https://doi.org/10.1007/s00392-025-02625-4
1Universitäres Herz- und Gefäßzentrum Hamburg Klinik für Kardiologie Hamburg, Deutschland; 2Universitäres Herz- und Gefäßzentrum Hamburg Allgemeine und Interventionelle Kardiologie Hamburg, Deutschland
Background:
Frailty is a significant predictor for adverse outcomes such as functional decline, hospitalization, and mortality. Currently, there is limited data on the prevalence and treatment of frail patients with acute coronary syndrome (ACS). We aimed to investigate frailty prevalence, interventional treatment frequency, and in-hospital outcome for all patients hospitalized for ACS in Germany from 2005-2022. Furthermore, we aimed to validate the Hospital Frailty Risk Score (HFRS) in this population.
Methods:
We used data from the Statistical Federal Office for the years 2005-2022 and included all cases with the primary diagnosis of ACS treated in Germany. The Hospital Frailty Risk Score (HFRS) was used and categorized patients as low, intermediate, and high risk of frailty. Information on prevalent diagnoses, performed procedures, and in-hospital outcome parameters were recorded. Univariable and multivariable logistic regressions as well as sensitivity analyses were performed.
Findings:
Between 2005 and 2022, 5,889,972 patients were hospitalized with ACS in Germany (35·4% unstable angina pectoris, 38·9% NSTEMI, 23·7% STEMI). The mean age was 69 years and 34·98 % were female. Mean in-hospital mortality was 6·15%. Among all patients, 84·9% had a low HFRS, 13·3% an intermediate HFRS, and 1·8% a high HFRS. Patients with ACS and a high HFRS were less likely to undergo invasive coronary angiography or intervention compared to those with a low HFRS (47·0% vs 70·6%) and had longer hospital stays (21·6 vs of 5·6 days). A high HFRS was associated with increased in-hospital mortality compared to patients with a low HFRS after adjusting for age, sex, and comorbidities (adjusted OR 3·34 [CI 3·29 – 3·4]). Throughout the study period, the total number of patients with ACS decreased (2,135,842 ACS patients in 2005 – 2010 vs 1,758,691 ACS patients in 2017 – 2022). Simultaneously, the prevalence of high frailty patients more than doubled over the study period over all age groups (1·0% in 2005-2010 vs. 2·5% in 2017 - 2022).
Interpretation:
Nearly one-sixth of ACS-patients were frail according to HFRS. Frail patients had longer hospital stays, less often received invasive diagnostics or therapy, 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.
Central illustration summarizing the main research objective and findings