty in older patients with acute coronary syndrome.
Why the study?
Recognising frailty guides clinical decisions in older patients with cardiac disease, but the relative strengths of different frailty instruments to predict mortality and hospitalization risk are uncertain.
Do different frailty instruments accurately predict mortality and hospitalization risk in older patients with acute coronary syndrome?
Cohort (n=1,174)
Yes
Do different frailty instruments accurately predict mortality and hospitalization risk in older patients with acute coronary syndrome?
Hazard Ratio: 5 (95% CI 3.4–7.4)
Absolute Event Rate: 46.2% vs 10.9%
The Edmonton Frail Scale discriminated the risk of mortality and hospitalization as well or better than other frailty instruments in older patients with acute coronary syndrome.
Edmonton Frail Scale may aid mortality risk stratification in older ACS patients; leaves open optimal tool selection and management impact.
Background Recognising frailty is important to guide clinical decisions in older patients with cardiac disease. The relative strengths of different frailty instruments to predict mortality and hospitalization risk are uncertain. Methods The Edmonton Frail Scale (EFS), Fried Criteria (Fried), Clinical Frailty Scale (CFS), Katz score (Katz), GP Cognition test (GPCog), and Euroscore II a disease based risk score, were completed in 1174 clinically stable inpatients >70 years of age admitted with an acute coronary syndrome to 5 New Zealand hospitals. Associations with all cause mortality (n=353, 29%) during a median follow-up of 5.1 (IQR: 4.6-5.5) years and hospitalization for > 10 days in the next year (n=267, 22%) were evaluated. Results There were graded associations between increasing frailty assessed by each tool and all cause mortality. For the EFS, which scores up to 17 points on different dimensions of frailty, hazard ratios for high (score 9-17, n=197) compared to low frailty (score 0-2, n=331) were 5.0 (95%CI: 3.4-7.4) for mortality, and 5.3 (3.4-8.3) for hospitalization. Discrimination for all-cause mortality according to Harrell’s C-index for each instrument were EFS 0.663, Euroscore II 0.654, Fried 0.648, CFS 0.640, GPCog 0.608, and Katz 0.593, P<0.001 for all. C-statistics for hospitalization >10 days were EFS 0.649, Fried 0.628, Katz 0.602, Euroscore II 0.589, CFS 0.584, and GPCog 0.552, P<0.001 for all. When combining tools integrated discrimination improvement for both mortality and hospitalization were greater for EFS than for other frailty instruments. Conclusion In acute coronary syndrome patients aged >70 years greater ‘frailty’ assessed using all tools was associated with higher mortality and hospitalization. The Edmonton Frail Scale, which provides a graded measure of severity of frailty based on information relevant to clinical care, discriminated the risk of mortality and hospitalization as well or better than other frailty instruments.
No takes yet. Share an insight, caveat, or question.
Langsted et al. (2023) conducted a cohort in Acute coronary syndrome (n=1,174). High frailty (Edmonton Frail Scale score 9-17) vs. Low frailty (Edmonton Frail Scale score 0-2) was evaluated on All-cause mortality (HR 5.0, 95% CI 3.4-7.4). High frailty assessed by the Edmonton Frail Scale was associated with a 5-fold increased risk of all-cause mortality compared to low frailty in older patients with acute coronary syndrome.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: