Frailty Tools for Assessment of Long-term Prognosis After Acute Coronary Syndrome

Juan Sanchis; Vicent Ruiz; Clara Sastre; Clara Bonanad; Arancha Ruescas; Agustín Fernández-Cisnal; Anna Mollar; Ernesto Valero; Sergio García Blas; Jessika González; Vicente Pernias; Gema Miñana; Julio Núñez; Albert Ariza-Solé

doi:10.1016/j.mayocpiqo.2020.06.011

Frailty Tools for Assessment of Long-term Prognosis After Acute Coronary Syndrome

Mayo Clin Proc Innov Qual Outcomes. 2020 Dec 10;4(6):642-648. doi: 10.1016/j.mayocpiqo.2020.06.011. eCollection 2020 Dec.

Affiliations

¹ Servicio de Cardiología, Hospital Clínico Universitario de Valencia, Universidad de Valencia, Valencia, Spain.
² Departamento de Fisioterapia, Universidad de Valencia, Valencia, Spain.
³ Servicio de Cardiología, Hospital Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain.

Abstract

Objective: To evaluate the 5 components of the Fried frailty phenotype (self-reported unintentional weight loss, physical activity questionnaire, gait speed, grip strength, and self-reported exhaustion) for long-term outcomes in elderly survivors of acute coronary syndrome.

Methods: A total of 342 consecutive patients (from October 1, 2010, to February 1, 2012) were included. The 5 components of the Fried score and albumin concentration, as malnutrition index, were assessed before hospital discharge. Patients were followed up until April 2020 (median follow-up, 8.7 years). The end point was postdischarge all-cause mortality.

Results: Mean ± SD age was 77±7 years and mean ± SD Fried score was 2.0±1.1 points. A total of 216 (63%) patients died. After adjusting for clinical covariates, the Fried phenotype was associated with mortality (per points, hazard ratio [HR], 1.35; 95% CI, 1.17 to 1.57; P<.001). Among Fried components, physical activity (HR, 2.21; 95% CI, 1.34 to 3.65; P=.002) and gait speed (HR, 1.77; 95% CI, 1.29 to 2.43; P<.001) were the deficits independendtly associated with mortality. Albumin level provided further prognostic information (per increase in g/dL; HR, 0.63, 95% CI, 0.45 to 0.88; P=.007). The model adding the components of the Fried score and albumin level to the clinical model showed the highest risk reclassification (integrated discrimination improvement, 0.040; 95% CI, 0.018 to 0.075; P=.001; continuous net reclassification improvement, 0.291; 95% CI, 0.132 to 0.397; P=.001) in comparison with the model using clinical covariates alone.

Conclusion: Frailty assessment using the Fried phenotype has prognostic value for long-term mortality in elderly survivors of acute coronary syndrome. Physical activity and gait speed are the predictive components of the Fried score. Albumin level provides incremental prognostic information.

Keywords: GRACE, Global Registry of Acute Coronary Events; HR, hazard ratio; IDI, integrated discrimination improvement; cNRI, continuous net reclassification improvement.