Impact of Frailty on the Short-term Prognosis of Hospitalized Elderly Patients with Coronary Heart Disease:A Prospective Cohort Study

  Objective  To analyze the effect of frailty on the short-term prognosis of hospitalized older patients with coronary heart disease.

  Methods  The clinical data were prospectively collected and analyzed in elderly patients with coronary heart disease that were hospitalized in Peking Union Medical College Hospital from December 2017 to November 2018. According to whether they were combined with frailty, the patients were divided into frailty group and non-frailty group.All the patients were followed up, and endpoint events included unscheduled return visits, major adverse cardiac and cerebral events (MACCE), and death from all causes. Multivariate Cox regression was used to analyze the relationship between frailty and the prognosis of patients with coronary heart disease. The Kaplan-Meier method and Log-Rank test were used to compare the MACCE-free survival curves between patients with and without frailty.

  Results  A total of 345 elderly patients with coronary heart disease who met the inclusion and exclusion criteria were selected for this study, including 250 cases of stable coronary heart disease and 95 cases of acute coronary syndrome. There were 74 cases (21.4%) in the frailty group including 38 cases of mild frailty and 36 cases of moderate frailty, and 271 cases (78.6%) in the non-frailty group. The median follow-up time was 351(300, 394) days, and 3 cases were lost to follow-up. Compared with the non-frailty group, the incidence of unscheduled return visits (36.1% vs. 21.5%) and all-cause mortality (11.1% vs. 4.1%) in the frailty group increased (all P < 0.05), and there is no significant difference in the incidence of MACCE (9.7 % vs. 4.8%) between the two groups (P > 0.05). The results of multivariate Cox regression analysis showed that mild and moderate frailty were risk factors for all causes of death in patients with stable coronary heart disease (HR=4.169, 95% CI: 1.055-16.474, P=0.042), but had no significant effect on unscheduled return visits (HR=1.704, 95% CI: 0.947-3.066, P=0.075) and MACCE (HR=1.268, 95% CI: 0.331-4.863, P=0.729). In patients with acute coronary syndrome, mild and moderate frailty had no significant effect on unscheduled return visits (HR=1.159, 95% CI: 0.342-3.924, P=0.812), MACCE (HR=0.822, 95% CI: 0.092-7.369, P=0.861) and death from all causes (HR=1.445, 95% CI: 0.210-9.964, P=0.708). The Kaplan-Meier curve showed that there was no significant in the MACCE-free survival curve between the two groups (P > 0.05).

  Conclusions  The prevalence of mild and moderate frailty in hospitalized older patients with coronary heart disease is high, which may increase the risk of short-term mortality for those with stable coronary heart disease.