Frailty and quality of life in elderly patients with acute coronary syndrome

Figures & data

Table 1 Patients’ sociodemographic and clinical characteristics

Variable n (%)	All participants n=91	Age (years)			Test result
		65–75 n=37	76–85 n=40	86–92 n=14
Sociodemographic
Age, M ± SD	76.7±7.8	68.9±3.9	79.9±3.6	87.9±2.1	P<0.001a
Sex
Female	44 (48.4%)	10 (27.0%)	25 (62.5%)	9 (64.3%)
Male	47 (51.6%)	27 (73.0%)	15 (37.5%)	5 (35.7%)	P=0.003b
Marital status
Married	46 (50.6%)	24 (64.9%)	20 (50.0%)	2 (14.3%)
Single	45 (49.4%)	13 (35.1%)	20 (50.0%)	12 (85.7%)	P=0.006b
Education
Primary	21 (23.1%)	5 (13.5%)	10 (25.0%)	6 (42.9%)
Vocational	26 (28.6%)	13 (35.1%)	11 (27.5%)	2 (14.3%)
High school	36 (39.5%)	15 (40.5%)	16 (40.0%)	5 (35.7%)	P=0.442b
University	8 (8.8%)	4 (10.8%)	3 (7.5%)	1 (7.1%)
Residence
Urban	76 (83.5%)	31 (83.8%)	34 (85.0%)	11 (78.6%)
Rural	15 (16.5%)	6 (16.2%)	6 (15.0%)	3 (21.4%)	P=0.854b
Living
With family	65 (71.4%)	27 (73.0%)	29 (72.5%)	9 (64.3%)
Alone	26 (28.6%)	10 (27.0%)	11 (27.5%)	5 (35.7%)	P=0.812b
Clinical
ACS type
STEMI	41 (45.0%)	18 (48.7%)	18 (45.0%)	5 (35.7%)
NSTEMI	41 (45.0%)	15 (40.5%)	18 (45.0%)	8 (57.2%)	P=0.888b
UA	9 (10.0%)	4 (10.8%)	4 (10.0%)	1 (7.1%)
Treatment
PCI	66 (72.5%)	32 (86.5%)	28 (70.0%)	6 (42.8%)
CT	16 (17.6%)	2 (5.4%)	10 (25.0%)	4 (28.6%)	P=0.007b
CABG	9 (9.9%)	3 (8.1%)	2 (5.0%)	4 (28.6%)
Comorbidities
Diabetes mellitus	20 (22.0%)	6 (16.2%)	11 (27.5%)	3 (21.4%)	P=0.489b
Arterial hypertension	74 (81.2%)	26 (70.3%)	36 (90.0%)	12 (85.7%)	P=0.077b
History of CVA	10 (11.0%)	4 (10.8%)	6 (15.0%)	0 (0.0%)	P=0.303b
COPD	12 (13.2%)	5 (13.5%)	7 (17.5%)	0 (0.0%)	P=0.249b

Notes:

a Student’s t-test,

b Pearson’s chi-square test. Data in bold indicates statistical significance.

Abbreviations: (%), interest; ACS, acute coronary syndrome; CABG, coronary artery bypass graft; COPD, chronic obstructive pulmonary disease; CT, conservative therapy; CVA, cerebrovascular accident; M, mean; n, cardinality; NSTEMI, no ST elevation myocardial infarction; PCI, percutaneous coronary intervention; SD, standard deviation; STEMI, ST elevation myocardial infarction; UA, unstable angina.

Table 2 QoL evaluation using the MacNew questionnaire in each domain: global, physical, emotional, and social

