Introduction: For the large and growing elderly population with cardiovascular (CV) disease, and frequently other concomitant diseases, it is crucial to identify measures of biological age and their contribution to overall risk. Frailty denotes increased vulnerability and decreased physiological reserves, and has earlier been shown to be useful in short and medium-term risk prediction.
Hypothesis: Frailty measures are importanat also for long-term risk prediction in elderly with non ST-elevation myocardial infarction (NSTEMI) patients.
Methods: Patients aged ≥75 years with NSTEMI were included from 2009 to 2010. Frailty was assessed according to the Canadian Study of Health and Aging Clinical Frailty Scale (CSHA) and comorbid conditions according to the Charlson Comorbidity Index (CCI). Vital status was assessed in 2016 after a median of 6.7 years (interquartile range, 6.5-6.8).
Results: Of 307 patients, the 149 (48.5%) who were considered frail (5-7/7 points on the CSHA scale) had significantly higher mortality (85.9% vs 53.8%, p<0.001). In a multivariable logistic regression analysis, including comorbidity, age, gender and CV risk factors, frailty was independently associated with mortality (OR, 3.36; 95% CI 1.79-6.32).
Conclusions: Frailty is independently and strongly associated with long-term mortality in elderly NSTEMI patients. The combined use of frailty and comorbidity may be the ultimate risk prediction concept in cardiovascular patients with complex needs.