P1752Impact of frailty addition in ischemic and bleeding risk scores in elderly patients with Atrial Fibrillation and Acute Coronary Syndrome: a subanalysis from LONGEVO-SCA registry

Background The prevalence of Atrial Fibrillation (AF) and Acute Coronary Syndrome (ACS) increases with age. Frail older adults are at high risk of multiple adverse events during admission and short term mortality. FRAIL score is an easy tool that evaluates: fatigue, resistance, ambulation, concomitant diseases and weight loss. Purpose The aim of this study was to validate FRAIL score in AF elderly patients with ACS related to adverse events and the impact of its addition in clinical scores. Methods The prospective multicenter LONGEVO-SCA enrolled unselected elderly patients hospitalized after non-STACS. We analyzed the predictive performance of FRAIL score in AF subgroup for adverse events (primary endpoint mortality or readmission) and the impact of frailty addition in ischaemic and bleeding scores. Results We analyzed 531 patients. 128 (24.1%) of them have AF (main age 84.6±3.7 years; 78 (61%) male) and 27.3% were frail (defined by FRAIL score ≥3). Frail AF patients had more prevalent comorbidities and received less evidence-based ACS therapies at discharge as oral anticoagulation (66% vs 60%; p<0.001) or statins 96.3% vs 82.6%; p<0.001). We analyzed the predictive performance of FRAIL score to adverse events and observed a modest predictive performance for mortality (c-statistic 0.648; 95% CI [0.605–0.690]; p<0.001), readmissions (c-statistic 0.600; 95% CI [0.557–0.642]; p<0.001) and for composite endpoint (c-statistic 0.620; 95% CI [0.577–0.663]; p<0.001). We compared the addition of FRAIL score to the original risk scores and observed a significant improvement for the primary endpoint with the addition to CHA2DS2-Vasc score (p=0.009), GRACE (p<0.001) and CRUSADE scores (p<0.001). (Table) C-indexes for mortality or readmissions C-index 95% CI p p* Z* CHA2DS2-VASc score 0.619 0.576 to 0.662 <0.001 0.009 2.586 CHA2DS2-VASc score + FRAIL 0.641 0.598 to 0.683 <0.001 HAS-BLED score 0.649 0.606 to 0.691 <0.001 0.445 0.764 HAS-BLED score + FRAIL 0.634 0.590 to 0.675 <0.001 GRACE score 0.599 0.554 to 0.644 0.006 0.001 3.930 GRACE score + FRAIL 0.602 0.556 to 0.646 <0.001 CRUSADE score 0.660 0.613 to 0.705 0.051 0.001 3.287 CRUSADE score + FRAIL 0.664 0.617 to 0.709 <0.001 CI: Confidence interval. *For c-index comparison. p: P value. Conclusions This is the first validation of the FRAIL score in AF patients under ACS with a modest predictive performance to adverse events. The addition of frailty to clinical scores improved the predictive performance to adverse events in AF patients.