QoL domains (MacNew) (patients)	Total N=91	Age (years)			Comparison resulta
		A 65–75	B 76–85	C 86–92
Global
M ± SD	4.4±0.8	4.7±0.7	4.2±0.9	4.4±0.6
Me (Q1; Q3)	4.5 (3.8; 5.0)	4.7 (4.3; 5.2)	4.3 (3.4; 4.8)	4.3 (3.9; 4.8)	A vs B
Min–Max	2.2–6.0	4.3–6.0	2.2–5.8	3.3–5.6	P=0.043
Physical
M ± SD	3.8±0.9	4.1±0.8	3.5±0.9	3.7±0.6
Me (Q1; Q3)	3.8 (3.2; 4.4)	4.2 (3.5; 4.6)	3.5 (2.8; 4.2)	3.7 (3.2; 4.2)	A vs B
Min–Max	1.4–5.9	2.8–5.9	1.4–5.3	2.6–4.8	P=0.008
Emotional
M ± SD	4.8±1.0	4.9±0.9	4.6±1.2	4.7±0.8
Me (Q1; Q3)	4.9 (4.0; 5.5)	4.9 (4.3; 5.6)	5.0 (3.5; 5.5)	4.9 (3.9; 5.2)	A vs B
Min–Max	2.2–6.9	2.9–6.9	2.2–6.9	3.6–6.4	P=0.655
Social
M ± SD	4.7±0.9	5.1±0.7	4.4±0.9	4.7±0.6
Me (Q1; Q3)	4.8 (4.1; 5.4)	5.2 (4.5; 5.5)	4.4 (3.6; 5.2)	4.7 (4.2; 5.2)	A vs B
Min–Max	2.5–6.6	3.2–6.6	2.5–6.2	3.5–5.6	P=0.009

Notes:

a Kruskal–Wallis test. Data in bold indicates statistical significance.

Abbreviations: M, mean; Max, the value of the largest; Me, median; Min, the smallest value; Q₁, lower quartile (25th percentile); Q₃, the upper quartile (75th percentile); QoL, quality of life; SD, standard deviation.

Table 3 FS evaluation in each domain: global, physical, psychological, and social

Tilburg scale scores (patients)	Total N=91	Age (years)			Comparison resulta
		65–75 N=37	76–85 N=40	86–92 N=14
Global
M ± SD	7.43±2.57	5.70±2.22	8.42±2.18	9.14±1.79
Me (Q1; Q3)	8 (5; 9)	5 (4; 8)	8 (7; 10)	9 (8; 10)	P<0.001
Min–Max	1–13	1–11	4–13	5–12
Physical
M ± SD	5.04±1.88	3.49±1.63	6.05±1.18	6.29±1.14
Me (Q1; Q3)	5 (4; 6)	3 (2; 5)	6 (5; 7)	6 (6; 7)	P<0.001
Min–Max	0–8	0–7	4–8	4–8
Psychological
M ± SD	1.53±0.96	1.32±0.91	1.62±0.98	1.79±0.97
Me (Q1; Q3)	2 (1; 2)	1 (1; 2)	2 (1; 2)	2 (1; 2)	P=0.159
Min–Max	0–3	0–3	0–3	0–3
Social
M ± SD	0.88±0.74	0.89±0.77	0.82±0.71	1.00±0.78
Me (Q1; Q3)	1 (0; 1)	1 (0; 1)	1 (0; 1)	1 (0; 2)	P=0.716
Min–Max	0–3	0–3	0–3	0–2

Notes:

a Kruskal–Wallis test. Data in bold indicates statistical significance.

Abbreviations: FS, frailty syndrome; M, mean; Max, the value of the largest; Me, median; Min, the smallest value; Q₁, lower quartile (25th percentile); Q₃, the upper quartile (75th percentile); SD, standard deviation.

Table 4 Spearman’s rank correlation coefficients (r_S) for MacNew questionnaire domains and TFI domains

Tilburg domains	MacNew questionnaire domains
	Physical	Emotional	Social	Global
Physical	rS =−0.372 P<0.05	rS =−0.274 P<0.05	rS =−0.367 P<0.05	rS =−0.363 P<0.05
Psychological	rS =−0.379 P<0.05	rS =−0.627 P<0.05	rS =−0.377 P<0.05	rS =−0.537 P<0.05
Social	rS =−0.036 P>0.05	rS =−0.314 P<0.05	rS =+0.072 P>0.05	rS =+0.129 P>0.05
Global	rS =−0.447 P<0.05	rS =−0.515 P<0.05	rS =−0.406 P<0.05	rS =−0.514 P<0.05

Note: Data in bold indicates statistical significance.

