Key result
Frailty upon admission increased the risk of in-hospital net adverse clinical events by over 7-fold (OR 7.12) compared to non-frail patients with acute coronary syndrome.
Why the study?
The study was conducted to explore the impact of frailty on in-hospital adverse outcomes and net adverse clinical events in older patients with acute coronary syndrome.
Does frailty increase the risk of net adverse clinical events in older patients with acute coronary syndrome?
Observational (n=116)
No
Does frailty increase the risk of net adverse clinical events in older patients with acute coronary syndrome?
Odds Ratio: 7.12 (95% CI 1.28–39.47)
Absolute Event Rate: 15.79% vs 2.56%
p-value: p=<0.01
The simple FRAIL scale is a valuable prognostic tool for predicting in-hospital adverse events in older adults with acute coronary syndrome.
May inform in-hospital risk stratification in older ACS patients; leaves open whether frailty-targeted interventions reduce NACE.
Purpose: The aim of this study was to explore the impact of frailty on in-hospital adverse outcomes and net adverse clinical events (NACE) in older patients with acute coronary syndrome. Patients and Methods: This observational study included elderly patients (≥60 years old), diagnosed with acute coronary syndrome (ACS) at admission from February 2021 to August 2021. The primary outcome was net adverse clinical events (NACE) defined as a composite of all-cause mortality, stroke, and major bleeding. Secondary outcome was in-hospital adverse outcomes including arrhythmia, acquired pneumonia, stroke, major bleeding, and all-cause mortality. Frailty was assessed using the Frail scale (FS). Data about socio-demographics, comorbidities, body mass index, ACS type, coronary angiography, left ventricular ejection fraction, and length of hospital stay were also collected. Univariate and multivariate logistic regressions were employed to identify the potential association between frailty and outcomes. Results: Of the 116 ACS patients, 38 patients were frail (32.76%). Frail subjects were more often female (50%) and older (p < 0.01) and had higher rates of in-hospital adverse outcomes (OR = 2.37, p = 0.05) and NACE (OR = 7.12; p < 0.01). In univariate analysis, the increased frail score was significantly associated with increased odds of NACE (unadjusted OR = 1.98, 95% CI 1.17-3.35 for each score increase in Frail Score). In multivariable logistic regression, models controlling for age, gender, PCI, LVEF, and coronary angiography (adjusted OR 2.19, 95% CI 1.12-4.29 for each score increase in Frail Score). Conclusion: This study revealed the reference data of frailty assessment in older patients with ACS in Vietnam. Our result indicated that over 30% of ACS older patients presented with frailty which was associated with an increased risk of in-hospital adverse outcomes and NACE. This study also provided promising information about the simple FRAIL scale's potential role in the risk stratification of older patients with ACS.
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Pham et al. (2023) conducted an observational in Acute coronary syndrome (n=116). Frailty vs. Non-frail was evaluated on Net adverse clinical events (NACE) defined as a composite of all-cause mortality, stroke, and major bleeding (OR 7.12, 95% CI 1.28-39.47, p=<0.01). Frailty upon admission increased the risk of in-hospital net adverse clinical events by over 7-fold (OR 7.12) compared to non-frail patients with acute coronary syndrome.
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