Abstract 19025: Frailty Assessment in Early Invasive Percutaneous Coronary (PCI) Management of Non-ST-Elevation Acute Coronary Syndromes (NSTE-CS): Is Clinical Perception of Frailty Enough?
Introduction: As our population ages, the role of frailty in CAD is increasingly clinically relevant. Approximately 12.4% of the US population with CAD is 65 years and older. It has been noted that females and the elderly are treated less aggressively in the setting of NSTE-CS.
Hypothesis: Subjective assessment of frailty compared to objective measure of frailty shows a significant difference in PCI management of NSTE-CS in women versus men, in the elderly population.
Methods: We conducted a retrospective review of patients 65 and older, from March 1, 2015 to December 31, 2015 that were admitted to an urban, multiracial tertiary care center for unstable angina or NSTEMI (n = 120). Primary endpoint of measured frailty compared with subjective assessment of frailty amongst the genders was assessed in the setting of NSTE-CS. Secondary endpoint of outcomes post - early intervention PCI in the frail were also assessed.
Results: Females presented with a higher GRACE risk score compared with men with a mean of 132 ± 30, p < 0.047. Mean modified Fried frailty score was 4.4 ± 2.7, SEM = 0.25. No statistical difference in Fried frailty scores was found between the genders. A positive correlation was noted between Fried frailty score and Charlson comorbidity index. There was no statistical difference found in subjective designation of frailty between male and female patients. Subjective assessment of frailty by cardiologist correlated well with higher objective measures of frailty with p < 0.0001, with mean Fried frailty score of 7.0 ± 2.6. Poorer outcomes were associated with higher frailty scores, specifically development of CHF, p = 0.029, and death, p = 0.026, but not with gender. Most common reasons for choosing delayed PCI or medical management alone were kidney disease, or gastrointestinal bleed. Early PCI was associated with decreased readmission rates, p < 0.05, but otherwise did not show a statistically significant difference in outcomes.
Conclusions: Subjective and objective measure of frailty showed no statistically significant difference in our sample population. Gender showed no statistical difference in frailty scores or outcomes post PCI. Objectively high measures of frailty were associated with poorer outcomes overall with or without early PCI.
Author Disclosures: T.K. Kahlon: None. S. Salahie: None. K. Hagglund: None. N. Mesiha: None.
- © 2016 by American Heart Association, Inc.