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Coronary artery disease
Original research
Frailty and quality of life after invasive management for non-ST elevation acute coronary syndrome
  1. Benjamin Beska1,2,
  2. Daniel Coakley3,
  3. Guy MacGowan2,4,
  4. Jennifer Adams-Hall2,
  5. Chris Wilkinson2,5,
  6. Vijay Kunadian1,2
  1. 1 Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
  2. 2 Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
  3. 3 Manchester University NHS Foundation Trust, Manchester Royal Infirmary, Manchester, UK
  4. 4 Biosciences Institute, Newcastle University, Newcastle upon Tyne, UK
  5. 5 Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
  1. Correspondence to Dr Vijay Kunadian, 4th Floor William Leech Building, Newcastle University Medical School, Newcastle upon Tyne, United Kingdom; vijay.kunadian{at}newcastle.ac.uk

Abstract

Objective Older patients presenting with non-ST elevation acute coronary syndrome (NSTEACS) require holistic assessment. We carried out a longitudinal cohort study to investigate health-related quality of life (HRQoL) of older, frail adults with NSTEACS undergoing coronary angiography.

Methods 217 consecutive patients aged ≥65 years (mean age 80.9±4.0 years, 60.8% male) with NSTEACS referred for coronary angiography were recruited from two tertiary cardiac centres between November 2012 and December 2015. Frailty was assessed with the Fried Frailty Index; a score of 0 was characterised as robust, 1–2 prefrail and ≥3 frail. The Short Form Survey 36 (SF-36), an HRQoL tool consisting of eight domains spanning physical and mental health, was performed at baseline and 1 year.

Results 186 patients (85.7%) had invasive revascularisation. At baseline, 52 (23.9%) patients were frail and 121 (55.8%) were prefrail, with most SF-36 domains falling below the norm-population mean. Patients with frailty had lower mean scores in all physical SF-36 domains (p≤0.05) compared with those without frailty. Robust patients had temporal improvement in two domains (role physical +5.80 (95% CI 1.31 to 10.3) and role emotional +6.46 (95% CI 1.02 to 11.9)) versus patients with frailty and prefrailty, who had a collective improvement in a greater number of physical and psychological domains at 1 year (2 domains vs 11 domains), notably role physical (prefrail +6.53 (95% CI 3.85 to 9.20) and frail +10.4 (95% CI 6.7814.1)).

Conclusions Frail older adults with NSTEACS have poor HRQoL. One year following invasive management, there are modest improvements in HRQoL, most marked in frail and prefrail patients, who received a proportionally larger benefit than robust patients.

Trial registration number NCT01933581.

  • acute coronary syndrome
  • atherosclerosis
  • percutaneous coronary intervention

Data availability statement

Data are available upon reasonable request. The study was conducted prior to 2019. Data can be shared following approval from the study sponsor.

https://doi.org/10.1136/heartjnl-2021-319064

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    Data availability statement

    Data are available upon reasonable request. The study was conducted prior to 2019. Data can be shared following approval from the study sponsor.

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    Footnotes

    • Contributors BB wrote the original manuscript, was involved in data curation, performed formal analysis and was involved in manuscript review and editing. DC contributed to the original manuscript and was involved in manuscript review and editing. GM contributed to manuscript review and editing. JA-H was involved in data collection and investigation and contributed to manuscript review and editing. CW was involved in manuscript review and editing. VK conceptualised the study and is responsible for the overall content, and was involved in supervision, project administration, funding acquisition and manuscript review and editing.

    • Funding The research is supported by the National Institute for Health Research (NIHR) Newcastle Biomedical Research Centre based at Newcastle upon Tyne Hospitals NHS Foundation Trust and Newcastle University. VK has received research funding from the British Heart Foundation (CS/15/7/31679). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.