The Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, 610041, China.
University of South Florida, Tampa, FL, USA.
Aging Clin Exp Res. 2020 Aug;32(8):1435-1442. doi: 10.1007/s40520-019-01311-6. Epub 2019 Sep 6.
There is very limited guidance in regard to how biological age should be estimated and how different comorbidity conditions influence the benefit-risk ration of interventions. Frailty is an important health-related problem in patients, especially in older adults. It is a reflection of biologic rather than chronologic age; frailty may explain why there remains substantial heterogeneity in clinical outcomes within the older patients' population.
We aimed to review the prognostic value of frailty for adverse outcomes in older patients with acute coronary syndrome (ACS).
Studies published until December 31, 2018, identified by systematic Medline, Embase, and Cochrane Controlled Register of Trials (CENTRAL) searches were reviewed for the association between frailty and mortality in older patients with ACS. We used the Newcastle-Ottawa Quality Assessment Scale to assess the quality of the included studies. We extracted the information of hazard ratios (HR) and odds ratios (OR) with accompanying 95% confidence intervals (CI), and P values of multivariable analysis. Heterogeneity across studies was determined using the Cochran Q value by Review Manager 5.3.
A total of 11 articles involving 7212 patients were included in this meta-analysis. Two studies (Sujino, Y 2015 and Alonso, S.GL 2016; n = 264) reported that frailty was significantly associated with in-hospital mortality in patients with ACS (range of reported OR between 6.38 and 12.0). We performed a subgroup analysis of the other nine studies based on differences in the follow-up time. Pooled meta-analysis demonstrates that frailty was associated with short-term, medium-term, and long-term mortality (HR = 3.67, 4.09, 1.66). There was no association between frailty and bleeding in older patients with ACS.
Frailty measured by Canadian Study of Health and Aging Clinical Frailty Scale (CSHA-CFS), the Edmonton Frail Scale (EFS), Fried score, Green scores, frailty instrument from the Survey of Health, Ageing and Retirement in Europe (SHARE-FI) index, and FRAIL (Fatigue, Resistance, Ambulation, Illnesses, Loss of weight) scale, leads to significantly higher mortality rates in older patients with ACS.
目前，关于如何评估生物年龄以及不同合并症如何影响干预措施的获益风险比，相关指导非常有限。衰弱是患者（尤其是老年人）的一个重要健康问题。它反映的是生物学年龄，而非实际年龄；衰弱可能可以解释为什么在老年患者群体中，临床结局仍然存在很大的异质性。
我们旨在回顾衰弱对急性冠状动脉综合征（ACS）老年患者不良结局的预测价值。
通过系统检索 Medline、Embase 和 Cochrane 对照试验注册中心（CENTRAL），我们对截至 2018 年 12 月 31 日发表的评估衰弱与 ACS 老年患者死亡率之间关系的研究进行了回顾。我们使用纽卡斯尔-渥太华质量评估量表评估纳入研究的质量。我们提取了危险比（HR）和比值比（OR）以及相应的 95%置信区间（CI）和多变量分析 P 值的信息。通过 Review Manager 5.3 的 Cochrane Q 值确定研究间的异质性。
共有 11 项纳入了 7212 名患者的研究被纳入本次荟萃分析。两项研究（Sujino，Y 2015 和 Alonso，S.GL 2016；n=264）报道衰弱与 ACS 患者住院期间死亡率显著相关（报告的 OR 范围为 6.38 至 12.0）。我们基于随访时间的差异，对其他九项研究进行了亚组分析。汇总分析表明，衰弱与短期、中期和长期死亡率相关（HR=3.67、4.09、1.66）。衰弱与 ACS 老年患者的出血无相关性。
通过加拿大健康与衰老研究临床衰弱量表（CSHA-CFS）、埃德蒙顿衰弱量表（EFS）、Fried 评分、Green 评分、欧洲健康、老龄化和退休调查（SHARE-FI）指数中的衰弱量表、以及 FRAIL（疲劳、抵抗、活动能力、疾病、体重减轻）量表评估的衰弱与 ACS 老年患者的死亡率显著升高相关。
