(VP113) THE IMPACT OF FRAILTY ON OUTCOMES FOR ELDERLY PATIENTS UNDERGOING PCI, CABG, OR MEDICAL MANAGEMENT FOLLOWING ACS

Background: Newfoundland and Labrador (NL) has one of the highest rates of ischemic heart disease (IHD) in Canada, and an aging population with significant comorbidities. Frailty is an established predictor of poor outcomes in IHD. The Clinical Frailty Scale (CFS) by Rockwood et al. is a validated tool to assess frailty on a scale of 1 (very fit) to 9 (terminally ill), which has not previously been used to evaluate the impact of frailty on acute coronary syndrome (ACS) outcomes. This study aims to determine the impact of frailty on mortality and quality of life (QOL) for elderly patients with ACS in NL.

METHODS AND RESULTS: This prospective cohort study, approved by the Health Research Ethics Board of NL, with informed consent obtained for all participants, included patients admitted to the Health Sciences Centre with an ACS event and age 65 or older, with no exclusion criteria. Frailty was assessed using the CFS (Rockwood et al.). QOL was assessed at baseline and one-year-post-ACS using a validated questionnaire, the EQ5D-5L. 280 participants were enrolled between June 2021 and March 2022. Approximately 50% (n=138) of patients were not frail, 41% (n=116) mild to moderately frail, and 9% (n=26) severely frail. Data analysis completed with SPSS v.28. One-year-all-cause mortality was 14.6%. Controlling for all confounders, there was a significant correlation between higher levels of frailty and mortality in ACS patients (p < 0.001). Using Cox regression, the hazard ratio of mild to moderate frailty is 3.883 (p=0.006), and of moderate to severe frailty is 5.418 (p=0.013). The type of ACS and management offered did not significantly impact mortality. Frail patients were significantly less likely to be offered PCI or CABG (p < 0.001). Frailty was significantly associated with poorer QOL at baseline (p < 0.001). 169 participants were re-assessed at one year (71% response rate; 41 participants deceased, 70 lost to follow-up) and showed a net significant improvement in overall QOL (p < 0.001). Improved QOL at one year correlated with lower levels of frailty (p < 0.001). However, QOL was not significantly impacted by the type of ACS or treatment offered.

Conclusion: This study shows that frailty is a significant independent risk factor for mortality for older adults with ACS. This data highlights the significant prevalence of frailty in NL and supports the use of frailty assessments when evaluating ACS patients. Frailty management and prevention strategies could significantly impact ACS patients' QOL and mortality.