Coronary artery disease
Comparison of Frail Patients Versus Nonfrail Patients ≥65 Years of Age Undergoing Percutaneous Coronary Intervention

https://doi.org/10.1016/j.amjcard.2012.01.384Get rights and content

Frailty is a geriatric syndrome characterized by functional impairments and is associated with poor outcomes; however, the prevalence of frailty and its association with health status in patients treated with percutaneous coronary intervention (PCI) are unknown. To assess the prevalence of frailty and its association with health status in PCI-treated patients, we studied 629 patients ≥65 years old undergoing PCI from October 2005 through September 2008. Frailty was characterized using the Fried criteria: weight loss >10 lbs. in previous 1 year, exhaustion, low physical activity, poor gait speed, and poor grip strength (3 features = frail; 1 feature to 2 features = intermediate frailty; 0 feature = not frail). Health status was assessed using the Short-Form 36 and the Seattle Angina Questionnaire (SAQ). Multivariable linear regression models were used to estimate the independent association between frailty and health status. Complete data on 545 patients demonstrated that 19% (n = 117) were frail, 47% (n = 298) had intermediate frailty, and 21% (n = 130) were not frail. Frail patients had more co-morbidities and more frequent left main coronary artery or multivessel disease after adjusting for age and gender (p <0.05 across groups). Multivariable linear regression demonstrated poorer health status in frail patients compared to nonfrail patients as evidenced by lower Short-Form 36 scores, lower SAQ scores for physical limitation, and lower SAQ scores for quality of life (p <0.001 for each health status domain). In conclusion, 1/5 of older patients are frail at the time of PCI and have greater comorbid burden, angiographic disease severity, and poorer health status than nonfrail adults.

Section snippets

Methods

Patients ≥65 years of age undergoing PCI at the Mayo Clinic in Rochester, Minnesota and Franciscan Skemp Hospital in LaCrosse, Wisconsin from October 2005 to September 2008 and who survived to hospital discharge were prospectively enrolled in a study assessing frailty and health status. A cross-sectional study design was used to administer standardized health status questionnaires and to perform functional assessments of frailty and abstraction of clinical co-morbidities from medical records.

Results

We screened 1,885 patients of whom 629 (33.4%) consented to participate. Slightly more men (69% vs 63%) and younger patients (74.3 ± 6.4 vs 75.8 ± 6.9 years) consented compared to nonconsenting patients. Mean age of participants was 74.8 ± 6.4 years. Of participants, 117 (18.6%) were frail, 298 (47.4%) had intermediate frailty, and 130 (20.6%) were not frail. Frailty status could not be classified in 84 patients (13.3%) because of incomplete or incorrectly completed forms. The most common

Discussion

In adults ≥65 years of age undergoing PCI, nearly 1/5 were frail as defined by the Fried criteria, and approximately 1/2 had an intermediate frailty phenotype. Features of frailty are associated with a greater co-morbid burden and greater angiographic disease severity. Frailty and intermediate frailty are independently associated with lower health-related quality of life and disease-specific quality of life. Lower quality-of-life scores for domains of physical limitation and disease-specific

References (26)

  • K.P. Alexander et al.

    Acute coronary care in the elderly, part II: ST-segment-elevation myocardial infarction: a scientific statement for healthcare professionals from the American Heart Association Council on Clinical Cardiology: in collaboration with the Society of Geriatric Cardiology

    Circulation

    (2007)
  • K.P. Alexander et al.

    Acute coronary care in the elderly, part I: Non-ST-segment-elevation acute coronary syndromes: a scientific statement for healthcare professionals from the American Heart Association Council on Clinical Cardiology: in collaboration with the Society of Geriatric Cardiology

    Circulation

    (2007)
  • H. Bergman et al.

    Frailty: an emerging research and clinical paradigm—issues and controversies

    J Gerontol A Biol Sci Med Sci

    (2007)
  • Cited by (0)

    This study was supported by a grant from the Mayo Clinic, Rochester, Minnesota. Dr. Gharacholou is a participant in the clinical research loan repayment program funded by Grant 1L30 AG034828-01 from the National Institutes of Health, Bethesda, Maryland.

    View full text