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Long-Term Prognostic Value of Cognitive Impairment on Top of Frailty in Older Adults after Acute Coronary Syndrome.
Sanchis, Juan; Bonanad, Clara; García-Blas, Sergio; Ruiz, Vicent; Fernández-Cisnal, Agustín; Sastre, Clara; Ruescas, Arancha; Valero, Ernesto; González, Jessika; Mollar, Anna; Miñana, Gema; Núñez, Julio.
Affiliation
  • Sanchis J; Servicio de Cardiología, Hospital Clínico Universitario de Valencia, INCLIVA, Universidad de Valencia, CIBERCV, 46010 Valencia, Spain.
  • Bonanad C; Servicio de Cardiología, Hospital Clínico Universitario de Valencia, INCLIVA, Universidad de Valencia, CIBERCV, 46010 Valencia, Spain.
  • García-Blas S; Servicio de Cardiología, Hospital Clínico Universitario de Valencia, INCLIVA, Universidad de Valencia, CIBERCV, 46010 Valencia, Spain.
  • Ruiz V; Servicio de Cardiología, Hospital Clínico Universitario de Valencia, INCLIVA, Universidad de Valencia, CIBERCV, 46010 Valencia, Spain.
  • Fernández-Cisnal A; Servicio de Cardiología, Hospital Clínico Universitario de Valencia, INCLIVA, Universidad de Valencia, CIBERCV, 46010 Valencia, Spain.
  • Sastre C; Servicio de Cardiología, Hospital Clínico Universitario de Valencia, INCLIVA, Universidad de Valencia, CIBERCV, 46010 Valencia, Spain.
  • Ruescas A; Departamento de Fisioterapia, Universidad de Valencia, 46010 Valencia, Spain.
  • Valero E; Servicio de Cardiología, Hospital Clínico Universitario de Valencia, INCLIVA, Universidad de Valencia, CIBERCV, 46010 Valencia, Spain.
  • González J; Servicio de Cardiología, Hospital Clínico Universitario de Valencia, INCLIVA, Universidad de Valencia, CIBERCV, 46010 Valencia, Spain.
  • Mollar A; Servicio de Cardiología, Hospital Clínico Universitario de Valencia, INCLIVA, Universidad de Valencia, CIBERCV, 46010 Valencia, Spain.
  • Miñana G; Servicio de Cardiología, Hospital Clínico Universitario de Valencia, INCLIVA, Universidad de Valencia, CIBERCV, 46010 Valencia, Spain.
  • Núñez J; Servicio de Cardiología, Hospital Clínico Universitario de Valencia, INCLIVA, Universidad de Valencia, CIBERCV, 46010 Valencia, Spain.
J Clin Med ; 10(3)2021 Jan 24.
Article in En | MEDLINE | ID: mdl-33498816
ABSTRACT
Frailty is a marker of poor prognosis in older adults after acute coronary syndrome. We investigated whether cognitive impairment provides additional prognostic information. The study population consisted of a prospective cohort of 342 older (>65 years) adult survivors after acute coronary syndrome. Frailty (Fried score) and cognitive function (Pfeiffer's Short Portable Mental Status Questionnaire-SPMSQ) were assessed at discharge. The endpoints were mortality or acute myocardial infarction at 8.7-year median follow-up. Patient distribution according to SPMSQ results was no cognitive impairment (SPMSQ = 0 errors; n = 248, 73%), mild impairment (SPMSQ = 1-2 errors; n = 52, 15%), and moderate to severe impairment (SPMSQ ≥3 errors; n = 42, 12%). A total of 245 (72%) patients died or had an acute myocardial infarction, and 216 (63%) patients died. After adjustment for clinical data, comorbidities, and Fried score, the SPMSQ added prognostic value for death or myocardial infarction (per number of errors; HR = 1.11, 95%, CI 1.04-1.19, p = 0.002) and death (HR = 1.11, 95% 1.03-1.20, p = 0.007). An SPMSQ with ≥3 errors identified the highest risk subgroup. Geriatric conditions (SPSMQ and Fried score) explained 19% and 43% of the overall chi-square of the models for predicting death or myocardial infarction and death, respectively. Geriatric assessment after acute coronary syndrome should include both frailty and cognitive function. This is particularly important given that cognitive impairment without dementia can be subclinical and thus remain undetected.
Key words

Full text: 1 Collection: 01-internacional Database: MEDLINE Type of study: Prognostic_studies Language: En Journal: J Clin Med Year: 2021 Document type: Article Affiliation country: España

Full text: 1 Collection: 01-internacional Database: MEDLINE Type of study: Prognostic_studies Language: En Journal: J Clin Med Year: 2021 Document type: Article Affiliation country: España