Frail patients hospitalized for MI receive less invasive cardiac care than nonfrail patients, and frailty may predict increased all-cause mortality after discharge, according to a study published in the Journal of the American Heart Association.
“Our study adds to the growing body of evidence on the implications of frailty in cardiovascular medicine,” Ashish Patel, MD, of the Terrence Donnelly Heart Centre and division of geriatric medicine at St. Michael’s Hospital in Toronto, and colleagues wrote. “Frailty is of high priority, given aging and the increasingly complex nature of cardiovascular patients.”
From the CONCORDANCE registry, researchers identified 3,944 MI patients aged at least 65 years who had been treated at 41 Australian hospitals from 2009 to 2016.
Patients were stratified into either the frail (frailty index 0.25 with a frailty score 7) or nonfrail (frailty index < 0.25 with a frailty score < 7) group.
The researchers also compared baseline demographics, presentation characteristics, in-hospital management (invasive or noninvasive therapy) and in-hospital outcomes (all-cause mortality, cardiac-specific mortality and major bleeding) between the two frailty groups while further stratifying by STEMI (n = 1,275; 15% frail) or non-STEMI (n = 2,669; 34% frail).
At 6 months, the researchers compared all-cause and cardiac-specific mortality between frail and nonfrail patients.
When investigating hospital management and the treatments patients received, researchers found that frail patients with STEMI received 30% less reperfusion therapy and 22% less revascularization during index hospitalization than nonfrail patients with STEMI. Frail patients with non-STEMI received 30% less diagnostic angiography and 39% less revascularization than nonfrail patients with STEMI.
According to the data, at 6 months, unadjusted all-cause mortality was 13% in the frail STEMI group vs. 3% in the nonfrail STEMI group. For those with non-STEMI, all-cause mortality was 13% in frail patients and 4% in nonfrail patients. For those with STEMI, unadjusted cardiac-specific mortality was 6% in frail patients and 1.4% nonfrail patients. For non-STEMI, cardiac-specific mortality was 3.2% in frail patients vs. 1.2% in nonfrail patients.
After researchers adjusted for known prognosticators, frailty index was not associated with 6-month cardiac-specific mortality in either STEMI (P = .99) or non-STEMI (P = .93) patients, but it was associated with higher 6-month all-cause mortality in both groups (STEMI, OR = 1.74 per 0.1 frailty index; 95% CI, 1.37-2.22; non-STEMI, OR = 1.62 per 0.1 frailty index; 95% CI, 1.4-1.87).
“These findings reinforce that presence of frailty identifies patients who are at increased risk of death after MI,” the researchers wrote. “However, additional cardiac interventions ... may not necessarily be sufficient to improve the prognosis of this high-risk population. Improving the outcomes of this patient population will require understanding of MI presentation in the context of other conditions and patient goals of care. It also requires addressing noncardiac reasons for mortality during and after hospitalization for MI.” – by Melissa J. Webb
: Patel reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.