title: Prognostic Value of Geriatric Conditions Beyond Age After Acute Coronary Syndrome.
abstract: The aim of the present study was to investigate the prognostic value of geriatric conditions beyond age after acute coronary syndrome. This was a prospective cohort design including 342 patients (from October 1, 2010, to February 1, 2012) hospitalized for acute coronary syndrome, older than 65 years, in whom 5 geriatric conditions were evaluated at discharge: frailty (Fried and Green scales), comorbidity (Charlson and simple comorbidity indexes), cognitive impairment (Pfeiffer test), physical disability (Barthel index), and instrumental disability (Lawton-Brody scale). The primary end point was all-cause mortality. The median follow-up for the entire population was 4.7 years (range, 3-2178 days). A total of 156 patients (46%) died. Among the geriatric conditions, frailty (Green score, per point; hazard ratio, 1.11; 95% CI, 1.02-1.20; P=.01) and comorbidity (Charlson index, per point; hazard ratio, 1.18; 95% CI, 1.0-1.40; P=.05) were the independent predictors. The introduction of age in a basic model using well-established prognostic clinical variables resulted in an increase in discrimination accuracy (C-statistic=.716-.744; P=.05), though the addition of frailty and comorbidity provided a nonsignificant further increase (C-statistic=.759; P=.36). Likewise, the addition of age to the clinical model led to a significant risk reclassification (continuous net reclassification improvement, 0.46; 95% CI, 0.21-0.67; and integrated discrimination improvement, 0.04; 95% CI, 0.01-0.09). However, the addition of frailty and comorbidity provided a further significant risk reclassification in comparison to the clinical model with age (continuous net reclassification improvement, 0.40; 95% CI, 0.16-0.65; and integrated discrimination improvement, 0.04; 95% CI, 0.01-0.10). In conclusion, frailty and comorbidity are mortality predictors that significantly reclassify risk beyond age after acute coronary syndrome.
authors.affiliation: Cardiology Department, University Clinic Hospital, INCLIVA, Valencia, Spain; CIBER-CV, University of Valencia, Valencia, Spain. Electronic address: sanchis_juafor@gva.es.
authors.forename: Juan
authors.initials: J
authors.lastname: Sanchis
authors.affiliation: CIBER-CV, University of Valencia, Valencia, Spain; Nursing School, University of Valencia, Valencia, Spain.
authors.forename: Vicente
authors.initials: V
authors.lastname: Ruiz
authors.affiliation: Cardiology Department, University Clinic Hospital, INCLIVA, Valencia, Spain; CIBER-CV, University of Valencia, Valencia, Spain.
authors.forename: Clara
authors.initials: C
authors.lastname: Bonanad
authors.affiliation: Cardiology Department, University Clinic Hospital, INCLIVA, Valencia, Spain; CIBER-CV, University of Valencia, Valencia, Spain.
authors.forename: Ernesto
authors.initials: E
authors.lastname: Valero
authors.affiliation: Physiotherapy Department, University of Valencia, Valencia, Spain.
authors.forename: Maria Arantzazu
authors.initials: MA
authors.lastname: Ruescas-Nicolau
authors.affiliation: Cardiology Department, University Clinic Hospital, INCLIVA, Valencia, Spain.
authors.forename: Yasmin
authors.initials: Y
authors.lastname: Ezzatvar
authors.affiliation: Cardiology Department, University Clinic Hospital, INCLIVA, Valencia, Spain.
authors.forename: Clara
authors.initials: C
authors.lastname: Sastre
authors.affiliation: Cardiology Department, University Clinic Hospital, INCLIVA, Valencia, Spain; CIBER-CV, University of Valencia, Valencia, Spain.
authors.forename: Sergio
authors.initials: S
authors.lastname: García-Blas
authors.affiliation: Cardiology Department, University Clinic Hospital, INCLIVA, Valencia, Spain.
authors.forename: Anna
authors.initials: A
authors.lastname: Mollar
authors.affiliation: Cardiology Department, San Juan University Hospital, Alicante, CIBER-CV, Alicante, Spain.
authors.forename: Vicente
authors.initials: V
authors.lastname: Bertomeu-González
authors.affiliation: Cardiology Department, University Clinic Hospital, INCLIVA, Valencia, Spain; CIBER-CV, University of Valencia, Valencia, Spain; Department of Medicine, University of Valencia, Valencia, Spain.
authors.forename: Gema
authors.initials: G
authors.lastname: Miñana
authors.affiliation: Cardiology Department, University Clinic Hospital, INCLIVA, Valencia, Spain; CIBER-CV, University of Valencia, Valencia, Spain; Department 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; D000367:Age Factors; D000368:Aged; D060825:Cognitive Dysfunction; D015897:Comorbidity / Q000639:trends; D006233:Persons with Disabilities; D016330:Frail Elderly / Q000706:statistics & numerical data*; D015577:Geriatric Assessment / Q000379:methods*; D006801:Humans; D009203:Myocardial Infarction / Q000453:epidemiology / Q000401:mortality; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors