Older adults with acute coronary syndrome: the impact of frailty and nutritional status on in-hospital complications.

Abstract

Aims: The optimal management of older patients with acute coronary syndrome (ACS) remains unclear. The most effective evaluation methods for frailty and malnutrition are yet to be delineated, despite being proposed as predictors of adverse outcomes. Consequently, this study aims to assess the significance of these factors in predicting in-hospital complications within this population.

Methods and results: In this single-centre, intrahospital case-control study, 217 older patients (aged >70 years) with ACS were categorized into two groups based on the occurrence of net adverse clinical events (NACE) during hospitalization: the NACE (n = 59) and non-NACE (n = 158) groups. Demographic and clinical variables, including assessments of frailty using the FRAIL scale (FS), dependency using the Barthel index, and nutritional status using both the prognostic nutritional index (PNI) and geriatric nutritional risk index, were collected. Regression models and receiver operating characteristics curves were constructed to predict NACE. Patients in the NACE group exhibited higher frailty (P < 0.001), increased dependency (P < 0.001), and poorer nutritional status (P < 0.05) compared with those in the non-NACE group. The FS [odds ratios (OR) 95% confidence interval (CI) = 2.03 (1.39-2.95), P < 0.001] and PNI [OR (95% CI) = 0.64 (0.41-0.99), P < 0.05] scores emerged as independent predictors of NACE in a multivariable model including age, sex, and traditional cardiovascular risk factors. This model demonstrated a high discriminatory power [area under the curve (95% CI) = 0.834 (0.768-0.899), P < 0.001] for NACE.

Conclusion: Frailty and nutritional status could significantly contribute to the stratification and identification of older adults with ACS who are at risk of developing in-hospital complications.