摘要
BACKGROUND Frailty is associated with adverse events in elderly patients with acute coronary syndrome(ACS).Our aim was to compare the prognostic value of four frailty scales in patients aged≥65 years hospitalized with ACS in a cardiac care unit(CCU).METHODS Patients aged≥65 years with ACS were included.Frailty was assessed using the Fried frailty scale(reference standard),the Edmonton Frail Scale(EFS),the FRAIL scale,and the Clinical frailty scale(CFS).The primary end point was all-cause mortality and the secondary end point was unscheduled rehospitalization.RESULTS One hundred and seventy four patients aged≥65 years with ACS were recruited.The median follow-up was 637.5 days.Frailty was identified in 41.4%,40.2%,39.1%and 36.3%patients by the Fried frailty scale,EFS,FRAIL scale and CFS,re-spectively.The agreement coefficients were 0.88,0.86,and 0.79 for the FRAIL scale,EFS and CFS,respectively.In the Cox regres-sion model,frailty was associated with all-cause mortality regardless of the scale used(univariate:hazard ratio[HR]95%CI=10.5,2.4-46.8 Fried frailty scale;12.0,2.7-53.4 FRAIL scale;7.1,2.0-25.2 EFS;8.3,2.4-29.6 CFS.Multivariate:HR=5.1,1.1-23.8 Fried frailty scale;5.7,1.2-26.8 FRAIL scale;3.7,1.0-14.0 EFS;4.2,1.1-15.9 CFS).The FRAIL scale had the highest HR.In the uni-variate analysis,frailty was associated with unscheduled rehospitalization(HR=3.2,1.7-6.0 Fried frailty scale;3.4,1.8-6.3 FRAIL scale;3.5,1.8-6.6 EFS;3.1,1.7-5.8 CFS).In the multivariate analysis,only the EFS independently predicted unscheduled rehospit-alization(HR=2.2,1.1-4.63).CONCLUSIONS Frailty assessed by the Fried frailty scale,FRAIL scale,EFS and CFS is associated with all-cause mortality and unscheduled rehospitalization in elderly patients hospitalized in a CCU with ACS.The adjusted HR of the FRAIL scale for all-cause mortality was the highest among the scales compared,whereas the EFS was an independent predictor of unscheduled re-hospitalization.These data should be taken into consideration when choosing a frailty assessment tool.
基金
found by statutory work number 3.19/III/18, National Institute of Cardiology, Warsaw, Poland.
