Comparison of frailty instruments in acute coronary syndrome patients

Background Recognising frailty is important to guide clinical decisions in older patients with cardiac disease. The relative strengths of different frailty instruments to predict mortality and hospitalization risk are uncertain. Methods The Edmonton Frail Scale (EFS), Fried Criteria (Fried), Clinical Frailty Scale (CFS), Katz score (Katz), GP Cognition test (GPCog), and Euroscore II, a non-frailty risk score, were completed in 1174 clinically stable inpatients >70 years of age admitted with suspected acute coronary syndrome. Associations with all cause mortality (n=353, 29%) during a median follow-up of 5.1 (IQR: 4.6-5.5) years and hospitalization for > 10 days in the next year (n=267, 22%) were evaluated. Results There were graded associations between increasing frailty assessed by each tool and all cause mortality. For the EFS, which scores up to 17 points on different dimensions of frailty, hazard ratios for high (score 9-17, n=197) compared to low frailty (score 0-2, n=331) were 5.0 (95%CI: 3.4-7.4) for mortality, and 5.3 (3.4-8.3) for hospitalization. Discrimination for all-cause mortality according to Harrell's C-index were EFS 0.663, Euroscore II 0.654, Fried 0.648, CFS 0.640, GPCog 0.608, and Katz 0.593, P<0.001 for all. C-statistics for hospitalization >10 days were EFS 0.649, Fried 0.628, Katz 0.602, Euroscore II 0.589, CFS 0.584, and GPCog 0.552, P<0.001 for all. When combining tools integrated discrimination improvement for both mortality and hospitalization were greater for EFS than for other frailty instruments. Conclusion In acute coronary syndrome patients the Edmonton Frail Scale discriminated the risk of mortality and hospitalization as well or better than other frailty instruments. ### Competing Interest Statement AL; JB; AK; KB; GD; AS; DS; AT; GW; RAHS had nothing to disclose HDW: received grant support paid to the institution and fees for serving on a steering committee for the ODYSSEY study from Sanofi-Aventis and Regeneron Pharmaceuticals, for the HEART-FID study from American Regent; for the dal-GenE study from DalCor Pharma UK Inc, for the AEGIS-II study from CSL Behring, for the SCORED trial and the SOLOIST-WHF trial from Sanofi-Aventis Australia Pty Ltd, and for the CLEAR Outcomes Study from Esperion Therapeutics Inc. He has served on an Advisory Board for Genentech, Inc. and received lecture fees from AstraZeneca outside the submitted work. ### Clinical Trial Was not a clinical trial ### Funding Statement Anne Langsted was supported by the Research Fund for the Capital Region of Denmark (A7160), the Beckett Foundation (21-2-7785), the Augustinus Foundation (21-2056), and the Reinholdt W. Jorck and Wife Foundation (21-JU-0053). This research was supported by a grant form the Health Research Council of New Zealand ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: This study was approved by the New Zealand Health and disciplinary Ethics Committee (number 14/NTB/207). I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes The Data will be made available on request