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Frailty as a predictor of all-cause mortality and readmission in older patients with acute coronary syndrome

A systematic review and meta-analysis

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Summary

Background

Evidence from longitudinal studies linking frailty and outcome after acute coronary syndrome (ACS) is mixed. This systematic review and meta-analysis aimed to examine whether frailty is a predictor of all-cause mortality and hospital readmission in older patients with ACS.

Methods

A systematic search was carried out in PubMed, EMBASE and Web of Science databases for studies evaluating the association between frailty and outcomes in older patients with ACS. A meta-analysis was performed to determine the pooled effect estimate for the association between frailty and mortality and hospital readmission, respectively.

Results

A total of 1459 articles were retrieved based on our search strategy. Fifteen studies involving 10,245 patients were included in the meta-analysis. The pooled prevalence of frailty was 32% (95% confidence interval [CI]: 25–39%), and the pooled prevalence of pre-frailty was 33% (95% CI: 26–40%) in elderly patients with ACS. Pooled analyses showed that frailty was associated with significantly higher risk of all-cause mortality and readmission (hazard ratios [HRs] = 2.43 and 2.32, respectively). Pre-frailty was also associated with significantly higher risk of all-cause mortality and readmission, respectively (HRs = 1.55 and 1.34, respectively).

Conclusions

Both frailty and pre-frailty are risk factors for all-cause mortality and readmission in older patients with ACS. Therefore, frailty assessment should be given sufficient attention in the management of older patients with ACS to help improve survival and reduce readmission rate.

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Authors and Affiliations

  1. Geriatric Cardiology Department of The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, 100853, Beijing, China

    Weihao Xu, Yulun Cai, Hongbin Liu & Li Fan

  2. Global Health Research Center, Duke Kunshan University, 215316, Kunshan, Jiangsu, China

    Chenkai Wu

  3. Duke Global Health Institute, Duke University, Durham, NC, USA

    Chenkai Wu

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  1. Weihao Xu
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  3. Hongbin Liu
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  4. Li Fan
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Correspondence to Hongbin Liu, Li Fan or Chenkai Wu.

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W. Xu, Y. Cai, H. Liu, L. Fan, and C. Wu declare that they have no competing interests.

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Weihao Xu and Yulun Cai contributed equally to the manuscript.

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Xu, W., Cai, Y., Liu, H. et al. Frailty as a predictor of all-cause mortality and readmission in older patients with acute coronary syndrome. Wien Klin Wochenschr 132, 301–309 (2020). https://doi.org/10.1007/s00508-020-01650-9

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