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RESEARCH PRODUCT

Prognostic Value of Geriatric Conditions Beyond Age After Acute Coronary Syndrome

Yasmin EzzatvarErnesto ValeroClara SastreGema MiñanaVicente RuizJulio NúñezMaria-arantzazu Ruescas-nicolauAnna MollarVicente Bertomeu-gonzalezJuan SanchisClara BonanadSergio García-blas

subject

Gerontologymedicine.medical_specialtyAcute coronary syndromePhysical disabilityActivities of daily livingFrail ElderlyMyocardial InfarctionComorbidity030204 cardiovascular system & hematology03 medical and health sciences0302 clinical medicineRisk FactorsInternal medicineActivities of Daily LivingmedicineClinical endpointHumansCognitive DysfunctionDisabled PersonsProspective Studies030212 general & internal medicineMyocardial infarctionAcute Coronary SyndromeProspective cohort studyGeriatric AssessmentAgedbusiness.industryHazard ratioAge FactorsGeneral MedicinePrognosismedicine.diseaseComorbiditybusiness

description

The aim of the present study was to investigate the prognostic value of geriatric conditions beyond age after acute coronary syndrome. This was a prospective cohort design including 342 patients (from October 1, 2010, to February 1, 2012) hospitalized for acute coronary syndrome, older than 65 years, in whom 5 geriatric conditions were evaluated at discharge: frailty (Fried and Green scales), comorbidity (Charlson and simple comorbidity indexes), cognitive impairment (Pfeiffer test), physical disability (Barthel index), and instrumental disability (Lawton-Brody scale). The primary end point was all-cause mortality. The median follow-up for the entire population was 4.7 years (range, 3-2178 days). A total of 156 patients (46%) died. Among the geriatric conditions, frailty (Green score, per point; hazard ratio, 1.11; 95% CI, 1.02-1.20; P=.01) and comorbidity (Charlson index, per point; hazard ratio, 1.18; 95% CI, 1.0-1.40; P=.05) were the independent predictors. The introduction of age in a basic model using well-established prognostic clinical variables resulted in an increase in discrimination accuracy (C-statistic=.716-.744; P=.05), though the addition of frailty and comorbidity provided a nonsignificant further increase (C-statistic=.759; P=.36). Likewise, the addition of age to the clinical model led to a significant risk reclassification (continuous net reclassification improvement, 0.46; 95% CI, 0.21-0.67; and integrated discrimination improvement, 0.04; 95% CI, 0.01-0.09). However, the addition of frailty and comorbidity provided a further significant risk reclassification in comparison to the clinical model with age (continuous net reclassification improvement, 0.40; 95% CI, 0.16-0.65; and integrated discrimination improvement, 0.04; 95% CI, 0.01-0.10). In conclusion, frailty and comorbidity are mortality predictors that significantly reclassify risk beyond age after acute coronary syndrome.

yearjournalcountryeditionlanguage
2016-10-07Mayo Clinic Proceedings
https://doi.org/10.1016/j.mayocp.2017.01.018