Barcelona, Spain – Saturday 30 August 2014: Frailty increases the risk of death or repeat heart attack in elderly MI patients by three-fold, according to research presented at ESC Congress today by Dr Clara Bonanad from the University Clinic Hospital of Valencia, Spain. The findings suggest that elderly patients admitted for heart attack should be routinely assessed for frailty.
Dr Bonanad said:
“Life expectancy is increasing and the general population is aging. This means that more patients admitted to the cardiology department with an acute coronary syndrome (myocardial infarction or angina) are elderly. We must adapt to this social change to give the most appropriate medical care.”
“However, age alone is not enough to determine the prognosis of elderly people. They have a number of what we called ‘geriatric conditions’ which put them at greater risk of illness and worse outcomes.”
The current study included 342 patients older than 65 admitted to the University Clinic Hospital in Valencia, Spain, with a diagnosis of angina or myocardial infarction. At discharge five geriatric conditions were evaluated: frailty, physical disability, instrumental disability, cognitive impairment and comorbidity.
The researchers used the following definitions:
- Frailty - a biological condition in which individuals are at increased vulnerability to stressors and have an elevated risk of catastrophic decline in health and function
- Physical disability - any impairment which limits the physical function of limbs, fine movements, or gross motor ability
- Instrumental disability – an inability to perform activities of daily living such as feeding themselves, bathing, dressing, grooming, working, housework and leisure activities
- Cognitive impairment - any characteristic that acts as a barrier to the cognition process. Cognitive deficits may be congenital, or caused by environmental factors such as brain injuries, neurological disorders or mental illness
- Comorbidity - the presence of one or more additional disorders occurring in addition to the primary disease or disorder.
The researchers analysed the relationship between these geriatric conditions and death or recurrent myocardial infarction at a 30 month median follow-up.
They found that all five geriatric conditions had a statistically significant association with worse outcome. Of them, frailty captured most of the prognostic information. Indeed, frailty was the strongest independent predictor of death or recurrent myocardial infarction and increased risk of mortality by three times.
Dr Bonanad said:
“We found that frailty was the strongest predictor of death or recurrent myocardial infarction in patients over the age of 65. But all of the geriatric conditions had some impact on prognosis. When elderly patients are admitted to hospital with angina or myocardial infarction their initial evaluation should include assessment of geriatric conditions. This will help practitioners to identify who is most at risk of poor outcomes.”
“Specific strategies are needed for patients with geriatric conditions including frailty that will improve their rehabilitation after myocardial infarction. Such strategies should include help with nutrition and mobility with the aim of achieving a better prognosis and quality of life in these patients.”