Langsted Anne, Benatar Jocelyne, Kerr Andrew, Bloomfield Katherine, Devlin Gerry, Sasse Alexander, Smythe David, To Andrew, White Harvey, Wilkins Gerrard, Stewart Ralph
Department of Clinical Biochemistry, Rigshospitalet, Denmark.
Cardiology Department, Health New Zealand Te Whatu Ora Te Toki Tumai, Green Lane Cardiovascular Services, Auckland, New Zealand.
PLoS One. 2025 Feb 7;20(2):e0318656. doi: 10.1371/journal.pone.0318656. eCollection 2025.
To evaluate the relative strengths of 3 frailty assessment instruments for predicting mortality and prolonged hospitalization in acute coronary syndrome patients.
Prospective cohort study.
Acute cardiac care units in New Zealand.
1174 patients >70 years of age hospitalized with an acute coronary syndrome.
The Clinical Frailty Scale (CFS), Edmonton Frail Scale (EFS) and Fried Criteria (Fried), were completed during hospital admission following an acute coronary syndrome when the patient was clinically stable.
All-cause mortality over the next ~5 years and hospitalization for >10 days in the next year determined from national administrative data.
During median follow-up of 5.1 years there were 353 deaths. Harrell's C-statistic for mortality for EFS was 0.663, Fried 0.648 and CFS 0.640 (p<0.001 for all). C-statistics for hospitalization >10 days (n = 267, 22%) were EFS 0.649, Fried 0.628, and CFS 0.584 (p<0.001 for all). Associations between increase in frailty scores and mortality were graded including in patients not classified as frail. The hazard ratio (HR) for mortality, adjusted for age and sex, for patients with an EFS score ≥9 (n = 197) compared to ≤2 (n = 331) was 5.0 (95% CI: 3.4-7.4). In models which included the Euroscore II or GRACE risk scores the EFS improved risk discrimination for both mortality and prolonged hospitalization more than the CFS and Fried.
In older patients assessed following an acute coronary syndrome the EFS discriminated the risk of all cause mortality and prolonged hospitalization better than the CFS and Fried tests, and improved risk discrimination when added to clinical risk scores.
评估3种衰弱评估工具预测急性冠脉综合征患者死亡率和延长住院时间的相对强度。
前瞻性队列研究。
新西兰的急性心脏监护病房。
1174例年龄>70岁的急性冠脉综合征住院患者。
临床衰弱量表（CFS）、埃德蒙顿衰弱量表（EFS）和弗里德标准（Fried），在急性冠脉综合征患者临床稳定后的住院期间完成。
根据国家行政数据确定未来约5年的全因死亡率和次年住院时间>10天的情况。
在中位随访5.1年期间，有353例死亡。EFS预测死亡率的Harrell C统计量为0.663，Fried为0.648，CFS为0.640（所有p<0.001）。住院时间>10天（n = 267，22%）的C统计量分别为：EFS为0.649，Fried为0.628，CFS为0.584（所有p<0.001）。衰弱评分增加与死亡率之间的关联呈分级状态，包括未被分类为衰弱的患者。与EFS评分≤2（n = 331）的患者相比，EFS评分≥9（n = 197）的患者在调整年龄和性别后的死亡风险比（HR）为5.0（95%CI：3.4 - 7.4）。在纳入欧洲心脏手术风险评估系统II（Euroscore II）或全球急性冠状动脉事件注册（GRACE）风险评分的模型中，EFS在死亡率和延长住院时间方面的风险辨别能力比CFS和Fried更强。
在急性冠脉综合征后接受评估的老年患者中，EFS在辨别全因死亡率和延长住院时间的风险方面优于CFS和Fried测试，并且在加入临床风险评分时可改善风险辨别能力。
