Author + information
- Received July 11, 2018
- Revision received August 20, 2018
- Accepted August 30, 2018
- Published online November 19, 2018.
- John A. Dodson, MD, MPHa,∗ (, )@JDodsonMD,
- Judith S. Hochman, MDa,
- Matthew T. Roe, MDb,
- Anita Y. Chen, MSb,
- Sarwat I. Chaudhry, MDc,
- Stuart Katz, MDa,
- Hua Zhong, PhDa,
- Martha J. Radford, MDa,
- Jacob A. Udell, MD, MPHd,
- Akshay Bagai, MDe,
- Gregg C. Fonarow, MDf,
- Martha Gulati, MDg,
- Jonathan R. Enriquez, MDh,
- Kirk N. Garratt, MDi and
- Karen P. Alexander, MDb
- aLeon H. Charney Division of Cardiology, Department of Medicine, NYU Langone Health, New York, New York
- bDuke Clinical Research Institute, Durham, North Carolina
- cDepartment of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
- dCardiovascular Division, Department of Medicine, Peter Munk Cardiac Centre, Toronto General Hospital and Women’s College Hospital, University of Toronto, Canada
- eTerrence Donnelly Heart Center, St. Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada
- fDivision of Cardiology, University of California Los Angeles, Los Angeles, California
- gDivision of Cardiology, Department of Medicine, University of Arizona-Phoenix, Phoenix, Arizona
- hDivision of Cardiology, Department of Medicine, Saint Luke's Mid America Heart Institute, Kansas City, Missouri
- iCenter for Heart and Vascular Health, Christiana Care Health System, Newark, Delaware
- ↵∗Address for correspondence:
Dr. John A. Dodson, New York University School of Medicine, 227 East 30th Street, TRB 851, New York, New York 10016.
Objectives The aim of this study was to determine whether frailty is associated with increased bleeding risk in the setting of acute myocardial infarction (AMI).
Background Frailty is a common syndrome in older adults.
Methods Frailty was examined among AMI patients ≥65 years of age treated at 775 U.S. hospitals participating in the ACTION (Acute Coronary Treatment and Intervention Outcomes Network) Registry from January 2015 to December 2016. Frailty was classified on the basis of impairments in 3 domains: walking (unassisted, assisted, wheelchair/nonambulatory), cognition (normal, mildly impaired, moderately/severely impaired), and activities of daily living. Impairment in each domain was scored as 0, 1, or 2, and a summary variable consisting of 3 categories was then created: 0 (fit/well), 1 to 2 (vulnerable/mild frailty), and 3 to 6 (moderate-to-severe frailty). Multivariable logistic regression was used to examine the independent association between frailty and bleeding.
Results Among 129,330 AMI patients, 16.4% had any frailty. Frail patients were older, more often female, and were less likely to undergo cardiac catheterization. Major bleeding increased across categories of frailty (fit/well 6.5%; vulnerable/mild frailty 9.4%; moderate-to-severe frailty 9.9%; p < 0.001). Among patients who underwent catheterization, both frailty categories were independently associated with bleeding risk compared with the non-frail group (vulnerable/mild frailty adjusted odds ratio [OR]: 1.33, 95% confidence interval [CI]: 1.23 to 1.44; moderate-to-severe frailty adjusted OR: 1.40, 95% CI: 1.24 to 1.58). Among patients managed conservatively, there was no association of frailty with bleeding (vulnerable/mild frailty adjusted OR: 1.01, 95% CI: 0.86 to 1.19; moderate-to-severe frailty adjusted OR: 0.96, 95% CI: 0.81 to 1.14).
Conclusions Frail patients had lower use of cardiac catheterization and higher risk of major bleeding (when catheterization was performed) than nonfrail patients, making attention to clinical strategies to avoid bleeding imperative in this population.
Dr. Dodson was supported by a Patient Oriented Career Development Award (K23 AG052463) from the National Institutes of Health/National Institute on Aging, and a Mentored Clinical and Population Research Award from the American Heart Association. Dr. Fonarow has served as a consultant to Bayer and Janssen; and is a member of the ACC NCDR ACTION Registry Research and Publications Committee. Dr. Garratt is on the Clinical Events Adjudication Committee for Abbott Vascular and Jarvik Heart; and has equity in LifeCuff Technologies and Ancora Heart. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received July 11, 2018.
- Revision received August 20, 2018.
- Accepted August 30, 2018.
- 2018 American College of Cardiology Foundation