For a study, researchers sought to investigate how fragile patients hospitalized with ST-segment elevation myocardial infarction (STEMI) were managed, treated, and used resources. The Nationwide Inpatient Sample data for 2005 to 2014 were examined retrospectively in this study. Using the frailty-defining diagnosis indicator from the Johns Hopkins Adjusted Clinical Groups, patients were categorized as “frail” or “nonfrail.” Secondary outcomes included in-hospital mortality, length of stay, and cost, with STEMI management being the major outcome. Outcomes were compared between frail and non-frail patients using propensity score-matched analysis. There were 36,316 (2.7%) fragile STEMI hospitalizations out of 1,360,597 total STEMI hospitalizations. Frail patients had significantly lower odds of overall revascularization (odds ratio [OR], 0.60; 95% CI, 0.55 to 0.65), percutaneous coronary intervention (OR, 0.53; 95% CI, 0.49 to 0.57), and coronary angiography (OR, 0.59; 95% CI, 0.55 to 0.64) when compared to healthy patients, according to a propensity score-matched analysis. Frail patients had significantly greater odds of obtaining total hemodynamic assistance (OR, 1.26; 95% CI, 1.15 to 1.39) and coronary artery bypass grafting (OR, 1.66; 95% CI, 1.48 to 1.86) than healthy patients. Frail patients had significantly higher rates of in-hospital mortality (18.7% vs 8.2%, P<0.001), duration of stay (7.7 vs 3.7 days, P<0.001), and cost ($90,060 vs $63,507, P<0.001). The results suggested that joint efforts by cardiologists and cardiovascular surgeons to identify frailty in STEMI patients and include frailty in risk estimate tools might improve management tactics, optimize resource use, and improve patient outcomes.

Source – ajconline.org/article/S0002-9149(22)00399-X/fulltext