Udell Jacob A, Lu Di, Bagai Akshay, Dodson John A, Desai Nihar R, Fonarow Gregg C, Goyal Abhinav, Garratt Kirk N, Lucas Joseph, Weintraub William S, Forman Daniel E, Roe Matthew T, Alexander Karen P
Cardiovascular Division, Department of Medicine, Peter Munk Cardiac Centre, Toronto General Hospital and Women's College Hospital, University of Toronto, Canada; Duke Clinical Research Institute, Cardiovascular Division, Department of Medicine, Duke University, Durham, NC.
Duke Clinical Research Institute, Cardiovascular Division, Department of Medicine, Duke University, Durham, NC.
Am Heart J. 2022 Jul;249:34-44. doi: 10.1016/j.ahj.2022.03.007. Epub 2022 Mar 24.
Little is known about the prevalence and prognostic impact of preexisting frailty on acute care and in-hospital outcomes in older adults in the setting of acute myocardial infarction (AMI).
Preexisting frailty was assessed at baseline in consecutive AMI patients ≥65 years of age treated at 778 hospitals participating in the NCDR ACTION Registry between January 1, 2015 to December 31, 2016. Three domains of preexisting frailty (cognition, ambulation, and functional independence) were abstracted from chart review and summed in 2 ways: an ACTION Frailty Scale based on responses to 6 groups adapted from the Canadian Study of Health and Aging Clinical Frailty Scale and an ACTION Frailty Score derived by summing a rank score of 0-2 assigned for each grade (total ranged between 0 to 6). Multivariable logistic regression examined the association between assigned frailty by score or scale and in-hospital mortality.
Among 143,722 older AMI patients, 108,059 (75.2%) were fit and/or well and 6,484 (4.5%) were vulnerable to frailty, while 7,527 (5.2%) had mild, 3,913 (2.7%) had moderate, 2,715 had (1.9%) severe, and 632 (0.4%) had very severe frailty according to the ACTION Frailty Scale, while 14,392 (10.0%) could not be categorized due to incomplete ascertainment. Frail patients were older, more frequently female, of non-white race and/or ethnicity, and less likely to be treated with guideline-recommended therapies. Increasing severity of frailty by this scale was associated with a step-wise higher risk for in-hospital mortality (P-trend < .001). Patient categories of the ACTION Frailty Score provided similar results. After adjustment, each 1-unit increase in Frailty Score was associated with a 12% higher mortality risk (OR 1.12, 95% CI 1.10-1.15).
Among older patients with acute myocardial infarction, frailty is common and independently associated with in-hospital mortality. These findings show the importance of pragmatic evaluation of frailty in hospital-level quality scores, guideline recommendations, and incorporation into other registry data collection efforts.
在急性心肌梗死（AMI）患者中，关于老年患者既往虚弱状态对急性护理及住院结局的患病率和预后影响，人们知之甚少。
在2015年1月1日至2016年12月31日期间，对参与国家心血管数据注册行动注册研究（NCDR ACTION Registry）的778家医院收治的连续≥65岁的AMI患者，在基线时评估其既往虚弱状态。通过病历审查提取既往虚弱状态的三个领域（认知、行走和功能独立性），并以两种方式进行汇总：一种是基于对改编自加拿大健康与老龄化临床虚弱量表的6个组的回答得出的行动虚弱量表，另一种是通过对每个等级分配的0至2的排名分数求和得出的行动虚弱评分（总分范围为0至6）。多变量逻辑回归分析了按评分或量表分配的虚弱状态与住院死亡率之间的关联。
在143,722例老年AMI患者中，108,059例（75.2%）健康和/或状况良好，6,484例（4.5%）易患虚弱，而根据行动虚弱量表，7,527例（5.2%）有轻度虚弱，3,913例（2.7%）有中度虚弱，2,715例（1.9%）有重度虚弱，632例（0.4%）有极重度虚弱，另有14,392例（10.0%）因信息不全无法分类。虚弱患者年龄更大，女性更常见，非白人种族和/或族裔比例更高，接受指南推荐治疗的可能性更小。按此量表，虚弱严重程度增加与住院死亡率逐步升高相关（P趋势<0.001）。行动虚弱评分的患者类别得出了类似结果。调整后，虚弱评分每增加1个单位，死亡风险增加12%（比值比1.12，95%置信区间1.10 - 1.15）。
在老年急性心肌梗死患者中，虚弱很常见，且与住院死亡率独立相关。这些发现表明，在医院层面的质量评分、指南推荐以及纳入其他注册数据收集工作中，对虚弱进行务实评估具有重要意义。
