Frailty and Outcomes After Myocardial Infarction: Insights From the CONCORDANCE Registry
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 2...
| Main Authors: | , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2018-09-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.118.009859 |
| _version_ | 1811334179228483584 |
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| author | Ashish Patel Shaun G. Goodman Andrew T. Yan Karen P. Alexander Camilla L. Wong Asim N. Cheema Jacob A. Udell Padma Kaul Mario D'Souza Karice Hyun Mark Adams James Weaver Derek P. Chew David Brieger Akshay Bagai |
| author_facet | Ashish Patel Shaun G. Goodman Andrew T. Yan Karen P. Alexander Camilla L. Wong Asim N. Cheema Jacob A. Udell Padma Kaul Mario D'Souza Karice Hyun Mark Adams James Weaver Derek P. Chew David Brieger Akshay Bagai |
| author_sort | Ashish Patel |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-04-13T17:03:58Z |
| format | Article |
| id | doaj.art-2570ad5ef8984b32b3de06e2172356d3 |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-04-13T17:03:58Z |
| publishDate | 2018-09-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-2570ad5ef8984b32b3de06e2172356d32022-12-22T02:38:32ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802018-09-0171810.1161/JAHA.118.009859Frailty and Outcomes After Myocardial Infarction: Insights From the CONCORDANCE RegistryAshish Patel0Shaun G. Goodman1Andrew T. Yan2Karen P. Alexander3Camilla L. Wong4Asim N. Cheema5Jacob A. Udell6Padma Kaul7Mario D'Souza8Karice Hyun9Mark Adams10James Weaver11Derek P. Chew12David Brieger13Akshay Bagai14Terrence Donnelly Heart Centre St Michael's Hospital Toronto Ontario CanadaTerrence Donnelly Heart Centre St Michael's Hospital Toronto Ontario CanadaTerrence Donnelly Heart Centre St Michael's Hospital Toronto Ontario CanadaDuke Clinical Research Institute Durham NCUniversity of Toronto Ontario CanadaTerrence Donnelly Heart Centre St Michael's Hospital Toronto Ontario CanadaUniversity of Toronto Ontario CanadaCanadian VIGOUR Centre University of Alberta Edmonton CanadaSchool of Public Health University of Sydney Clinical Research Centre Sydney Local Health District Sydney AustraliaANZAC Institute Westmead Clinical School Sydney Medical School University of Sydney AustraliaDepartment of Cardiology Royal Prince Alfred Hospital Sydney AustraliaUniversity of New South Wales Sydney AustraliaDepartment of Cardiology Flinders University Adelaide AustraliaDepartment of Cardiology Concord Hospital University of Sydney Sydney AustraliaTerrence Donnelly Heart Centre St Michael's Hospital Toronto Ontario CanadaBackground 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.https://www.ahajournals.org/doi/10.1161/JAHA.118.009859frailtyhealth services researchmyocardial infarctionoutcomes |
| spellingShingle | Ashish Patel Shaun G. Goodman Andrew T. Yan Karen P. Alexander Camilla L. Wong Asim N. Cheema Jacob A. Udell Padma Kaul Mario D'Souza Karice Hyun Mark Adams James Weaver Derek P. Chew David Brieger Akshay Bagai Frailty and Outcomes After Myocardial Infarction: Insights From the CONCORDANCE Registry Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease frailty health services research myocardial infarction outcomes |
| title | Frailty and Outcomes After Myocardial Infarction: Insights From the CONCORDANCE Registry |
| title_full | Frailty and Outcomes After Myocardial Infarction: Insights From the CONCORDANCE Registry |
| title_fullStr | Frailty and Outcomes After Myocardial Infarction: Insights From the CONCORDANCE Registry |
| title_full_unstemmed | Frailty and Outcomes After Myocardial Infarction: Insights From the CONCORDANCE Registry |
| title_short | Frailty and Outcomes After Myocardial Infarction: Insights From the CONCORDANCE Registry |
| title_sort | frailty and outcomes after myocardial infarction insights from the concordance registry |
| topic | frailty health services research myocardial infarction outcomes |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.118.009859 |
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