Frailty and quality of life after invasive management for non-ST elevation acute coronary syndrome

Benjamin Beska; Daniel Coakley; Guy MacGowan; Jennifer Adams-Hall; Chris Wilkinson; Vijay Kunadian

doi:10.1136/heartjnl-2021-319064

Frailty and quality of life after invasive management for non-ST elevation acute coronary syndrome

Benjamin Beska, Daniel Coakley, Guy MacGowan, Jennifer Adams-Hall, Chris Wilkinson, Vijay Kunadian

The Hull York Medical School

Research output: Contribution to journal › Article › peer-review

Abstract

OBJECTIVE: Older patients presenting with non-ST elevation acute coronary syndrome (NSTEACS) require holistic assessment. We carried out a longitudinal cohort study to investigate health-related quality of life (HRQoL) of older, frail adults with NSTEACS undergoing coronary angiography.

METHODS: 217 consecutive patients aged ≥65 years (mean age 80.9±4.0 years, 60.8% male) with NSTEACS referred for coronary angiography were recruited from two tertiary cardiac centres between November 2012 and December 2015. Frailty was assessed with the Fried Frailty Index; a score of 0 was characterised as robust, 1-2 prefrail and ≥3 frail. The Short Form Survey 36 (SF-36), an HRQoL tool consisting of eight domains spanning physical and mental health, was performed at baseline and 1 year.

RESULTS: 186 patients (85.7%) had invasive revascularisation. At baseline, 52 (23.9%) patients were frail and 121 (55.8%) were prefrail, with most SF-36 domains falling below the norm-population mean. Patients with frailty had lower mean scores in all physical SF-36 domains (p≤0.05) compared with those without frailty. Robust patients had temporal improvement in two domains (role physical +5.80 (95% CI 1.31 to 10.3) and role emotional +6.46 (95% CI 1.02 to 11.9)) versus patients with frailty and prefrailty, who had a collective improvement in a greater number of physical and psychological domains at 1 year (2 domains vs 11 domains), notably role physical (prefrail +6.53 (95% CI 3.85 to 9.20) and frail +10.4 (95% CI 6.7814.1)).

CONCLUSIONS: Frail older adults with NSTEACS have poor HRQoL. One year following invasive management, there are modest improvements in HRQoL, most marked in frail and prefrail patients, who received a proportionally larger benefit than robust patients.

TRIAL REGISTRATION NUMBER: NCT01933581.

Original language	English
Pages (from-to)	203-211
Number of pages	9
Journal	Heart
Volume	108
Issue number	3
Early online date	14 May 2021
DOIs	https://doi.org/10.1136/heartjnl-2021-319064
Publication status	Published - 11 Jan 2022

Keywords

Acute Coronary Syndrome/diagnosis
Aged
Aged, 80 and over
Female
Frail Elderly
Frailty/diagnosis
Geriatric Assessment
Humans
Longitudinal Studies
Male
Quality of Life

Access to Document

10.1136/heartjnl-2021-319064

Cite this

@article{b5cce4ecdc2245be93d09dc616840b0f,

title = "Frailty and quality of life after invasive management for non-ST elevation acute coronary syndrome",

abstract = "OBJECTIVE: Older patients presenting with non-ST elevation acute coronary syndrome (NSTEACS) require holistic assessment. We carried out a longitudinal cohort study to investigate health-related quality of life (HRQoL) of older, frail adults with NSTEACS undergoing coronary angiography.METHODS: 217 consecutive patients aged ≥65 years (mean age 80.9±4.0 years, 60.8% male) with NSTEACS referred for coronary angiography were recruited from two tertiary cardiac centres between November 2012 and December 2015. Frailty was assessed with the Fried Frailty Index; a score of 0 was characterised as robust, 1-2 prefrail and ≥3 frail. The Short Form Survey 36 (SF-36), an HRQoL tool consisting of eight domains spanning physical and mental health, was performed at baseline and 1 year.RESULTS: 186 patients (85.7%) had invasive revascularisation. At baseline, 52 (23.9%) patients were frail and 121 (55.8%) were prefrail, with most SF-36 domains falling below the norm-population mean. Patients with frailty had lower mean scores in all physical SF-36 domains (p≤0.05) compared with those without frailty. Robust patients had temporal improvement in two domains (role physical +5.80 (95% CI 1.31 to 10.3) and role emotional +6.46 (95% CI 1.02 to 11.9)) versus patients with frailty and prefrailty, who had a collective improvement in a greater number of physical and psychological domains at 1 year (2 domains vs 11 domains), notably role physical (prefrail +6.53 (95% CI 3.85 to 9.20) and frail +10.4 (95% CI 6.7814.1)).CONCLUSIONS: Frail older adults with NSTEACS have poor HRQoL. One year following invasive management, there are modest improvements in HRQoL, most marked in frail and prefrail patients, who received a proportionally larger benefit than robust patients.TRIAL REGISTRATION NUMBER: NCT01933581.",

keywords = "Acute Coronary Syndrome/diagnosis, Aged, Aged, 80 and over, Female, Frail Elderly, Frailty/diagnosis, Geriatric Assessment, Humans, Longitudinal Studies, Male, Quality of Life",

author = "Benjamin Beska and Daniel Coakley and Guy MacGowan and Jennifer Adams-Hall and Chris Wilkinson and Vijay Kunadian",

year = "2022",

month = jan,

day = "11",

doi = "10.1136/heartjnl-2021-319064",

language = "English",

volume = "108",

pages = "203--211",

journal = "Heart",

issn = "1355-6037",

publisher = "BMJ",

number = "3",

}

TY - JOUR

T1 - Frailty and quality of life after invasive management for non-ST elevation acute coronary syndrome

