Frailty prevalence, invasive treatment frequency, and in-hospital outcome in patients hospitalized for acute coronary syndrome in Germany (2005-2022): a nationwide registry study

Abstract

Background: Frailty is a significant predictor for adverse outcomes. Yet, data on prevalence and treatment of frail patients with acute coronary syndrome (ACS) remains limited. We aimed to investigate frailty prevalence, interventional treatment frequency, and in-hospital outcome for all patients hospitalized for ACS in Germany from 2005 to 2022 and validate the Hospital Frailty Risk Score (HFRS) in this population.

Methods: Data for 2005-2022 from the Statistical Federal Office included all cases with primary diagnosis of ACS treated in Germany. Patients were categorized into low, intermediate, and high frailty by HFRS. Diagnoses, procedures, and in-hospital outcomes were analyzed. Univariable and multivariable logistic regressions as well as sensitivity analyses were performed.

Findings: Between 2005 and 2022, 5,889,972 ACS patients were hospitalized in Germany. Mean age was 69 years (standard deviation (SD) ± 12.85 years) and 2,060,224 (34.98%) were female. In-hospital mortality was 6.2%. Among all, 5,001,812 (84.9%) had a low, 784,106 (13.3%) an intermediate, and 104,054 (1.8%) a high HFRS. High-frailty patients were less likely to undergo coronary intervention than low-frailty patients (47.0% vs. 70.6%, p < 0.001), had longer hospital stays (21.6 days SD 19.4 ± vs. 5.6 days SD ± 5.2, p < 0.001), and higher in-hospital mortality (adjusted odds ratio (OR) 3.34 [confidence interval (95% CI) 3.29-3.4]).

Interpretation: Nearly one-sixth of ACS-patients were frail according to HFRS. Frail patients had longer hospital stays, less often received interventional procedures, and showed substantially increased in-hospital mortality. In our aging population, frailty will play an increasing role in patient management. Frailty scores based on electronic patient records, like the HFRS, offer clinicians a tool for assessing in-hospital outcome in ACS patients, potentially enabling more individualized treatment approaches.

Funding: None.

Keywords: Acute coronary syndrome; Coronary artery intervention; Frailty; Mortality; Myocardial infarction; Risk factor.

Fig. 1

Histogram showing the frequency of HFRS. Histogram showing HFRS frequency on a logarithmic scale in combined groups.

Fig. 2

Central illustration summarizing the main research objective and findings. Our study involves all patients with a primary diagnosis of ACS in Germany from 2005 to 2022. Patients were categorized according to frailty status using the Hospital Frailty Risk Score (HFRS). Outcome parameters were in-hospital mortality as well as use of procedures such as coronary angiography or PCI. Panel A shows overall in-hospital mortality of 6.2% for all ACS patients. HFRS was associated with in-hospital mortality (high HFRS = 19.8%, intermediate HFRS = 16.7% and low HFRS = 4.2%). Panel B shows the prevalence of ACS in different time periods according to the patients’ frailty status as well as the use of interventional procedures in these patients. Abbreviations: ACS = Acute coronary syndrome, PCI = percutaneous coronary intervention.