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Frailty as an instrument for evaluation of elderly patients with non-ST-segment elevation myocardial infarction: A follow-up after more than 5 years
Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences. NU NAL Uddevalla Hosp Grp, Sweden.
Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping.
Duke Clin Res Inst, NC USA.
Linköping University, Department of Management and Engineering, Economics. Linköping University, Faculty of Arts and Sciences.
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2018 (English)In: European Journal of Preventive Cardiology, ISSN 2047-4873, E-ISSN 2047-4881, Vol. 25, no 17, p. 1813-1821Article in journal (Refereed) Published
Abstract [en]

Background There is a growing body of evidence on the relevance of using frailty measures also in a cardiovascular context. The estimated time to death is crucial in clinical decision-making in cardiology. However, data on the importance of frailty in long-term mortality are very scarce. The aim of the study was to assess the prognostic value of frailty on mortality at long-term follow-up of more than 5 years in patients 75 years or older hospitalised for non-ST-segment elevation myocardial infarction. We hypothesised that frailty is independently associated with long-term mortality. Design This was a prospective, observational study conducted at three centres. Methods and results Frailty was assessed according to the Canadian Study of Health and Aging clinical frailty scale (CFS). Of 307 patients, 149 (48.5%) were considered frail according to the study instrument (degree 5-7 on the scale). The long-term all-cause mortality of more than 5 years (median 6.7 years) was significantly higher among frail patients (128, 85.9%) than non-frail patients (85, 53.8%), (P amp;lt; 0.001). In Cox regression analysis, frailty was independently associated with mortality from the index hospital admission to the end of follow-up (hazard ratio 2.06, 95% confidence interval 1.51-2.81; P amp;lt; 0.001) together with age (P amp;lt; 0.001), ejection fraction (P = 0.012) and Charlson comorbidity index (P = 0.018). Conclusions In elderly non-ST-segment elevation myocardial infarction patients, frailty was independently associated with all-cause mortality at long-term follow-up of more than 6 years. The combined use of frailty and comorbidity may be the ultimate risk prediction concept in the context of cardiovascular patients with complex needs.

Place, publisher, year, edition, pages
SAGE PUBLICATIONS LTD , 2018. Vol. 25, no 17, p. 1813-1821
Keywords [en]
Elderly; frailty; NSTEMI; long-term mortality
National Category
Cardiac and Cardiovascular Systems
Identifiers
URN: urn:nbn:se:liu:diva-153178DOI: 10.1177/2047487318799438ISI: 000450356000005PubMedID: 30247067OAI: oai:DiVA.org:liu-153178DiVA, id: diva2:1267312
Available from: 2018-12-01 Created: 2018-12-01 Last updated: 2019-04-30

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Ekerstad, NiklasPettersson, StaffanAndersson, DavidEriksson, SofiaJanzon, MagnusLindenberger, MarcusSwahn, EvaAlfredsson, Joakim
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Division of Health Care AnalysisFaculty of Medicine and Health SciencesDepartment of Medical and Health SciencesDepartment of Cardiology in LinköpingEconomicsFaculty of Arts and SciencesDivision of Cardiovascular Medicine
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European Journal of Preventive Cardiology
Cardiac and Cardiovascular Systems

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