Elderly and frailty in acute cardiac care: a growing concern. Prevalence and outcomes

Abstract Background Elderly patient population are growing in acute cardiac care setting. Frailty syndrome worsens outcomes in cardiovascular patients. However, frailty is not routinely detected in patients admitted into the acute cardiac care unit (ACCU) . Systematic frailty screening can be useful for better risk stratification in patients. Purpose To assess the prevalence and prognostic impact of frailty in elderly patients in the ACCU. Methods Patients older than 65 years admitted to the ACCU for 3 consecutive months was studied and followed up for 22 months. Demographics and clinical variables, geriatric tests and scales, in-hospital complications and mortality and at 22 months follow-up were collected. Results 105 patients, mean age 78±7 years, 66% men were included. The most frequent admission diagnoses were acute coronary syndrome (29.5%), atrioventricular block (24.8%), acute heart failure (15.25%) and post-structural heart intervention (14.3%). Patients were classified frail 22.9%, pre-frail 42.9%, and robust 34.3%. Compared with robust patients, frail patients were older (80.7±6.7 vs 77.8±7.03 years; p = 0.014), more frequently female (82.9 vs 58.6%; p = 0.014), had lower Hb level on admission (11.71±1.82 vs 13.53±1.83 gr/dl; p = 0.001) and higher score on the CHA2DS2-Vasc scale (p = 0.002). Frailty was associated with polypharmacy (91.7 vs 25.7%; p = 0.001), dependency (83.3 vs 26.1%; p = 0.001), cognitive impairment (31.8 vs 2.9%; p = 0.001), nutritional risk (78.3 vs 37.1%; p = 0.004), depression (50 vs 6.1%; p = 0.001) and worse score in perceived quality of life (0.77 vs 0.54; p = 0.001). No differences were found in diagnostic and therapeutic management and length of hospital stay between group patients. However, frail patients group shown higher rate of complications such as heart failure (50% vs 2.8%; p = 0.0001), acute renal failure (25% vs 0%; p = 0.006) and phlebitis (0% vs 12.5%; p = 0.03). Frail patients had a higher rate of in-hospital mortality (20% vs 0%; p = 0.017). Mortality rate at 22-month follow-up was 33.3% for frail patients, 29.5% for pre-frail patients, and 5.6% for robust patients. Analysis of survival probability using the Kaplan-Meier actuarial method showed a higher risk of mortality among frail patients [Hazard ratio: 7.42 (95% CI: 2.43 – 22.68)] and pre-frail patients [Hazard ratio: 5.9 (95% CI: 2.41 – 14.48)] compared with robust patients (figure 1). Conclusions In our study, frailty was present in about one in five patients admitted to the UCCA. It was associated with higher incidence of in-hospital complications and mortality. Frail and pre-frail patient showed worse long-term outcome. Early detection of frailty provides significant information to risk stratification on elderly UCCA patients. Frailty syndrome is reversible. Special nursing and multidisciplinary care plans are needed to modify it.Kaplan-Meier survival analysis