Sanchis Juan, Ruiz Vicent, Sastre Clara, Bonanad Clara, Ruescas Arancha, Fernández-Cisnal Agustín, Mollar Anna, Valero Ernesto, Blas Sergio García, González Jessika, Pernias Vicente, Miñana Gema, Núñez Julio, Ariza-Solé Albert
Servicio de Cardiología, Hospital Clínico Universitario de Valencia, Universidad de Valencia, Valencia, Spain.
Departamento de Fisioterapia, Universidad de Valencia, Valencia, Spain.
Mayo Clin Proc Innov Qual Outcomes. 2020 Dec 10;4(6):642-648. doi: 10.1016/j.mayocpiqo.2020.06.011. eCollection 2020 Dec.
To evaluate the 5 components of the Fried frailty phenotype (self-reported unintentional weight loss, physical activity questionnaire, gait speed, grip strength, and self-reported exhaustion) for long-term outcomes in elderly survivors of acute coronary syndrome.
A total of 342 consecutive patients (from October 1, 2010, to February 1, 2012) were included. The 5 components of the Fried score and albumin concentration, as malnutrition index, were assessed before hospital discharge. Patients were followed up until April 2020 (median follow-up, 8.7 years). The end point was postdischarge all-cause mortality.
Mean ± SD age was 77±7 years and mean ± SD Fried score was 2.0±1.1 points. A total of 216 (63%) patients died. After adjusting for clinical covariates, the Fried phenotype was associated with mortality (per points, hazard ratio [HR], 1.35; 95% CI, 1.17 to 1.57; <.001). Among Fried components, physical activity (HR, 2.21; 95% CI, 1.34 to 3.65; =.002) and gait speed (HR, 1.77; 95% CI, 1.29 to 2.43; <.001) were the deficits independendtly associated with mortality. Albumin level provided further prognostic information (per increase in g/dL; HR, 0.63, 95% CI, 0.45 to 0.88; =.007). The model adding the components of the Fried score and albumin level to the clinical model showed the highest risk reclassification (integrated discrimination improvement, 0.040; 95% CI, 0.018 to 0.075; =.001; continuous net reclassification improvement, 0.291; 95% CI, 0.132 to 0.397; =.001) in comparison with the model using clinical covariates alone.
Frailty assessment using the Fried phenotype has prognostic value for long-term mortality in elderly survivors of acute coronary syndrome. Physical activity and gait speed are the predictive components of the Fried score. Albumin level provides incremental prognostic information.
评估急性冠状动脉综合征老年幸存者中Fried衰弱表型的5个组成部分（自我报告的非故意体重减轻、体力活动问卷、步速、握力和自我报告的疲惫感）对长期预后的影响。
纳入了总共342例连续患者（从2010年10月1日至2012年2月1日）。在出院前评估Fried评分的5个组成部分以及作为营养不良指标的白蛋白浓度。对患者进行随访直至2020年４月（中位随访时间为8.7年）。终点为出院后全因死亡率。
平均年龄±标准差为77±7岁，平均Fried评分为2.0±1.1分。共有216例（63%）患者死亡。在对临床协变量进行校正后，Fried表型与死亡率相关（每增加1分，风险比[HR]为1.35；95%置信区间[CI]为1.17至1.57；P<.001）。在Fried表型的各个组成部分中，体力活动（HR为2.21；95%CI为1.34至3.65；P=.002）和步速（HR为1.77；95%CI为1.29至2.43；P<.001）是与死亡率独立相关的缺陷因素。白蛋白水平提供了进一步的预后信息（每增加1g/dL；HR为0.63，95%CI为0.45至0.88；P=.007）。与仅使用临床协变量的模型相比，将Fried评分组成部分和白蛋白水平添加到临床模型中的模型显示出最高的风险重新分类（综合判别改善为0.040；95%CI为0.018至0.075；P=.001；连续净重新分类改善为0.291；95%CI为0.132至0.397；P=.001）。
使用Fried表型进行衰弱评估对急性冠状动脉综合征老年幸存者的长期死亡率具有预后价值。体力活动和步速是Fried评分的预测组成部分。白蛋白水平提供了额外的预后信息。