AU - Beska, Benjamin

AU - Coakley, Daniel

AU - MacGowan, Guy

AU - Adams-Hall, Jennifer

AU - Wilkinson, Chris

AU - Kunadian, Vijay

PY - 2022/1/11

Y1 - 2022/1/11

N2 - OBJECTIVE: Older patients presenting with non-ST elevation acute coronary syndrome (NSTEACS) require holistic assessment. We carried out a longitudinal cohort study to investigate health-related quality of life (HRQoL) of older, frail adults with NSTEACS undergoing coronary angiography.METHODS: 217 consecutive patients aged ≥65 years (mean age 80.9±4.0 years, 60.8% male) with NSTEACS referred for coronary angiography were recruited from two tertiary cardiac centres between November 2012 and December 2015. Frailty was assessed with the Fried Frailty Index; a score of 0 was characterised as robust, 1-2 prefrail and ≥3 frail. The Short Form Survey 36 (SF-36), an HRQoL tool consisting of eight domains spanning physical and mental health, was performed at baseline and 1 year.RESULTS: 186 patients (85.7%) had invasive revascularisation. At baseline, 52 (23.9%) patients were frail and 121 (55.8%) were prefrail, with most SF-36 domains falling below the norm-population mean. Patients with frailty had lower mean scores in all physical SF-36 domains (p≤0.05) compared with those without frailty. Robust patients had temporal improvement in two domains (role physical +5.80 (95% CI 1.31 to 10.3) and role emotional +6.46 (95% CI 1.02 to 11.9)) versus patients with frailty and prefrailty, who had a collective improvement in a greater number of physical and psychological domains at 1 year (2 domains vs 11 domains), notably role physical (prefrail +6.53 (95% CI 3.85 to 9.20) and frail +10.4 (95% CI 6.7814.1)).CONCLUSIONS: Frail older adults with NSTEACS have poor HRQoL. One year following invasive management, there are modest improvements in HRQoL, most marked in frail and prefrail patients, who received a proportionally larger benefit than robust patients.TRIAL REGISTRATION NUMBER: NCT01933581.

AB - OBJECTIVE: Older patients presenting with non-ST elevation acute coronary syndrome (NSTEACS) require holistic assessment. We carried out a longitudinal cohort study to investigate health-related quality of life (HRQoL) of older, frail adults with NSTEACS undergoing coronary angiography.METHODS: 217 consecutive patients aged ≥65 years (mean age 80.9±4.0 years, 60.8% male) with NSTEACS referred for coronary angiography were recruited from two tertiary cardiac centres between November 2012 and December 2015. Frailty was assessed with the Fried Frailty Index; a score of 0 was characterised as robust, 1-2 prefrail and ≥3 frail. The Short Form Survey 36 (SF-36), an HRQoL tool consisting of eight domains spanning physical and mental health, was performed at baseline and 1 year.RESULTS: 186 patients (85.7%) had invasive revascularisation. At baseline, 52 (23.9%) patients were frail and 121 (55.8%) were prefrail, with most SF-36 domains falling below the norm-population mean. Patients with frailty had lower mean scores in all physical SF-36 domains (p≤0.05) compared with those without frailty. Robust patients had temporal improvement in two domains (role physical +5.80 (95% CI 1.31 to 10.3) and role emotional +6.46 (95% CI 1.02 to 11.9)) versus patients with frailty and prefrailty, who had a collective improvement in a greater number of physical and psychological domains at 1 year (2 domains vs 11 domains), notably role physical (prefrail +6.53 (95% CI 3.85 to 9.20) and frail +10.4 (95% CI 6.7814.1)).CONCLUSIONS: Frail older adults with NSTEACS have poor HRQoL. One year following invasive management, there are modest improvements in HRQoL, most marked in frail and prefrail patients, who received a proportionally larger benefit than robust patients.TRIAL REGISTRATION NUMBER: NCT01933581.

KW - Acute Coronary Syndrome/diagnosis

KW - Aged

KW - Aged, 80 and over

KW - Female

KW - Frail Elderly

KW - Frailty/diagnosis

KW - Geriatric Assessment

KW - Humans

KW - Longitudinal Studies

KW - Male

KW - Quality of Life

U2 - 10.1136/heartjnl-2021-319064

DO - 10.1136/heartjnl-2021-319064

M3 - Article

C2 - 33990413

SN - 1355-6037

VL - 108

SP - 203

EP - 211

JO - Heart

JF - Heart

IS - 3

ER -