Pre-existing Frailty Linked with Worse Clinical Outcome in Older Adults with Acute MI

The physical frailty phenotype is a clinical state in which there is increased vulnerability to stressors due to diminished reserves across multiple physiological systems, resulting in functional decline, increased mortality, and a higher likelihood of complications from disease and from therapeutic interventions. However, the prevalence and prognostic impact of preexisting frailty on acute care and in-hospital outcomes in older adults in the setting of acute myocardial infarction (AMI) is under-studied. Therefore, Dr Jacob A.Udell and his team conducted a study to evaluate the prevalence and prognostic impact of preexisting frailty among older patients with AMI.

In this study, the researchers assessed preexisting frailty at baseline in consecutive AMI patients ≥65 years of age treated at 778 hospitals participated in the NCDR ACTION Registry. They examined three domains of preexisting frailty (cognition, ambulation, and functional independence) and summed them in two ways:

• An ACTION Frailty Scale based on responses to six groups adapted from the Canadian Study of Health and Aging Clinical Frailty Scale and
• An ACTION Frailty Score is derived by summing a rank score of 0-2 assigned for each grade (total ranging between 0 to 6).

They further used multivariable logistic regression to examine the association between assigned frailty by score or scale and in-hospital mortality.

Key findings of the study:

• Among 143,722 older AMI patients, the researchers observed 108,059 (75.2%) were fit/well and 6,484 (4.5%) were vulnerable to frailty, while 7,527 (5.2%) had mild, 3,913 (2.7%) had moderate, 2,715 had (1.9%) severe, and 632 (0.4%) had very severe frailty according to the ACTION Frailty Scale, while 14,392 (10.0%) could not be categorized due to incomplete ascertainment.
• They noted that frail patients were older, more frequently female, of non-white race/ethnicity, and less likely to be treated with guideline-recommended therapies.
• They found that increasing severity of frailty by this scale was associated with a step-wise higher risk for in-hospital mortality.
• They also found that patient categories of the ACTION Frailty Score provided similar results
• After adjustment, they noted that each 1-unit increase in Frailty Score was associated with a 12% higher mortality risk (OR 1.12).

The authors concluded, "Among older patients with acute myocardial infarction, frailty is common and independently associated with in-hospital mortality. These findings show the importance of pragmatic evaluation of frailty in hospital-level quality scores, guideline recommendations, and incorporation into other registry data collection efforts."

For further information:

DOI: https://doi.org/10.1016/j.ahj.2022.03.007

Keywords: Acute myocardial infarction, NCDR ACTION Registry, frailty, older adults, aged, myocardial infarction, function, Clinical outcomes, coronary heart disease, American Heart Journal