title: Frailty and other geriatric conditions for risk stratification of older patients with acute coronary syndrome.
abstract: BACKGROUND
  Geriatric conditions may predict outcomes beyond age and standard risk factors. Our aim was to investigate a wide spectrum of geriatric conditions in survivors after an acute coronary syndrome.
  
  
  METHODS
  A total of 342 patients older than 65 years were included. At hospital discharge, 5 geriatric conditions were evaluated: frailty (Fried and Green scores), physical disability (Barthel index), instrumental disability (Lawton-Brody scale), cognitive impairment (Pfeiffer questionnaire), and comorbidity (Charlson and simple comorbidity indexes). The outcomes were postdischarge mortality and the composite of death/myocardial infarction during a 30-month median follow-up.
  
  
  RESULTS
  Seventy-four (22%) patients died and 105 (31%) suffered from the composite end point. Through univariable analysis, all individual geriatric indexes were associated with outcomes, mainly mortality. Of all of them, frailty using the Green score had the strongest discriminative accuracy (area under the receiver operating characteristic curve 0.76 for mortality). After full adjustment including clinical and geriatric data, the Green score was the only independent predictive geriatric condition (per point; mortality: hazard ratio 1.25, 95% CI 1.15-1.36, P = .0001; composite end point: hazard ratio 1.16, 95% CI 1.09-1.24, P = .0001). A Green score ≥ 5 points was the strongest mortality predictor. The addition of the Green score to the clinical model improved discrimination (area under the receiver operating characteristic curve 0.823 vs 0.846) and significantly reclassified mortality risk (net reclassification improvement 26.3, 95% CI 1.4-43.5; integrated discrimination improvement 4.0, 95% CI 0.8-9.0). The incremental predictive information was even greater over the GRACE score.
  
  
  CONCLUSIONS
  Frailty captures most of the prognostic information provided by geriatric conditions after acute coronary syndromes. The Green score performed better than the other geriatric indexes.
authors.affiliation: Department of Cardiology, Hospital Clínico Universitario, School of Medicine, University of Valencia, Valencia, Spain. Electronic address: sanchis_juafor@gva.es.
authors.forename: Juan
authors.initials: J
authors.lastname: Sanchis
authors.affiliation: Department of Cardiology, Hospital Clínico Universitario, School of Medicine, University of Valencia, Valencia, Spain.
authors.forename: Clara
authors.initials: C
authors.lastname: Bonanad
authors.affiliation: Nursing School, University of Valencia, Valencia, Spain.
authors.forename: Vicente
authors.initials: V
authors.lastname: Ruiz
authors.affiliation: Nursing School, University of Valencia, Valencia, Spain.
authors.forename: Julio
authors.initials: J
authors.lastname: Fernández
authors.affiliation: Department of Cardiology, Hospital Clínico Universitario, School of Medicine, University of Valencia, Valencia, Spain.
authors.forename: Sergio
authors.initials: S
authors.lastname: García-Blas
authors.affiliation: Department of Cardiology, Hospital Clínico Universitario, School of Medicine, University of Valencia, Valencia, Spain.
authors.forename: Luis
authors.initials: L
authors.lastname: Mainar
authors.affiliation: Department of Cardiology, Hospital Clínico Universitario, School of Medicine, University of Valencia, Valencia, Spain.
authors.forename: Silvia
authors.initials: S
authors.lastname: Ventura
authors.affiliation: Department of Clinical Biochemistry, Hospital Clínico Universitario, Valencia, Spain.
authors.forename: Enrique
authors.initials: E
authors.lastname: Rodríguez-Borja
authors.affiliation: Department of Cardiology, Hospital Clínico Universitario, School of Medicine, University of Valencia, Valencia, Spain.
authors.forename: Francisco J
authors.initials: FJ
authors.lastname: Chorro
authors.affiliation: Department of Physiology, University of Valencia, Valencia, Spain.
authors.forename: Carlos
authors.initials: C
authors.lastname: Hermenegildo
authors.affiliation: Department of Cardiology, Hospital San Juan, Alicante, Spain.
authors.forename: Vicente
authors.initials: V
authors.lastname: Bertomeu-González
authors.affiliation: Department of Cardiology, Hospital Clínico Universitario, School of Medicine, University of Valencia, Valencia, Spain.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Núñez
authors.affiliation: Department of Cardiology, Hospital Clínico Universitario, School of Medicine, University of Valencia, Valencia, Spain.
authors.forename: Julio
authors.initials: J
authors.lastname: Núñez
mesh_terms: D000203:Activities of Daily Living; D054058:Acute Coronary Syndrome / Q000453:epidemiology* / Q000401:mortality; D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D003072:Cognition Disorders / Q000453:epidemiology*; D015331:Cohort Studies; D015897:Comorbidity; D005080:Exercise Test; D005260:Female; D016330:Frail Elderly / Q000706:statistics & numerical data*; D015577:Geriatric Assessment; D018737:Hand Strength; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000453:epidemiology*; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012372:ROC Curve; D018570:Risk Assessment; D012307:Risk Factors