Key result
Frailty linked to ~13-point lower physical quality of life in symptomatic CAD patients over 80.
Why the study?
Elderly, frail patients with symptomatic coronary artery disease are often excluded from clinical trials, resulting in a lack of data on optimal management and outcomes in this population.
Cohort (n=150)
No
Absolute Event Rate: 30.5% vs 43.5%
p-value: p=0.005
In elderly patients (≥80 years) with CAD, frailty is common and associated with higher mortality, though cardiac treatment can improve mental quality of life and cardiovascular symptoms.
May support frailty screening in octogenarians with CAD for QoL risk stratification; leaves open whether frailty-targeted interventions improve outcomes.
BACKGROUND: Elderly, frail patients are often excluded from clinical trials so there is lack of data regarding optimal management when they present with symptomatic coronary artery disease (CAD). OBJECTIVE: The aim of this observational study was to evaluate an unselected elderly population with CAD for the occurrence of frailty, and its association with quality of life (QoL) and clinical outcomes. METHODS: Consecutive patients aged ≥80 years presenting with CAD were prospectively assessed for frailty (Fried frailty phenotype (FFP), Edmonton frailty scale (EFS)), QoL (Short form survey (SF-12)) and comorbidity (Charlson Comorbidity Index (CCI)). Patients were re-assessed at 4 months to determine any change in frailty and QoL status as well as the clinical outcome. RESULTS: One hundred fifty consecutive patients with symptomatic CAD were recruited in the study. The mean age was 83.7±3.2 years, 99 (66.0%) were men. The clinical presentation was stable angina in 68 (45.3%), the remainder admitted with an acute coronary syndrome including 21 (14.0%) with ST-elevation myocardial infarction. Frailty was present in 28% and 26% by FFP and EFS, respectively, and was associated with a significantly higher CCI (7.5±2.4 in frail, 6.2±2.2 in prefrail, 5.9±1.6 in those without frailty, p=0.005). FFP was significantly related to the physical composite score for QoL, while EFS was significantly related to the mental composite score for QoL (p=0.003). Treatment was determined by the cardiologist: percutaneous coronary intervention in 51 (34%), coronary artery bypass graft surgery in 15 (10%) and medical therapy in 84 (56%). At 4 months, 14 (9.3%) had died. Frail participants had the lowest survival. Cardiovascular symptom status and the mental composite score of QoL significantly improved (52.7±11.5 at baseline vs 55.1±10.6 at follow-up, p=0.04). However, overall frailty status did not significantly change, nor the physical health composite score of QoL (37.2±11.0 at baseline vs 38.5±11.3 at follow-up, p=0.27). CONCLUSIONS: In patients referred to hospital with CAD, frailty is associated with impaired QoL and a high coexistence of comorbidities. Following cardiac treatment, patients had improvement in cardiovascular symptoms and mental component of QoL.
No takes yet. Share an insight, caveat, or question.
Qayyum et al. (2020) conducted a cohort in Coronary artery disease (n=150). Frailty vs. Non-frail was evaluated on SF-12 Physical Composite Score (PCS) (p=0.005). In patients aged 80 years and older with symptomatic coronary artery disease, frailty was significantly associated with lower physical quality of life (SF-12 PCS 30.5 vs 43.5, p=0.005) and mental quality of life.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: