Frailty Among Older Adults With Acute Myocardial Infarction and Outcomes From Percutaneous Coronary Interventions

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Abstract

Background Frailty is a predictor of adverse outcomes after acute myocardial infarction (AMI). Methods and Results We estimated the prevalence of frailty among adults age ≥75 years admitted with AMI and examined the relationship between frailty, interventions, and mortality. We used the Premier Healthcare Database to identify older adults with primary diagnoses of AMI. We classified individuals as frail or not using the validated Claims-based Frailty Index. We described patients' characteristics and receipt of percutaneous coronary intervention stratified by frailty status. The primary outcome was hospital mortality. From 2000 to 2016, we identified 469 390 encounters for older patients admitted with AMI. The median age was 82 years, 53% were women, and 75% were white. The prevalence of frailty was 19%. Frail patients were less likely to receive percutaneous coronary intervention than nonfrail (15% versus 33%, P<0.001) and much less likely to receive coronary artery bypass surgery (1% versus 9%, P<0.001). There were far fewer interventions in individuals over age 85 years. Frailty was associated with higher mortality during AMI admission (unadjusted odds ratio [OR] 1.43, CI 1.39-1.46). While there was a differential benefit of the interventions because of frailty, frail patients had reduced hospital mortality with percutaneous coronary intervention (frail: OR 0.59, CI 0.55-0.63; nonfrail: OR 0.49, CI 0.47-0.50, P for interaction <0.001) and with coronary artery bypass surgery (frail: OR 0.77, CI 0.65-0.93; nonfrail: OR 0.74, CI 0.71-0.77, P for interaction <0.001) relative to no intervention. Conclusions In the United States, frailty is common among older patients admitted with AMI. While these vulnerable patients are at an increased risk for mortality, judicial use of revascularization with percutaneous coronary intervention in frail older patients still confers immediate survival benefit.

Original languageEnglish (US)
Pages (from-to)e013686
JournalJournal of the American Heart Association
Volume8
Issue number17
DOIs
StatePublished - Sep 3 2019

Fingerprint

Percutaneous Coronary Intervention
Myocardial Infarction
Odds Ratio
Hospital Mortality
Coronary Artery Bypass
Mortality
Databases
Delivery of Health Care
Survival

Keywords

  • administrative claims
  • cardiovascular disease
  • elderly
  • frailty
  • myocardial infarction

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

@article{f7ff591c7d384e8f984ef33107d75811,
title = "Frailty Among Older Adults With Acute Myocardial Infarction and Outcomes From Percutaneous Coronary Interventions",
abstract = "Background Frailty is a predictor of adverse outcomes after acute myocardial infarction (AMI). Methods and Results We estimated the prevalence of frailty among adults age ≥75 years admitted with AMI and examined the relationship between frailty, interventions, and mortality. We used the Premier Healthcare Database to identify older adults with primary diagnoses of AMI. We classified individuals as frail or not using the validated Claims-based Frailty Index. We described patients' characteristics and receipt of percutaneous coronary intervention stratified by frailty status. The primary outcome was hospital mortality. From 2000 to 2016, we identified 469 390 encounters for older patients admitted with AMI. The median age was 82 years, 53{\%} were women, and 75{\%} were white. The prevalence of frailty was 19{\%}. Frail patients were less likely to receive percutaneous coronary intervention than nonfrail (15{\%} versus 33{\%}, P<0.001) and much less likely to receive coronary artery bypass surgery (1{\%} versus 9{\%}, P<0.001). There were far fewer interventions in individuals over age 85 years. Frailty was associated with higher mortality during AMI admission (unadjusted odds ratio [OR] 1.43, CI 1.39-1.46). While there was a differential benefit of the interventions because of frailty, frail patients had reduced hospital mortality with percutaneous coronary intervention (frail: OR 0.59, CI 0.55-0.63; nonfrail: OR 0.49, CI 0.47-0.50, P for interaction <0.001) and with coronary artery bypass surgery (frail: OR 0.77, CI 0.65-0.93; nonfrail: OR 0.74, CI 0.71-0.77, P for interaction <0.001) relative to no intervention. Conclusions In the United States, frailty is common among older patients admitted with AMI. While these vulnerable patients are at an increased risk for mortality, judicial use of revascularization with percutaneous coronary intervention in frail older patients still confers immediate survival benefit.",
keywords = "administrative claims, cardiovascular disease, elderly, frailty, myocardial infarction",
author = "Damluji, {Abdulla A.} and Jin Huang and Karen Bandeen-Roche and Forman, {Daniel E.} and Gary Gerstenblith and Mauro Moscucci and Resar, {Jon R.} and Ravi Varadhan and Walston, {Jeremy D.} and Segal, {Jodi B.}",
year = "2019",
month = "9",
day = "3",
doi = "10.1161/JAHA.119.013686",
language = "English (US)",
volume = "8",
pages = "e013686",
journal = "Journal of the American Heart Association",
issn = "2047-9980",
publisher = "Wiley-Blackwell",
number = "17",

}

TY - JOUR

T1 - Frailty Among Older Adults With Acute Myocardial Infarction and Outcomes From Percutaneous Coronary Interventions

AU - Damluji, Abdulla A.

