title: Is frailty associated with short-term outcomes for elderly patients with acute coronary syndrome?
abstract: BACKGROUND
  Frailty is a new prognostic factor in cardiovascular medicine due to the aging and increasingly complex nature of elderly patients. It is useful and meaningful to prospectively analyze the manner in which frailty predicts short-term outcomes for elderly patients with acute coronary syndrome (ACS).
  
  
  METHODS
  Patients aged ≥ 65 years, with diagnosis of ACS from cardiology department and geriatrics department were included from single-center. Clinical data including geriatrics syndromes were collected using Comprehensive Geriatrics Assessment. Frailty was defined according to the Clinical Frailty Scale and the impact of the co-morbidities on risk was quantified by the coronary artery disease (CAD)-specific index. Patients were followed up by clinical visit or telephone consultation and the median follow-up time is 120 days. Following-up items included all-cause mortality, unscheduled return visit, in-hospital and recurrent major adverse cardiovascular events. Multivariable regression survival analysis was performed using Cox regression.
  
  
  RESULTS
  Of the 352 patients, 152 (43.18%) were considered frail according to the study instrument (5-7 on the scale), and 93 (26.42%) were considered moderately or severely frail (6-7 on the scale). Geriatrics syndromes including incontinence, fall history, visual impairment, hearing impairment, constipation, chronic pain, sleeping disorder, dental problems, anxiety or depression, and delirium were more frequently in frail patients than in non-frail patients (P = 0.000, 0.031, 0.009, 0.014, 0.000, 0.003, 0.022, 0.000, 0.074, and 0.432, respectively). Adjusted for sex, age, severity of coronary artery diseases (left main coronary artery lesion or not) and co-morbidities (CAD specific index) by Cox survival analysis, frailty was found to be strongly and independently associated with risk for the primary composite outcomes: all-cause mortality [Hazard Ratio (HR) = 5.393; 95% CI: 1.477-19.692, P = 0.011] and unscheduled return visit (HR = 2.832; 95% CI: 1.140-7.037, P = 0.025).
  
  
  CONCLUSIONS
  Comprehensive Geriatrics Assessment and Clinical Frail Scale were useful in evaluation of elderly patients with ACS. Frailty was strongly and independently associated with short-term outcomes for elderly patients with ACS.
authors.affiliation: Geriatrics Department, Peking Union Medical College Hospital, Beijing, China.
authors.forename: Lin
authors.initials: L
authors.lastname: Kang
authors.affiliation: Cardiology Department, Peking Union Medical College Hospital, Beijing, China.
authors.forename: Shu-Yang
authors.initials: SY
authors.lastname: Zhang
authors.affiliation: Cardiology Department, Peking Union Medical College Hospital, Beijing, China.
authors.forename: Wen-Ling
authors.initials: WL
authors.lastname: Zhu
authors.affiliation: Central Research Lab, Peking Union Medical College Hospital, Beijing, China.
authors.forename: Hai-Yu
authors.initials: HY
authors.lastname: Pang
authors.affiliation: Clinical laboratory, Peking Union Medical College Hospital, Beijing, China.
authors.forename: Li
authors.initials: L
authors.lastname: Zhang
authors.affiliation: Geriatrics Department, Peking Union Medical College Hospital, Beijing, China.
authors.forename: Ming-Lei
authors.initials: ML
authors.lastname: Zhu
authors.affiliation: Geriatrics Department, Peking Union Medical College Hospital, Beijing, China.
authors.forename: Xiao-Hong
authors.initials: XH
authors.lastname: Liu
authors.affiliation: Cardiology Department, Peking Union Medical College Hospital, Beijing, China.
authors.forename: Yong-Tai
authors.initials: YT
authors.lastname: Liu
keywords: Acute coronary syndrome; Comprehensive Geriatrics Assessment; Frailty; Survival analysis; Unscheduled return visit