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
Abstract
<sec><strong>BACKGROUND</strong> 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. </sec><sec><strong>METHODS</strong> 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). </sec><sec><strong>RESULTS</strong> 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 <i>vs</i>. robust: 45.5% <i>vs</i>. 16.7%, <i>P</i> < 0.001) and infection (54.4% <i>vs</i>. 11.1%, <i>P</i> < 0.001), including pneumonia/lower respiratory tract infections (LRTI) and urinary tract infections (UTI). Incidence of antibiotic therapy (52.9% <i>vs</i>. 13.0%, <i>P</i> < 0.001), atrial fibrillation (AF) (47.1% <i>vs</i>. 9.3%, <i>P</i> < 0.001), AKI (57.3% <i>vs</i>. 20.4%, <i>P</i> < 0.001), delirium (52.9% <i>vs</i>. 3.7%, <i>P</i> < 0.001), liver injury, were higher in frail patients (17.6% <i>vs</i>. 0, <i>P</i> = 0.001), whilst their length of stay in the CCU was longer (4 days (2-6.5) <i>vs</i>. 2 days (2-3), <i>P</i> < 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]). </sec><sec><strong>CONCLUSIONS</strong> Frailty was associated with an increased risk of numerous in-hospital complications in elderly patients who had been hospitalized with ACS. </sec>