Poor quality of life in patients with and without frailty: Co-prevalence and prognostic implications in patients undergoing percutaneous coronary interventions and cardiac catheterization

Amrit Kanwar, Veronique Lee Roger, Ryan J. Lennon, S. Michael Gharacholou, Mandeep Singh

Research output: Contribution to journalArticlepeer-review

Abstract

Aims: We hypothesize that poor quality of life (QOL) is highly prevalent in frail older adults and is associated with worse prognosis. Methods and results: Predismissal standardized tests for frailty and QOL were prospectively administered to patients included in two cohorts. In Cohort 1, 629 patients ≥65 years who underwent percutaneous coronary intervention (PCI) from 2005 to 2008, frailty (Fried criteria), and QOL [SF-36 and Seattle Angina Questionnaires (SAQ)] were ascertained. Cohort 2 included 921 patients ≥55 years who underwent cardiac catheterization (535 had PCI) from 2014 to 2018 and frailty was determined by Rockwood criteria and QOL by single-item, self-reported health questionnaire. In Cohort 1, 19% were frail and 20% patients in Cohort 2 were frail with a frailty index >0.30. The median SAQ for physical limitation (58.9 vs. 82.2, P < 0.001), physical (29.5 vs. 43.9, P < 0.001), and mental (49.2 vs. 57.4, P < 0.001) component scores of SF-36 in Cohort 1 were lower and self-rating of fair/poor health (56% vs 18%, P < 0.001) in Cohort 2 was significantly higher in frail patients. As compared to patients without frailty, frail patients were five times more likely (59% vs. 11%, P < 0.001) in Cohort 1 and seven times more likely (56% vs. 8%) in Cohort 2 to be classified with poor QOL. Age- and gender-adjusted 3-year all-cause death and death or myocardial infarction (MI) was significantly higher for patients undergoing PCI with frailty; [hazard ratio (95% confidence interval) death, 4.20 (2.63-6.68, P < 0.001) and death or MI hazard ratio (HR) 2.72 (1.91-3.87, P < 0.001)] and with poor QOL [HR death 2.47 (1.59-3.84, P < 0.001)] and death or MI 1.61 (1.16-2.24, P < 0.001). There was no significant interaction between frailty and QOL (P = 0.64) and only modest attenuation was observed when considered together indicating their independent prognostic influence. Conclusion: In elderly patients undergoing cardiac catheterization or PCI, poor QOL is seen more frequently in frail patients. Both frailty and poor QOL had significant and independent association with long-term survival.

Original languageEnglish (US)
Pages (from-to)591-600
Number of pages10
JournalEuropean Heart Journal - Quality of Care and Clinical Outcomes
Volume7
Issue number6
DOIs
StatePublished - Dec 1 2021

Keywords

  • Ageing
  • Frailty
  • Quality of life

ASJC Scopus subject areas

  • Health Policy
  • Cardiology and Cardiovascular Medicine

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