In older adults with acute myocardial infarction (AMI), frailty is associated with a lower rate of cardiac catheterizations and a higher risk for major bleeding if catheterization is performed, according to study results published in the Journal of American College of Cardiology: Cardiovascular Interventions.
The study included participants age ≥65 with AMI treated at 775 hospitals in the United States included in the Acute Coronary Treatment and Intervention Outcomes Network (ACTION) Registry from January 2015 to December 2016.
The researchers classified frailty on the basis of impairments in 3 domains: walking (unassisted, assisted, wheelchair/non- ambulatory), cognition (normal, mildly impaired, moderately/severely impaired), and activities of daily living. They scored impairment in each domain as 0, 1, or 2 and then created a summary variable consisting of all 3 categories: 0 (fit/well), 1 to 2 (vulnerable/mild frailty), and 3 to 6 (moderate to severe frailty). They used multivariable logistic regression to examine the association between frailty and bleeding.
Of 129,330 participants, 16.4% had any frailty. The researchers found that participants with frailty were older, more often women, and less likely to undergo cardiac catheterization.
The rate of major bleeding increased across categories of frailty: 6.5% in patients who were fit/well, 9.4% in patients who were vulnerable/mild frailty, and 9.9% in patients with moderate-to-severe frailty (P <.001).
In participants who underwent catheterization, the researchers found that both mild and moderate to severe frailty were independently associated with bleeding risk compared with the non-frail group (vulnerable/mild frailty adjusted odds ratio [OR], 1.33; 95% CI, 1.23 to 1.44; moderate to severe frailty adjusted OR, 1.40; 95% CI, 1.24 to 1.58).
“Awareness of vulnerability and greater utilization of evidence-based strategies to reduce bleeding, including radial access and properly dose-adjusted anticoagulant therapies, may mitigate some bleeding events,” the researchers wrote.
Dodson JA, Hochman JS, Roe MT, et al. The association of frailty with in-hospital bleeding among older adults with acute myocardial infarction: insights from the ACTION registry. JACC Cardiovasc Interv. 2018;11(22):2287-2296.