Abstract
Background: We hypothesize that poor 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 2 cohorts. In cohort 1, 629 patients ≥ 65 years who underwent percutaneous coronary intervention (PCI) from 2005-2008, 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 2014-18 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 5 times more likely (59% vs. 11%, p < 0.001) in cohort 1 and 7 times more likely (56% vs. 8%) in cohort 2 to be classified with poor QOL. Age- and gender-adjusted three year all-cause death and death or myocardial infarction (MI) was significantly higher for patients undergoing PCI with frailty; HR (95% CI) death, 4.20 (2.63, 6.68, p < 0.001) and death or MI 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.
Conclusions: 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.
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