6 Frailty is Associated with Undiagnosed Early Cognitive Impairment in older patients (≥75 years) with non-ST Elevation Acute Coronary Syndrome Managed by Invasive Strategy
Bibliographic record
Abstract
Introduction Non ST elevation Acute Coronary Syndrome (NSTEACS) is more common in older patients and invasive treatment is an established management strategy in the United Kingdom. Frailty is an independent marker of adverse cardiovascular (CV) outcomes in older patients. Older patients with atherosclerotic disease are at risk of developing cognitive impairment. Frailty and cognitive impairment in older patients with NSTEACS can be a predictor of poor CV outcomes. The prevalence of undiagnosed early cognitive impairment in frail older patients with NSTEACS managed by invasive strategy is not known. Methods Cognitive status was assessed using Montreal Cognitive Assessment (MoCA) tool (maximum score 30, normal ≥26) in consecutive patients (≥ 75 years) admitted to a tertiary cardiac centre for invasive management of NSTEACS as a sub-study of an ongoing prospective study. Patients with known severe dementia were excluded from the study. Frailty status was assessed by Fried (Cardiovascular Health Study) frailty assessment tool (score 0–5) and patients categorised into frail (score ≥3) and non-frail (score 0–2) groups. Results MoCA score was available in 175 (89.3%) patients. About a third (30.8%) of these patients were frail and half of the patients (50.3%) had MoCA score <26 suggestive of cognitive impairment. The mean (standard deviation [SD]) age of patients with MoCA score <26 was higher compared to patients with MoCA score ≥26 (82.3 years (4.0) versus 80.4 years (3.9), p = 0.002). There was no difference in the proportion of females (37.9% vs. 43.1%, p = 0.469) respectively between the two groups. The baseline characteristics are displayed in the Table 1. The mean MoCA score was significantly lower in the frail group (23.7, SD 3.5) compared to the non-frail group (25.7, SD 2.4, p < 0.0001). Cognitive impairment with score <26 was more common in the frail group compared to the non-frail group (68.5% vs. 42.1% respectively, p = 0.002). Conclusion Undiagnosed early cognitive impairment is very common in 75+ year old patients presenting with NSTEACS managed by invasive strategy. Cognitive impairment is more common in frail patients compared to non-frail patients. Combination of frailty and cognitive impairment may have an adverse impact on the cardiovascular outcomes of older patients with NSTEACS managed by invasive strategy. Frailty and cognitive assessment may need to be part of risk assessment in older patients planned for invasive management.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".