Correlation between frailty and coronary heart disease in the elderly

Abstract

Objective To prospectively analyze the impact of frailty on the short-term outcomes of coronary heart disease (CHD) and its related factors. Methods A total of 505 patients aged ≥65 years, with diagnosis of CHD in Cardiology Department and Geriatrics Department in our hospital were selected. Clinical data including geriatrics syndromes were collected by using Comprehensive Geriatrics Assessment (CGA). Frailty was defined according to the Clinical Frailty Scale (CFS). The impact of the comorbid conditions on the risk was quantified by the coronary artery disease-specific index. Patients were followed up by clinic visit or telephone consultation. Following-up items included recurrence of all-cause mortality, recurrence of cardiovascular events, and unscheduled returned visit. The impact of frailty on the prognosis of coronary heart disease was analyzed by Cox regression. Results Of the 505 patients, 221 patients (43.76%) were considered to be frail elderly, in whom 126 patients (24.95%) were assessed as moderately to severely frail elderly. The incidences of comorbidities and geriatrics syndrome including incontinence, fall history, visual impairment, hearing impairment, constipation, chronic pain, sleeping disorder, dental problems, anxiety or depression, and delirium were higher in frail patients than in non-frail patients〔51.1% (113/221)vs. 30.6% (87/284), 31.2% (69/221) vs. 19.0% (54/284), 43.9% (97/221) vs. 29.9% (85/284), 49.3% (109/221) vs. 29.6% (84/284), 60.2% (133/221) vs. 33.8% (96/284), 62.0% (137/221) vs. 46.8% (133/284), 49.3% (109/221) vs. 37.7% (107/284), 79.2% (175/221) vs. 55.6% (158/284), 11.3% (25/221) vs. 6.0% (17/284), 2.7% (6/221) vs. 0 (0/284), χ2=21.831, 10.053, 10.510, 20.519, 34.894, 11.481, 6.886, 30.695, 4.624, 7.803, respectively, all P<0.05〕. After adjusting for sex, age, severity of illness and other coexist factors, the Cox survival analysis showed that frailty was the independent risk predictor for the all-cause mortality and unscheduled return visit in CHD patients (HR=2.881 and 1.835, 95%CI: 1.591-5.215 and 1.458-2.311, both P<0.001). Conclusions Comprehensive Geriatrics Assessment and Clinical Frail Scale are useful to evaluate the clinical features in elderly CHD patients. Frailty is the independent risk predictor for the short-term prognosis including all-cause mortality and unscheduled return visit in elderly CHD patients. Key words: Coronary disease; Frail elderly; Risk assessment