Single Center Research Of Correlation Between Frailty And Coronary Heart Disease In The Elderly

【Background】 Frailty is a common and important geriatric syndrome characterized by age-associated declines in physiologic reserve and function across multi-organ systems, leading to increased vulnerability for adverse health outcomes including functional disability, reduced quality of life, and increased unscheduled return visit and mortality.On the basis of existing cardiovascular disease risk model, frailty assessment can provide additional valuable prognostic indicators and help clinicians selecting better treatment for patients. While in the process of clinical decision-making and cardiovascular disease prognosis, the concept has not been accepted seriously in China.[Objective]1. Analyze the prevalence of frailty and Geriatric Syndrome in elderly patients with coronary artery disease in cross-sectional, analyze some clinical parameters and laboratory parameters associated with frailty.2. Prospectively analyze the manner in which frailty predicts short-term outcomes for elderly patients with coronary artery disease.【Methods】1. Patients aged ≥65 years, with diagnosed of coronary artery disease from Cardiology department and Geriatric Department were included from single-center, Peking Union Medical College Hospital (PUMCH). Clinical data including Geriatric Syndromes, co-morbidities and quality of life were collected using Comprehensive Geriatrics Assessment.2. Frailty was defined according to the Clinical Frailty Scale. The impact of the co-morbid conditions on risk was quantified by the coronary artery disease-specific index (CAD-specific Index). Multiple-linear regression was used to analyze relationship between frailty and other risk factors.3. Patients were followed up by clinic visit or telephone consultation. Following-up items included recurrence of cardiovascular events, all-cause mortality, unscheduled return visit. Multivariable regression analysis was performed using Cox regression.[Results]1. Of 505 patients,221 (43.8%) were considered frail,126 (25.0%) were moderately to severely frail among them.2. Co-morbidities and Geriatric Syndrome including incontinence, fall history, visual impairment, hearing impairment, constipation, chronic pain, sleeping disorder, dental problems, anxiety or depression, delirium were more frequently in frail patients 51.1% (113/221)、31.2%(69/221)、43.9%(97/221)、49.3%(109/221)、 60.2%(133/221)、62.0%(137/221)、49.3%(109/221)、79.2%(175/221)、 11.3%(25/221)、2.7%(6/221) than in non-frail patients 30.6%(87/284)、 19.0%(54/284)、29.9%(85/284)、29.6%(84/284)、33.8%(96/284)、46.8% (133/284)、37.7%(107/284)、55.6%(158/284)、6.0%(17/284)、0 (0/284) respectively (x2=21.831,10.053,10.510,20.519,34.894,11.481,6.886,30.695, 4.624,7.803, p=0.000、0.002、0.001、0.000、0.000、0.001、0.009、0.000、 0.032、0.005)3. Multiple linear regression analysis relationship between frailty and hemoglobin (HGB), hematocrit (HCT), serum albumin (Alb), pre-albumin (PA). Correlation showed, adjusted for anemia, CAD-specific index, middle-severe renal failure and other disease factors, frailty was still closely associated with the above parameters. (r=0.555、0.537、0.341、0.329, P=0.000、0.000、0.000、0.000)4. Adjusted for sex, age, severity of illness and other coexist factors, by Cox survival analysis, CFS was found to be strongly and independently associated with risk for the primary composite outcome in CAD patients:all-cause mortality (Hazard Ratio, 2.881; 95% confidence interval,1.591-5.215, p<0.001) and unscheduled return visit(Hazard Ratio,1.835; 95% confidence interval,1.458-2.311, p<0.001).5. In sub-group analysis of ACS patients, adjusted for sex, age, severity of coronary artery diseases (LM lesion or not) and co-morbidities (CAD specific index), by Cox survival analysis, CFS was found to be strongly and independently associated with risk for the primary composite outcomes:all-cause mortality (Hazard Ratio, 5.393; 95% confidence interval 1.477-19.692, p=0.011) and unscheduled return visit(Hazard Ratio, HR=2.832; 95% confidence interval,1.140-7.037, p=0.025).6. In sub-group analysis of stable CAD patients, IL-6 and hs-CRP level were both significantly higher in frail group than in non-frail group (P<0.05). Walking speed was better than grip strength as an indicator of frailty during assessment, especially for women. In our study, best cutoff of walking speed to diagnose frailty was 0.879m/s for men, with a sensitivity of 70.6% and a specificity of 83.7%; 0.870m /s for women, diagnostic sensitivity 92.3%, specificity of 80%.7. In sub-group comparisons among stable coronary artery disease, unstable angina and acute myocardial infarction, levels of hs-CRP and IL-6were both showing a rising trend as the stable of CAD decreasing, while the level of 25 (OH) VitD3 showing a decreasing trend as the stable of CAD decreasing。All three had significant difference (P<0.001)【Conclusions】1. Comprehensive Geriatrics Assessment and Clinical Frail Scale were useful in evaluation of elderly patients with coronary artery diseases.2. Elderly patients with coronary artery disease had high prevalence of frailty, more attention should be paid especially in moderate-severe frail patients.3. Frailty was strongly and independently associated with short-term outcomes for elderly patients with coronary arterydisease, including acute coronary syndrome.4. Walking speed and grip strength were vital signs of elderly patients, both could be as individual indicators of frailty during assessment.