Frailty scale with the best prediction of mortality in individuals diagnosed with acute coronary syndrome: systematic review and meta-analysis

Acute Coronary Syndrome (ACS) is a major cause of hospitalizations and deaths worldwide. Conditions such as frailty worsen these outcomes. Frailty assessment improves risk stratification, complements scores and favors personalized treatments. However, there are numerous tools available for assessing frailty, and there is still no consensus on which would be the most recommended in conditions such as ACS. The objective was to evaluate which frailty diagnostic scale has the best predictive value for mortality in individuals with ACS.

This meta-analysis was conducted using Medline, Embase, and Cochrane, with a search conducted on March 5, 2024. Studies that met the PECOS criteria were included: adult and elderly individuals diagnosed with ACS, frailty assessment determined by a scale, mortality registry and intervention studies or prospective and retrospective cohorts. The risk of bias and quality of evidence were assessed by two researchers using the Joana Briggs Institute Case Series tool and the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) system, respectively. The meta-analysis was conducted using Review Manager software and subgroup analyses using R software.

The results of the meta-analysis indicate that frailty is associated with a significantly higher risk of mortality in patients with ACS (P < 0.001). However, the results of the meta-regression did not indicate a significant difference between the five scales evaluated (P = 0.227). The choice of scale, therefore, can be based on other factors such as practicality and availability of resources, without compromising the prognosis.

Individuals with ACS and frailty have a higher chance of mortality, and all scales evaluated showed good predictive value, with no statistical difference. We suggest that the Clinical Frailty Scale (CFS) is suitable for hospital settings and acute conditions, such as ACS.