Lower functional status, measured by a 10-point decrease in the Modified Barthel Index, strongly predicted membership in the rapidly worsening frailty trajectory (OR 9.34) in older AMI patients.
Cohort (n=583)
No
La progression de la fragilité chez les personnes âgées après un infarctus du myocarde est hétérogène et peut être classée en quatre trajectoires distinctes, ce qui peut aider à cibler des interventions infirmières précoces pour les individus à haut risque.
Effect estimate: OR 9.34 (95% CI 7.37-11.82)
p-value: p=<0.05
Abstract Background Frailty significantly complicates clinical outcomes in older adults with acute myocardial infarction, yet its progression is dynamic and heterogeneous. This study aimed to identify distinct frailty trajectory patterns and their predictors using a machine learning approach, to support evidence-based nursing interventions. Methods A prospective cohort study was conducted, enrolling 583 older adults with acute myocardial infarction hospitalized between March 2023 and March 2024. We collected multidimensional clinical, physiological, psychological, and functional data at six time points over a one-year follow-up period. A patient similarity network was constructed from these longitudinal data, and the Structural Entropy Clustering algorithm was employed to identify frailty trajectory groups. Group differences were analyzed using ANOVA and Tukey’s post hoc tests, while multinomial logistic regression was used to determine key predictors of trajectory membership. Results Four distinct frailty trajectories were identified: “Rapidly Worsening Frailty” (n=78, 13. 4%), “Stable Non-Frail” (n=261, 44. 7%), “Slowly Progressive Frailty” (n=218, 37. 4%), and “Improving Frailty” (n=26, 4. 5%). Significant differences were observed among the groups in functional status, psychological scores, nutritional status, left ventricular ejection fraction, and Charlson Comorbidity Index (p<0. 05). Multivariate analysis revealed that lower functional status (Modified Barthel Index per 10-point decrease: OR=9. 34, 95% CI: 7. 37–11. 82, p<0. 05) and advanced age (OR=1. 07, p<0. 05) were strong predictors for the “Rapidly Worsening Frailty” trajectory, while psychological factors including anxiety (OR=2. 33, p<0. 05) and depression (OR=2. 50, p<0. 05) were significant predictors for the “Slowly Progressive Frailty” trajectory. Conclusions Frailty progression following acute myocardial infarction is heterogeneous, and distinct trajectory patterns can be identified using structural entropy clustering. These findings may support the development of differentiated nursing strategies for early identification of high-risk individuals, pending validation in multicenter settings.
Zhang et al. (Thu,) ont mené une cohorte sur l'infarctus du myocarde et la fragilité (n=583). L'observation des trajectoires de fragilité a été évaluée sur l'appartenance à la trajectoire de fragilité se détériorant rapidement (prédit par une diminution de 10 points de l'Indice de Barthel modifié) (OR 9.34, IC 95% 7.37-11.82, p=<0.05). Un statut fonctionnel inférieur, mesuré par une diminution de 10 points de l'Indice de Barthel modifié, prédisait fortement l'appartenance à la trajectoire de fragilité se détériorant rapidement (OR 9.34) chez les patients âgés ayant subi un AIM.