Table 2.
Studies included in the qualitative synthesis
| Study | Country | Population | Interventions compared | Outcomes | |||||
|---|---|---|---|---|---|---|---|---|---|
| ACS Subclass | Frailty Scale | Age mean (SD) / Med [IQR] | Number Frail e | Primary Outcome Measure | Results | ||||
| Di Bari et al. [17]a | Italy | AMI | Silver Code | 82.0 (0.3)c | 62 | PCI vs | One-year mortality | HR = 0.26 (95% CI 0.14–0.48) | HR decreased progressively with increasing silver code scores |
| 85.0 (0.3) c | 116 | no PCI | |||||||
| Alonso et al. [15]a | Spain | AMI | SHARE-FI | 83.1 (5.1) | 58 | Invasive strategy vs | One-year Death or MI | 41.4% | p = 0.078 |
| 87.7 (5.6) | 22 | conservative strategy | 59% | ||||||
| Nunez et al. [18]a | Spain | NSTEACS | Fried Score | 78 (7.0)c,d | 96 d | PCI vs | Long-term all-cause readmission | IRR = 0.6 (95% CI 0.43–0.84) p = 0.001 | Significant "Frailty status by PCI" interaction (p < 0.05) |
| no PCI | |||||||||
| Llao et al. [19]a | Spain | NSTEACS | FRAIL Scale | 86.7 (4.0)c | 47 | Conservative strategy vs | 6-month Death, MI or unplanned revascularisation | HR = 1.40 (95% CI 0.72–2.75) p = 0.325 | Significant "Frailty status by invasive treatment" interaction |
| 83.6 (3.8)c | 98 | Invasive strategy | |||||||
| Dodson et al. [20]a | U.S | AMI | Study-specific measure | 82.2 (8.6) d | 3,213 | Invasive treatment: frail vs non-frail | In-hospital major bleeding | OR = 1.40 (95% CI 1.24–1.58) | Significant "Frailty status by invasive treatment " interaction (p < 0.001) |
| 3,782 | Conservative treatment: frail vs non-frail | OR = 0.96 (95% CI 0.81–1.14) | |||||||
| Damluji et al. [21]a | U.S | AMI | CFI | 85.9 (NR)d | 13,832 | PCI vs | In-hospital mortality | OR = 0.59 (95% CI 0.55–0.63) | Significant "Frailty status by PCI" interaction (p < 0.001) |
| 63,413 | no PCI | ||||||||
| 12,575 | CABG vs | OR = 0.77 (95% CI 0.65–0.93) | Significant "Frailty status by CABG" interaction (p < 0.001) | ||||||
| 63,413 | no PCI | ||||||||
| Kwok et al. [22]a | U.S | ACS | HFRS | 80.0 (11d | 966 | PCI vs | In-hospital mortality | 16.9% | No additional statistics provided |
| NR | Conservative strategy vs | 15.0% | |||||||
| NR | Angio-MM | 12.1% | |||||||
| Wong, Lee, & El-Jack [23]b | NZ | ACS | EFT | 87.6 (2.8) | 47 | PCI vs Medical Management | Long-term mortality | 43% | HR = 1.0 (95% CI 0.5–2.0) |
| 88.9 (NR) | NR | 54% | p = ns | ||||||
| Fishman et al. [24]b | Israel | NSTEMI | NR | 86 [83–90]c | NR | Invasive treatment vs Conservative treatment | Long-term mortality | HR = 0.52 [95% CI 0.34–0.78] |
Non-significant treatment by frailty risk subgroup interaction p = ns |
SD Standard Deviation, Med Median, IQR Interquartile range, AMI Acute Myocardial Infarction, PCI Percutaneous Coronary Intervention, HR Hazard Ratio, CI Confidence Interval
SHARE-FI Survey of Health, Ageing and Retirement in Europe Frailty Instrument, MI Myocardial Infarction, NSTEACS Non-ST-Elevation Acute Myocardial Infarction;
IRR Incidence Rate Ratio, U.S. United States, OR Odds Ratio, CFI Claims-Based Frailty Index, NR Not Reported, CABG Coronary Artery Bypass Grafting, ACS Acute Coronary Syndrome
HFRS Hospital Frailty Risk Score, Angio-MM Angiography without revascularisation, NZ New Zealand, EFT Essential Frailty Toolset, ns Not Significant
aJournal article, bConference abstract, cTotal cohort (including non-frail), dNo break-down by treatment group, eIn the highest risk frailty group