Blog | Tuesday, November 12, 2013

QD: News Every Day--Simple screening tool assess frailty in elderly patients with acute coronary syndrome

The highest frailty category of the Edmonton Frail Scale (EFS) was associated with increased comorbidity, longer lengths of stay, and decreased procedure use, and was independently associated with mortality in elderly patients with acute coronary syndrome, a study found.

The Edmonton Frail Scale, a user-friendly screening interview that requires less than 5 minutes to administer as was designed for non-geriatricians, with scores ranging from 0 (not frail) to 17 (very frail), was administered to a pilot study of 183 consecutive patients 65 years or older who were admitted to a single center in Edmonton, Alberta, Canada. Frailty was defined as a weight loss, fatigue, and weakness or a state of vulnerability arising from biological, cognitive and social factors.

Results appeared in the Canadian Journal of Cardiology.

Patient scores ranged from 0 to 13. Patients with higher scores were older, with more comorbidities, longer lengths of stay (EFS 0 to 3: mean, 7.0 days; EFS 4 to 6: mean, 9.7 days; and EFS ≥7: mean, 12.7 days; P=0.03), and decreased procedure use. Crude mortality rates at 1 year were 1.6% for EFS 0 to 3, 7.7% for EFS 4 to 6, and 12.7% for EFS ≥7 (P=0.05).

After adjusting for baseline risk differences using a “burden of illness” score, the hazard ratio for mortality for EFS ≥7 compared with EFS 0 to 3 was 3.49 (95% CI, 1.08 to 7.61; P=0.002).

Researchers noted the advantages and disadvantages to simple screening tools in the context of frailty. The complexity of some other methods makes simple tools attractive to clinicians. Even if they may lose some nuances, they can still be predictive. And, the EFS has been validated in multiple settings. Still, the authors noted that this was a pilot study designed to assess its use in acute coronary syndrome.

Researchers wrote, “Further work is needed to determine whether the use of a validated frailty instrument to better delineate some of the ‘unmeasured factors’ involved in medical decision making in elderly patients with cardiovascular disease would provide more transparent and refined discussions of risk and the opportunity for interventions to improve this risk in this important, often disadvantaged, population.”