Frailty and Outcomes After Myocardial Infarction: Insights From the CONCORDANCE Registry.

Published

Journal Article

Background Little is known about the prognostic implications of frailty, a state of susceptibility to stressors and poor recovery to homeostasis in older people, after myocardial infarction ( MI ). Methods and Results We studied 3944 MI patients aged ≥65 years treated at 41 Australian hospitals from 2009 to 2016 in the CONCORDANCE ( Australian Cooperative National Registry of Acute Coronary Care, Guideline Adherence and Clinical Events ) registry. Frailty index ( FI ) was determined using the health deficit accumulation method. All-cause and cardiac-specific mortality at 6 months were compared between frail ( FI >0.25) and nonfrail ( FI ≤0.25) patients. Among 1275 patients with ST-segment-elevation MI (STEMI), 192 (15%) were frail, and among 2669 non-STEMI ( NSTEMI) patients, 902 (34%) were frail. Compared with nonfrail counterparts, frail STEMI patients received 30% less reperfusion therapy and 22% less revascularization during index hospitalization; frail NSTEMI patients received 30% less diagnostic angiography and 39% less revascularization. Unadjusted 6-month all-cause mortality ( STEMI : 13% versus 3%; NSTEMI : 13% versus 4%) and cardiac-specific mortality ( STEMI : 6% versus 1.4%, NSTEMI : 3.2% versus 1.2%) were higher among frail patients. After adjustment for known prognosticators, FI was significantly associated with higher 6-month all-cause ( STEMI : odds ratio: 1.74 per 0.1 FI [ 95% confidence interval, 1.37-2.22], P<0.001; NSTEMI : odds ratio: 1.62 per 0.1 FI [95% confidence interval, 1.40-1.87], P<0.001) but not cardiac-specific mortality ( STEMI : P=0.99; NSTEMI : P=0.93). Conclusions Frail patients receive lower rates of invasive cardiac care during MI hospitalization. Increased frailty was independently associated with increased postdischarge all-cause mortality but not cardiac-specific mortality. These findings inform identification of frailty during MI hospitalization as a potential opportunity to address competing risks for mortality in this high-risk population.

Full Text

Duke Authors

Cited Authors

  • Patel, A; Goodman, SG; Yan, AT; Alexander, KP; Wong, CL; Cheema, AN; Udell, JA; Kaul, P; D'Souza, M; Hyun, K; Adams, M; Weaver, J; Chew, DP; Brieger, D; Bagai, A

Published Date

  • September 18, 2018

Published In

Volume / Issue

  • 7 / 18

Start / End Page

  • e009859 -

PubMed ID

  • 30371219

Pubmed Central ID

  • 30371219

Electronic International Standard Serial Number (EISSN)

  • 2047-9980

Digital Object Identifier (DOI)

  • 10.1161/JAHA.118.009859

Language

  • eng

Conference Location

  • England