54 Frail older patients have a greater improvement in physical quality of life than robust patients at one year following invasive treatment for non-st elevation acute coronary syndrome

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Abstract

Introduction

Frailty, a vulnerability to physiological stressors due to a decline in reserve with age, is common in older patients who present with non-ST elevation coronary syndrome (NSTEACS) and is associated with a disproportionately high morbidity and mortality. We aimed to determine how frailty influences physical quality of life (QoL) outcomes after invasive treatment for NSTEACS.

Methods

From February 2013 to April 2015, 232 patients aged 75 years with NSTEACS were enrolled into a multicentre prospective observational study. Frailty was assessed using the Fried criteria, where a score of 0 is robust, 1 or 2 is pre-frail and 3 is frail. QoL was evaluated using the Short Form-36 (SF-36) questionnaire (license number QM033917) at baseline and 1 year follow-up. The norm-based Physical Component Score (PCS), an aggregated summary score of the 8 SF-36 subscales, is reported.

Results

Mean age was 81±4 years, 60% were male and 88% received invasive treatment (percutaneous coronary intervention or coronary artery bypass grafting). At presentation, 39 (16.8%) patients were robust, 123 (53%) were pre-frail and 70 (30.2%) were frail. Increasing frailty was associated with decreased physical QoL at both baseline and 1 year (p<0.001 for both time points). Although all frailty groups saw an increase in mean PCS, this difference was only statistically significant in frail patients (robust: 42.4±11.4 to 44.3±12.4, p=0.372; pre-frail: 38.4±11.4 to 41.6±11.7, p=0.117; frail: 27.2±8.1 to 32.9±12.7, p=0.015). In addition, only frail patients who received invasive treatment saw this significant increase in PCS between baseline and 1 year, although numbers receiving medical therapy was low (Figure 1).

Conclusion

Although frail older patients with NSTEACS have a poorer physical QoL overall, our data suggest frailty is associated with a similar or greater improvement from baseline QoL in those who receive invasive treatment.

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