Introduction Non ST elevation Acute Coronary Syndrome (NSTEACS) is more common in older patients and invasive treatment is an established management strategy in the United Kingdom. Frailty is an independent marker of adverse cardiovascular (CV) outcomes in older patients. Older patients with atherosclerotic disease are at risk of developing cognitive impairment. Frailty and cognitive impairment in older patients with NSTEACS can be a predictor of poor CV outcomes. The prevalence of undiagnosed early cognitive impairment in frail older patients with NSTEACS managed by invasive strategy is not known.
Methods Cognitive status was assessed using Montreal Cognitive Assessment (MoCA) tool (maximum score 30, normal ≥26) in consecutive patients (≥ 75 years) admitted to a tertiary cardiac centre for invasive management of NSTEACS as a sub-study of an ongoing prospective study. Patients with known severe dementia were excluded from the study. Frailty status was assessed by Fried (Cardiovascular Health Study) frailty assessment tool (score 0–5) and patients categorised into frail (score ≥3) and non-frail (score 0–2) groups.
Results MoCA score was available in 175 (89.3%) patients. About a third (30.8%) of these patients were frail and half of the patients (50.3%) had MoCA score <26 suggestive of cognitive impairment. The mean (standard deviation [SD]) age of patients with MoCA score <26 was higher compared to patients with MoCA score ≥26 (82.3 years (4.0) versus 80.4 years (3.9), p = 0.002). There was no difference in the proportion of females (37.9% vs. 43.1%, p = 0.469) respectively between the two groups. The baseline characteristics are displayed in the Table 1. The mean MoCA score was significantly lower in the frail group (23.7, SD 3.5) compared to the non-frail group (25.7, SD 2.4, p < 0.0001). Cognitive impairment with score <26 was more common in the frail group compared to the non-frail group (68.5% vs. 42.1% respectively, p = 0.002).
Conclusion Undiagnosed early cognitive impairment is very common in 75+ year old patients presenting with NSTEACS managed by invasive strategy. Cognitive impairment is more common in frail patients compared to non-frail patients. Combination of frailty and cognitive impairment may have an adverse impact on the cardiovascular outcomes of older patients with NSTEACS managed by invasive strategy. Frailty and cognitive assessment may need to be part of risk assessment in older patients planned for invasive management.
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