September 18, 2019
Older adults with acute myocardial infarction are less likely to receive revascularization with percutaneous coronary intervention or coronary artery bypass surgery if they are frail, even though the procedures increase their likelihood of survival, according to a study published online in the Journal of the American Heart Association.
“Frail older adults experienced higher hospital mortality during their acute myocardial infarction admission,” researchers wrote, “and were more likely to be discharged to rehabilitation or hospice care.”
The findings stem from an analysis of 469,390 hospital admissions for patients 75 and older with acute myocardial infarction. Older adults were deemed frail or nonfrail using the validated Claims-based Frailty Index. The prevalence of frailty in the study sample was 19%.
Some 33% of nonfrail older adults received percutaneous coronary intervention compared with 15% of frail older adults. Coronary artery bypass surgery was performed on 9% of nonfrail older adults compared with just 1% of frail older adults, the study found.
Despite a differential benefit of both interventions with frailty, frail patients still had reduced hospital mortality with either of the interventions compared with no intervention.
In-hospital mortality rates, hospice referrals, and discharge to rehabilitation centers were all higher in frail older adults compared with nonfrail older adults, the study found.
“In the United States, frailty is common among older patients admitted with acute myocardial infarction,” researchers wrote. “While these vulnerable patients are at an increased risk for mortality, judicial use of revascularization with percutaneous coronary intervention in frail older patients still confers immediate survival benefit.”
Damluji AA, Huang J, Bandeen-Roche K, et al. Frailty among older adults with acute myocardial infarction and outcomes from percutaneous coronary interventions [published online ahead of print August 31, 2019]. J Am Heart Assoc. 3;8(17):e013686. doi: 10.1161/JAHA.119.013686