AU - Huang, Jin

AU - Bandeen-Roche, Karen

AU - Forman, Daniel E.

AU - Gerstenblith, Gary

AU - Moscucci, Mauro

AU - Resar, Jon R.

AU - Varadhan, Ravi

AU - Walston, Jeremy D.

AU - Segal, Jodi B.

PY - 2019/9/3

Y1 - 2019/9/3

N2 - Background Frailty is a predictor of adverse outcomes after acute myocardial infarction (AMI). Methods and Results We estimated the prevalence of frailty among adults age ≥75 years admitted with AMI and examined the relationship between frailty, interventions, and mortality. We used the Premier Healthcare Database to identify older adults with primary diagnoses of AMI. We classified individuals as frail or not using the validated Claims-based Frailty Index. We described patients' characteristics and receipt of percutaneous coronary intervention stratified by frailty status. The primary outcome was hospital mortality. From 2000 to 2016, we identified 469 390 encounters for older patients admitted with AMI. The median age was 82 years, 53% were women, and 75% were white. The prevalence of frailty was 19%. Frail patients were less likely to receive percutaneous coronary intervention than nonfrail (15% versus 33%, P<0.001) and much less likely to receive coronary artery bypass surgery (1% versus 9%, P<0.001). There were far fewer interventions in individuals over age 85 years. Frailty was associated with higher mortality during AMI admission (unadjusted odds ratio [OR] 1.43, CI 1.39-1.46). While there was a differential benefit of the interventions because of frailty, frail patients had reduced hospital mortality with percutaneous coronary intervention (frail: OR 0.59, CI 0.55-0.63; nonfrail: OR 0.49, CI 0.47-0.50, P for interaction <0.001) and with coronary artery bypass surgery (frail: OR 0.77, CI 0.65-0.93; nonfrail: OR 0.74, CI 0.71-0.77, P for interaction <0.001) relative to no intervention. Conclusions In the United States, frailty is common among older patients admitted with AMI. While these vulnerable patients are at an increased risk for mortality, judicial use of revascularization with percutaneous coronary intervention in frail older patients still confers immediate survival benefit.

AB - Background Frailty is a predictor of adverse outcomes after acute myocardial infarction (AMI). Methods and Results We estimated the prevalence of frailty among adults age ≥75 years admitted with AMI and examined the relationship between frailty, interventions, and mortality. We used the Premier Healthcare Database to identify older adults with primary diagnoses of AMI. We classified individuals as frail or not using the validated Claims-based Frailty Index. We described patients' characteristics and receipt of percutaneous coronary intervention stratified by frailty status. The primary outcome was hospital mortality. From 2000 to 2016, we identified 469 390 encounters for older patients admitted with AMI. The median age was 82 years, 53% were women, and 75% were white. The prevalence of frailty was 19%. Frail patients were less likely to receive percutaneous coronary intervention than nonfrail (15% versus 33%, P<0.001) and much less likely to receive coronary artery bypass surgery (1% versus 9%, P<0.001). There were far fewer interventions in individuals over age 85 years. Frailty was associated with higher mortality during AMI admission (unadjusted odds ratio [OR] 1.43, CI 1.39-1.46). While there was a differential benefit of the interventions because of frailty, frail patients had reduced hospital mortality with percutaneous coronary intervention (frail: OR 0.59, CI 0.55-0.63; nonfrail: OR 0.49, CI 0.47-0.50, P for interaction <0.001) and with coronary artery bypass surgery (frail: OR 0.77, CI 0.65-0.93; nonfrail: OR 0.74, CI 0.71-0.77, P for interaction <0.001) relative to no intervention. Conclusions In the United States, frailty is common among older patients admitted with AMI. While these vulnerable patients are at an increased risk for mortality, judicial use of revascularization with percutaneous coronary intervention in frail older patients still confers immediate survival benefit.

KW - administrative claims

KW - cardiovascular disease

KW - elderly

KW - frailty

KW - myocardial infarction

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U2 - 10.1161/JAHA.119.013686

DO - 10.1161/JAHA.119.013686

M3 - Article

C2 - 31475601

AN - SCOPUS:85071746976

VL - 8

SP - e013686

JO - Journal of the American Heart Association

JF - Journal of the American Heart Association

SN - 2047-9980

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