title: Usefulness of Clinical Data and Biomarkers for the Identification of Frailty After Acute Coronary Syndromes.
abstract: BACKGROUND
  Frailty predicts mortality after acute coronary syndrome (ACS). The standard frailty scales, such as the Fried score, consist of a variety of questionnaires and physical tests. Our aim was to investigate easily available clinical data and blood markers to predict frailty at discharge, in elderly patients after ACS.
  
  
  METHODS
  A total of 342 patients older than 65 years, survivors after ACS, were included. A high number of clinical variables were collected. In addition, blood markers potentially linked to frailty and related to the processes of inflammation, coagulation, hormonal dysregulation, nutrition, renal dysfunction, and heart dysfunction were determined. Frailty was evaluated using the Fried score at discharge. The main outcome was frailty defined by a Fried score ≥ 3 points. Secondary endpoints were mortality and myocardial infarction at 30-month median follow-up.
  
  
  RESULTS
  A total of 116 patients were frail. Seven clinical variables or biomarkers predicted frailty: age ≥ 75 years, female, prior ischemic heart disease, admission heart failure, haemoglobin ≤ 12.5 g/dL, vitamin D ≤ 9 ng/mL, and cystatin-C ≥ 1.2 mg/L. This model based on clinical data and biomarkers showed an excellent discrimination accuracy for frailty (C-statistic = 0.818). During the follow-up, 105 patients died and 137 died or suffered myocardial infarction. The clinical data and biomarker model (C-statistics = 0.730 and 0.691) performed better than the Fried score (C-statistics = 0.676 and 0.650) for death and death or myocardial infarction, respectively.
  
  
  CONCLUSIONS
  Easy available clinical data and biomarkers can identify frail patients at discharge after ACS and predict outcomes better than the standard Fried's frailty scale.
authors.affiliation: Department of Cardiology, Hospital Clínico Universitario, Valencia, 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, Valencia, School of Medicine, University of Valencia, Valencia, Spain.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Núñez
authors.affiliation: Nursing School, University of Valencia, Valencia, Spain.
authors.forename: Vicente
authors.initials: V
authors.lastname: Ruiz
authors.affiliation: Department of Cardiology, Hospital Clínico Universitario, Valencia, 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: Julio
authors.initials: J
authors.lastname: Fernández
authors.affiliation: Nursing School, University of Valencia, Valencia, Spain.
authors.forename: Omar
authors.initials: O
authors.lastname: Cauli
authors.affiliation: Department of Cardiology, Hospital Clínico Universitario, Valencia, 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, Valencia, 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, Valencia, School of Medicine, University of Valencia, Valencia, Spain.
authors.forename: Ernesto
authors.initials: E
authors.lastname: Valero
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, Valencia, 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 Clínico Universitario, Valencia, School of Medicine, University of Valencia, Valencia, Spain.
authors.forename: Julio
authors.initials: J
authors.lastname: Núñez
mesh_terms: D054058:Acute Coronary Syndrome / Q000097:blood*; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood*; D015331:Cohort Studies; D015897:Comorbidity; D055316:Cystatin C / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D016330:Frail Elderly; D015577:Geriatric Assessment; D006452:Hemoglobinometry; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000097:blood / Q000401:mortality; D010351:Patient Discharge; D063868:Patient Outcome Assessment; D011379:Prognosis; D012307:Risk Factors; D014807:Vitamin D / Q000097:blood
chemical_list: D015415:Biomarkers; D055316:Cystatin C; D014807:Vitamin D