The impact of frailty on in-hospital complications in elderly patients with acute coronary syndrome

Wojciech Nowak; Ilona Kowalik; Michał Nowicki; Tomasz Cichocki; Janina Stępińska

doi:10.26599/1671-5411.2023.03.003

The impact of frailty on in-hospital complications in elderly patients with acute coronary syndrome

J Geriatr Cardiol. 2023 Mar 28;20(3):174-184. doi: 10.26599/1671-5411.2023.03.003.

Authors

Wojciech Nowak¹, Ilona Kowalik², Michał Nowicki¹, Tomasz Cichocki³, Janina Stępińska¹

Affiliations

¹ Department of Intensive Cardiac Therapy, National Institute of Cardiology, Warsaw, Poland.
² Clinical Research Support Center, National Institute of Cardiology, Warsaw, Poland.
³ Department of Coronary Artery Disease and Cardiac Rehabilitation, National Institute of Cardiology, Warsaw, Poland.

Abstract

Background: Acute coronary syndrome (ACS) is linked to a range of in-hospital complications, and age is recognized as risk factor for adverse events. Discrepancies between physiological and chronological age are explained by frailty. However, the relationship between frailty and in-hospital complications is not clear.

Methods: Assessment of frailty in patients was carried out using the FRAIL scale. In-hospital complications assessed included, bleeding, infection, arrhythmia, acute kidney injury (AKI), delirium, stroke/transient ischemic attack (TIA), liver injury, hypoglycemia, length of stay in the cardiac care unit (CCU).

Results: Of the 174 patients, frailty was identified in 39.1% and pre-frailty in 29.9%. Frailty was associated with a higher incidence of all types of bleeding (frail vs. robust: 45.5% vs. 16.7%, P < 0.001) and infection (54.4% vs. 11.1%, P < 0.001), including pneumonia/lower respiratory tract infections (LRTI) and urinary tract infections (UTI). Incidence of antibiotic therapy (52.9% vs. 13.0%, P < 0.001), atrial fibrillation (AF) (47.1% vs. 9.3%, P < 0.001), AKI (57.3% vs. 20.4%, P < 0.001), delirium (52.9% vs. 3.7%, P < 0.001), liver injury, were higher in frail patients (17.6% vs. 0, P = 0.001), whilst their length of stay in the CCU was longer (4 days (2-6.5) vs. 2 days (2-3), P < 0.001). Infections, pneumonia/LRTI, antibiotic therapy during hospitalization, the incidence of AF and liver injury were more often in patients with pre-frailty compared to the robust group. After adjustment for potential confounders, frailty remained independently associated with an increased risk of infection (OR: 3.3 [1.6-7.0]), including pneumonia/LRTI (OR: 2.5 [1.1-5.8]) and UTI (OR: 4.8 [1.8-12.5]). Frail individuals had an increased requirement for antibiotic therapy (OR: 3.9 [1.9-8.1]), and greater risk of AF (OR: 3.5 [1.3-9.3]), AKI (OR: 2.6 [1.2-5.3]) delirium (OR: 11.7 [4.8-28.7]), as well as having to stay longer in the CCU (> 3 days) (OR: 3.7 [1.9-7.3]).

Conclusions: Frailty was associated with an increased risk of numerous in-hospital complications in elderly patients who had been hospitalized with ACS.