The effect of age and frailty on outcomes for older adults admitted with Acute Coronary Syndrome: an analysis of MINAP registry

Introduction

Frailty, independent of age, is associated with adverse outcomes following admission with Acute Coronary Syndrome (ACS) but is often not accounted in risk stratification scores. Those identified as frail may not be considered for invasive interventions despite evidence that they stand to benefit (1) and are at risk of worsening geriatric syndromes on discharge (2,3).

Purpose

We aimed to categorise clinical outcomes in older adults admitted with ACS, with or without frailty to suggest if there is a role for geriatrician input in reducing length of stay and preventing adverse events.

Methods

Anonymised data was obtained from an NHS trust’s MINAP registry of patients admitted with ACS between April 2022 to March 2023. Baseline demographics, Clinical Frailty Score (CFS), GRACE and HEART scores, total length of stay (LOS), days as inpatient pre- and post-procedure, adverse events during admission, readmission rates and all-cause mortality rate at 30 days and 1 year were calculated.

Results

288 patients over age 65 admitted with ACS were included in analysis.

Median age was 73 [IQR 67-80.75]. Patients over 75 years had higher rates of frailty (38.5% of 75-84 years and 50.0 % over 85 years had CFS ≥ 5 versus 14.9% 65-74 years (p<0.00001)).

253 (87%) patients underwent invasive angiogram during admission. Although, age was not a limiting factor, frail patients were less likely to have an angiogram: 24.9% CFS ≥ 5 versus 57.1% of CFS ≤ 3 (p=0.00199).

Mean LOS was 9.02 days with a median of 7[IQR 4-12] v mean LOS 6 days for all under 65 (p<0.0001). There was a trend for longer LOS post-angiogram particularly for patients with CFS 4-5 versus CFS 3 or less (11.3 days v 8.92 days p=0.053).

Conclusions

Older people admitted with ACS are more likely to have a prolonged admission. Input from geriatricians and the wider multidisciplinary team may help to identify and optimise care and decision making of patients admitted with ACS and mild to moderate frailty.

1. Damluji et al. J Am Heart Assoc. 2019;8:e013686