The Frail Scale - A Risk Stratification in Older Patients with Acute Coronary Syndrome

Hung Manh Pham; Anh Phuong Nguyen; Huong Thi Thu Nguyen; Tam Ngoc Nguyen; Thanh Xuan Nguyen; Thu Thi Hoai Nguyen; Huong Thi Thanh Nguyen; Anh Trung Nguyen; Quang Ngoc Nguyen; Giang Song Tran; Huyen Thi Thanh Vu

doi:10.2147/JMDH.S409535

The Frail Scale - A Risk Stratification in Older Patients with Acute Coronary Syndrome

J Multidiscip Healthc. 2023 May 30:16:1521-1529. doi: 10.2147/JMDH.S409535. eCollection 2023.

Authors

Hung Manh Pham^{1

2}, Anh Phuong Nguyen^{1

2}, Huong Thi Thu Nguyen^{3

4}, Tam Ngoc Nguyen^{3

4}, Thanh Xuan Nguyen^{3

4}, Thu Thi Hoai Nguyen^{3

4}, Huong Thi Thanh Nguyen^{5

6}, Anh Trung Nguyen^{3

4}, Quang Ngoc Nguyen^{1

2}, Giang Song Tran¹, Huyen Thi Thanh Vu^{3

4}

Affiliations

¹ Vietnam National Heart Institute, Bach Mai Hospital, Hanoi, 100000, Vietnam.
² Department of Cardiology, Hanoi Medical University, Hanoi, 100000, Vietnam.
³ Department of Geriatrics, Hanoi Medical University, Hanoi, 100000, Vietnam.
⁴ Scientific Research Department, National Geriatric Hospital, Hanoi, 100000, Vietnam.
⁵ Physiology Department, Hanoi Medical University, Hanoi, 100000, Vietnam.
⁶ Dinh Tien Hoang Institute of Medicine, Hanoi, 100000, Vietnam.

Abstract

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.

Keywords: Frail scale; acute coronary syndrome; elderly.