Abbreviation: TFI, Tilburg frailty indicator.

Figure 1 Diagram of correlations between MacNew global QoL scores and TFI global FS scores.

Abbreviations: FS, frailty syndrome; QoL, quality of life; FS, frailty syndrome; TFI, Tilburg frailty indicator.

Table 5 Influence of demographic characteristics, clinical factors and comorbidities on global MacNew QoL scores

Variable	MacNew: Global QoL			Comparison result
	M ± SD	Me (Q1; Q3)	Min–Max
Marital status
Married	4.62±0.81	4.69 (3.90; 5.25)	2.97–6.05	P=0.047a
Single	4.25±0.82	4.40 (3.72; 4.80)	2.25–5.88
Education
Primary	4.29±0.89	4.15 (3.62; 5.00)	2.72–6.05	P=0.728b
Vocational	4.39±0.78	4.59 (3.85; 5.52)	2.25–5.52
High school	4.51±0.88	4.61 (3.85; 5.15)	2.60–5.90
University	4.63±0.69	4.59 (4.08; 5.09)	3.72–5.78
Living
With family	4.47±0.87	4.25 (3.82; 5.15)	2.72–6.05	P=0.654a
Alone	4.34±0.76	4.59 (3.90; 4.90)	2.25–5.28
ACS type
STEMI	4.48±0.82	4.53 (3.83; 5.15)	2.60–5.83
NSTEMI	4.45±0.84	4.65 (3.93; 4.98)	2.25–6.05	STEMI vs NSTEMI
UA	4.19±0.88	3.90 (3.53; 4.68)	3.13–5.68	P=0.587
Treatment
PCI	4.56±0.82	4.66 (3.90; 5.15)	2.25–6.05
CABG	4.35±0.63	4.55 (4.05; 4.80)	3.10–5.15	PCI vs CT
CT	3.96±0.85	3.90 (3.36; 4.49)	2.60–5.68	P=0.043
Comorbidities
Diabetes mellitus	4.61±0.78	4.73 (3.95; 5.21)	3.38–5.90
Arterial hypertension	4.34±0.83	4.41 (3.80; 4.93)	2.25–6.05
Hypercholesterolemia	4.42±0.69	4.55 (3.89; 4.95)	3.10–5.78
Renal insufficiency	4.30±0.80	4.16 (3.83; 4.90)	2.73–5.68
COPD	4.22±1.22	4.26 (3.31; 5.30)	2.25–5.88
History of CVA	3.98±1.07	3.99 (2.98; 4.70)	2.60–5.58

Notes:

a Mann–Whitney U-test,

b Kruskal–Wallis test. Data in bold indicates statistical significance.

Abbreviations: ACS, acute coronary syndrome; CABG, coronary artery bypass graft; COPD, chronic obstructive pulmonary disease; CT, conservative therapy; CVA, cerebrovascular accident; M, Mean; Max, the value of the largest; Me, median; Min, the smallest value; NSTEMI, no ST elevation acute coronary syndrome; PCI, percutaneous coronary intervention; Q1, lower quartile (25th percentile); Q3, the upper quartile (75th percentile); SD, standard deviation; STEMI, ST elevation myocardial infarction; UA, unstable angina.

Table 6 QoL models

Global score (QoL)	Simple regression		Stepwise multiple regression
	β ± SE	P-value	β ± SE	P-value
FS	−0.423±0.096	<0.001	−0.246±0.122	0.048
Single	−0.223±0.103	0.034	–	>0.05
Conservative therapy	−0.263±0.102	0.012	–	>0.05
Arterial hypertension	−0.230±0.103	0.028	–	>0.05
TFI >7	−0.434±0.095	<0.001	−0.277±0.122	0.026

Note: Data in bold indicates statistical significance.

Abbreviations: β, standardized beta coefficient for independent variables; FS, frailty syndrome; QoL, quality of life; SE, standard error; TFI, Tilburg frailty indicator; −, not applicable.

Figure 2 ROC curve for the global TFI score (cutoff value: TFI ≤7).

Abbreviations: ROC, receiver operating characteristic; TFI, Tilburg frailty indicator; AUC, area under ROC curve.